5 Requirements for the CMS Hospital IQR Program in 2016

This year marks a significant change to the CMS Inpatient Quality Reporting (IQR) program requirements for submitting Electronic Clinical Quality Measures, commonly referred to as “eCQMs.” In 2016, hospitals, for the first time, are required to electronically submit four of the available 28 eCQMs. This new hospital IQR program requirements expresses a shift from the Meaningful Use program to a focus on quality of care.

The start of Meaningful Use

Let’s take a look at how we got here. Back in 2004, President George W. Bush made it a national goal to bring all U.S. health care systems into the 21^st century with computer technology. He also created the Office of the National Coordinator for Health Information Technology (ONC). Things moved slowly at first, but in 2008, when Congress passed the $700 billion stimulus package to assist in economic recovery, they set aside $30 billion to help get health care systems connected via Electronic Health Records (EHR) technology. ¹

Many policymakers were concerned that this new technology wouldn’t be adopted unless health care systems and providers were either forced or enticed. So they developed a set of objective criteria which required hospitals to document and report the collection of specific data. If hospitals met these criteria, they would be rewarded with stimulus funds. In other words, they would be paid to prove the “meaningful use” of their EHR.

In 2008, EHR usage was around 10%. By the end of 2014, 76% of hospitals had adopted some form of EHR and 8 out of 10 physicians reported using an EHR. Clearly, the program worked.

Beyond Meaningful Use to true Quality measurement

“Meaningful Use, while successful in its initial task, was and is primarily an IT initiative,” said Kristen Beatson, RN, Director of Electronic Measures at Medisolv. “CMS’ initial focus on eCQMs was to only demonstrate the hospital had an EHR in place capable of producing eCQM results. Hospitals would submit their eCQM and objective measures to CMS and receive their Meaningful Use incentive payment.”

A new trend has emerged over the last two years. CMS is transitioning payment from fee-for-service to pay-for-performance (P4P). To keep up with this trend, hospital IT departments are passing the torch for eCQM program reporting to Quality. The IQR program, while not a new quality initiative, is now tied directly to revenue through the new P4P model. With mandatory eCQMs, as well as the other measures, Quality departments are integral in fulfilling all of these program requirements in order to avoid penalties. (Is your Quality department ready? Take the eCQMs 101 Quiz to find out.)

In 2014, CMS introduced the option to submit eCQMs using data pulled directly from the EHR. In 2016, it has become an IQR program requirement. And if you don’t? Up to 2% of your Medicare reimbursement funding is at risk. (Check out this infographic showing all at-risk Medicare funding.)

“This means that a hospital’s Quality department has to be more involved than ever. Quality must work with IT to select the appropriate eCQMs and both parties must have a high degree of trust in the data they are submitting,” said Kristen. (Tips for selecting and validating your eCQMs)

2016 CMS eCQM reporting requirements for the IQR program

These are the eCQM requirements for the IQR program for 2016.

1. Hospitals must choose four of the available 28 eCQMs to report electronically.
2. Hospitals must submit data based on the June 2015 version of the specifications, using a certified EHR (CEHRT).
3. The data must be submitted from either Q3 or Q4 of 2016.
4. Data from that period must be submitted in a QRDA I file format.
5. Submission must be completed by February 28, 2017.

Keep in mind that this submission for the IQR program is in addition to all of the other existing IQR program requirements hospitals currently fulfill. There is no option, for instance, to reduce the number of chart abstracted measures that a hospital submits.

What to do now

As with Meaningful Use, CMS is providing a ramp-up period to ensure that you can submit electronically. In fact, CMS isn’t even going to publish the eCQM data on Hospital Compare…yet.

“This is the time for Quality to review and become familiar with their eCQM data,” said Kristen. They should start comparing their chart abstracted data to their eCQMs. The eCQM submission requirements are very likely to increase in the coming years.  You want your hospital to be ready.”

So, it’s prep time. Get Quality and IT together to start strategizing a plan for this year. CMS has opened their testing environment where you can submit your hospital’s eCQM data for validation. Use this testing period to assess your hospital’s ability to pull and submit this data. If you know your hospital will not be able to meet these requirements, find a vendor partner that has a long track record of success with eCQMs.   

Medisolv’s ENCOR Quality Reporting and Management software solution provides hospitals with the tools they need to meet the CMS reporting requirements. ENCOR is the only endorsed solution for quality reporting and management by the American Hospital Association.

Learn about ENCOR >>