The Centers for Medicare & Medicaid Services (CMS) and the National Library of Medicine (NLM) has published an addendum to the 2016 eCQM specifications (published in April 2016). This addendum updates relevant International Classification of Diseases (ICD)-10 Clinical Modification (CM) and Procedure Coding System (PCS) eCQM value sets for the 2017 performance year. These changes affect electronic reporting of eCQMs for the following programs:
• The Hospital Inpatient Quality Reporting Program;
• The Medicare Electronic Health Record (EHR) Incentive Program for eligible hospitals and critical access hospitals (CAHs);
• The Merit-based Incentive Payment System (MIPS) for MIPS eligible clinicians.
What Changes are Included in the Addendum?
Changes will only affect the value sets for eCQMs remaining in the programs listed above for 2017 reporting. The Health Quality Measure Format (HQMF) specifications, the value set object identifiers (OIDs), and the measure version numbers for 2017 eCQM reporting will not change.
The changes to the ICD-10 value sets consist of deletion of expired codes and addition of relevant replacement codes. Newly available codes that represent concepts consistent with the intent of the value set and corresponding measure(s) were also added. CMS is prioritizing these ICD-10 updates. Updates for other terminologies will take place during the 2017 Annual Update.
All changes to ICD-10 value sets are detailed in revised technical release notes, including the OIDs affected and information on the codes added or deleted from the value sets.
Where is the Addendum Posted?
The following updated measure information is available on the eCQM library and the electronic Clinical Quality Improvement (eCQI) Resource Center websites, including:
• eCQM specifications, which include only measures in use for 2017 eCQM reporting
• eCQMs for Eligible Clinicians Table January 2017 and eCQMs for Eligible Hospitals Table January 2017, which include only measures in use for 2017 eCQM reporting
• Revised release notes, which provide an overview of technical changes implemented in the addendum. Two sets of release notes will be available.
-The first set provides information on ICD-10 value set updates for measures affected by this addendum.
-The second set provides information on changes from this addendum and all other updates for the measures included for 2017 eCQM reporting.
All changes to the eCQM value sets are available through the NLM’s Value Set Authority Center (https://vsac.nlm.nih.gov/). The value sets are available as a complete set, as well as value sets per measure. The Data Element Catalog on the VSAC home page contains the complete list of updated eCQMs and value set names.
What Do I Need to Do?
Measure implementers should review these changes and revise mapping of ICD-10 codes as needed to ensure their submissions comply with the updated requirements included in this addendum for 2017 reporting. Clinicians may also have to revise their workflows to comply with the ICD-10 code additions and removals included in this addendum.
More information on implementing and mapping of ICD-10 codes can be found on the CMS website at: https://www.cms.gov/Medicare/Coding/ICD10/Frequently-Asked-Questions.html.
Where Do I Go for Assistance?
Questions regarding the addendum, eCQM value sets, appropriateness of mapping, and non-ICD-10 code system updates should be reported to the ONC CQM Issue Tracker available at http://jira.oncprojectracking.org/browse/CQM/.
The Centers for Medicare & Medicaid Services (CMS) has published Version 0.1 of the 2017 CMS Implementation Guide for Quality Reporting Document Architecture Category III (QRDA-III) Eligible Clinician Programs with schematrons and sample files. As CMS continues to build the submission portal for eligible clinician reporting, ongoing testing and feedback from stakeholders is essential. As part of this process, CMS encourages partners and stakeholders to utilize these tools and provide feedback on an ongoing basis. CMS has made the guide, schematrons and sample files available for a public comment period on the ONC QRDA JIRA Issue Tracker until April 1, 2017. A JIRA account is required to comment. You can find the implementation guide and supplemental documents on the CMS eCQM Library and the Electronic Clinical Quality Improvement (eCQI) Resource Center. Additional information pertaining to eligible clinician reporting can be found on the Quality Payment Program website.
This Version 0.1 implementation guide provides CMS-specific instructions for submitting QRDA-III documents for the 2017 performance period for the:
• Comprehensive Primary Care Plus (CPC+)
• Merit-Based Incentive Payment System (MIPS)
• QRDA-III is a standard document format for the exchange of aggregated electronic clinical quality measure (eCQM) data. QRDA is one format CMS supports for eCQM submission.
• The implementation guide defines the form and manner required to implement a valid QRDA file for submission.
• The Schematron ensures that the submitted files follow all requirements defined in the implementation guide.
The Version 0.1 2017 CMS Implementation Guide for QRDA-III Eligible Clinician Programs contains the following high-level changes compared with the reporting specifications for Eligible Professionals in the 2016 CMS Implementation Guide for QRDA-III Eligible Professional Programs. The Version 0.1 2017 implementation guide:
• Replaces the term “Eligible Professional” with “Eligible Clinician”.
• Only contains CMS QRDA-III reporting guidance for eligible clinician programs. The QRDA Category I is no longer an accepted submission method in 2017 for eligible clinician programs.
• Is based on the HL7 Implementation Guide for CDA Release 2 Quality Reporting Document Architecture – Category III, Standard for Trial Use (STU) Release 2. The HL7 implementation guide includes template updates to:
-Support advancing care information and improvement activities performance categories under the MIPS; and
-Address the HL7 September 2016 ballot cycle ballot reconciliation.
• Includes updated eCQM Universally Unique IDs (UUIDs) based on the April 2016 annual update eCQM specifications, advancing care information measure identifiers, and improvement activities identifiers.
• Provides implementation reporting guidance for the CPC+ and MIPS programs.
• Establishes new requirements for adding C4 filtering based on the 2015 Edition Health IT Certification Criteria final rule for the CPC+ Program.
The Version 0.1 2017 implementation guide does not contain the following previously published information. You can find these resources on the CMS eCQM Library:
• The April 2016 annual update eCQM specifications for 2017 reporting; and
• Reporting instructions for the Hospital Quality Reporting Program for Eligible Hospitals and Critical Access Hospitals
Contact Kentucky REC for additional information!
On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue the Administration’s progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models will reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.
The announcement finalizes significant new policies that:
• Improve cardiac care: Three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.
• Improve orthopedic care: One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
• Provides an Accountable Care Organization opportunity for small practices: The new Medicare ACO Track 1+ Model will have more limited downside risk than in Tracks 2 or 3 of the Medicare Shared Savings Program in order to encourage more practices, especially small practices, to advance to performance-based risk.
These new payment models and the updated Comprehensive Care for Joint Replacement Model give clinicians additional opportunities to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. For the new cardiac and orthopedic payment models, clinicians may potentially earn the incentive payment beginning in performance year 2019 or potentially as early as performance year 2018 if they collaborate with participant hospitals that choose the Advanced APM path. For the Comprehensive Care for Joint Replacement model, clinicians may potentially earn the incentive payment beginning in performance year 2017. For the Track 1+ Model, clinicians may potentially earn the incentive payment beginning in performance year 2018, and the application cycle will align with the other Shared Savings Program tracks.
These models are being implemented by the CMS Innovation Center under section 1115A of the Social Security Act, with participation by all hospitals in selected geographic areas in order to yield more generalizable results, and additional protections for small and rural providers. The models will be referred to as:
• The Acute Myocardial Infarction (AMI) Model
• The Coronary Artery Bypass Graft (CABG) Model
• The Surgical Hip and Femur Fracture Treatment (SHFFT) Model
• The Cardiac Rehabilitation (CR) Incentive Payment Model
CMS is also announcing the new Medicare ACO Track 1+ Model. This new opportunity, beginning in 2018, will allow clinicians to join Advanced Alternative Payment Models to improve care and potentially earn an incentive payment under the Quality Payment Program, created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new Medicare ACO Track 1+ Model will test a payment model that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Medicare Shared Savings Program in order to encourage more rapid progression to performance-based risk.
Below is a list of Kentucky areas affected by the new payment models:
For more information about the individual models finalized through this rule, visit the CMS Innovation Center website.
NCQA has recently updated their PCMH 2014 and PCSP 2016 Standards. The updates come out three times per year: March, July and November. While these updates are not drastic, organizations must follow the most current requirements. Therefore it is important to review them each time.
Updated Standards and Guidelines with the Summary of Updates are available below for each program:
PCMH 2014 Standards and Guidelines
PCMH 2014 Summary of Updates
PCSP 2016 Standards and Guidelines
PCSP 2016 Summary of Updates
All updates can be found in the ISS survey tool. If you would like an e-publication you can access an updated one via the NCQA website. If you have previously downloaded an e-publication in the past, you can sign into the Download Center here and access the most updated full publication. If you have never downloaded an e-publication, you can visit the NCQA Store here.
For those who have previously downloaded e-publications from NCQA, an email is sent out notifying you of updates in order to keep you current with the latest version of standards.
Contact the Kentucky REC at 859-323-3090 with your questions about PCMH and PCSP. We’re here to help.
Looking forward to a happy and productive 2017.
Your friends at Kentucky Regional Extension Center.