Clinical quality measures for Meaningful Use Stage 2 still in flux

Clinical quality measures are a major focus in both the proposals for Meaningful Use stage 2 and the 2014 EHR certification criteria, government officials told attendees at the Las Vegas meeting of the Healthcare Information and Management Systems Society (HIMSS) this week. But this critical element of Meaningful Use remains in flux. The just published Notice of Proposed Rule Making (NPRM) asks commenters to provide guidance in this area, the officials said.

In general, the proposed rules require eligible professionals (EP) to report on 12 clinical quality measures (CQMs) in Stage 2, twice the number in Stage 1. Hospitals must report on 24 CQMs, up from 15 in Stage 1. They must choose one or more of the CQMs from each of the domains adopted by CMS from the National Quality Strategy.

The uncertainty comes in deciding which of the optional measures EPs must use. In Stage 1, there were three core measures, and EPs could select the other three from a menu. Under one proposal for stage 2, EPs might have to report on 11 core measures and select one from a menu. An alternative proposal would have them choose all 12 measures from the National Quality Strategy domains. The Centers for Medicare & Medicaid Services (CMS) is also seeking input on which measures to include in the final rule.

As previously reported, providers will be able to continue attestation to the quality measures in 2012. Meanwhile, CMS is conducting an electronic reporting pilot and is seeking more providers to participate in that voluntary test.

One feature calculated to please EPs is a group reporting option for practices of two or more physicians. In addition, EPs who report quality data to accountable care organizations (ACOs) for Medicare's shared savings program won't have to report the same data again to the Meaningful Use program.

The same is true for practices that report data to CMS' Physician Reporting Quality System (PQRS). The only caveat is that their EHRs must meet the criteria for both programs for EPs to receive double incentives.

Steve Posnack, director of the federal policy division, Office of the National Coordinator for Health IT, pointed out that EHR certification criteria related to CQMs are still being worked out, as well.

For example, he said, ONC might require vendors to show their EHRs can capture data and calculate numerators and denominators for every CQM that providers can select. But he admitted that might be too burdensome for vendors, especially if their products are designed for EPs who don't have enough volume in a particular area to collect data for certain CQMs.

To learn more:
- read the NPRM for Meaningful Use Stage 2