Tag: CMS

Quality Measures & Telehealth

Just before the 4th of July holiday weekend, CMS released new guidance for which eCQMs can be used during a telehealth visit for Reporting Year 2020. This unexpected update was the result of questions regarding if home-captured data was “good enough” for Quality Measures. Fortunately, out of the 47 eCQMs that exist, a total of 42 are telehealth allowable. As with everything, there is a caveat: some measures may require an in-person element that cannot be achieved fully with just telehealth. So while an eCQM is eligible, there may be an extra step required to complete the measure.

Measure Highlights

While the complete list available here, we do want to highlight the ones that we find most commonly used by practices:


  1. 50v8 – Receipt of Specialist Report
  2. 68v9 – Documentation of Current Medications
  3. 122v8 – Diabetes Hemoglobin A1c Poor Control
  4. 128v8 – Anti-depressant Medication Management
  5. 135v8 – Heart Failure Medication Therapy (ACE inhibitor or ARB or ARNI therapy)
  6. 138v8 – Tobacco Screening & Cessation
  7. 139v8 – Falls Screening
  8. 156v8 – Use of High-Risk Medication in the Elderly (inverse measure)
  9. 159v8 – Depression Remission at 12 months
  10. 161v8 – MDD Suicide Risk Assessment
  11. 165v8 – Controlling High Blood Pressure
  12. 347v3 – Statin Therapy for Treatment of CVD

NOT Allowed:

  1. 22v8 – Screening for High Blood Pressure & Follow-up
  2. 69v8 – BMI Screening & Follow-up
  3. 157v8 – Medication & Radiation Paint Intensity Quantified
  4. 129v9 – Prostate Cancer Overuse of Bone Scan
  5. 133v8 – Cataracts 20/40 or Better Within 90-days Following Surgery

What About MIPS CQMs?

eCQMs that have a MIPS CQM equivalent (formerly called Registry Measures) are also telehealth eligible/ineligible! Remember, the difference between the measure sets is: targeted population and (usually minor) differences in their formulas. Generally, however, the MIPS CQMs are identical in nature to their matched eCQMs.

If you have a MIPS CQM (there are 196 of them) you can safely assume it is NOT telehealth eligible if it is not on the list. If you are relying on telehealth visits and have MIPS CQMs not on the list, you will need to adjust your measures.

What About Specialty Registry Measures?

The guidance released only applies to measures that CMS oversees: MIPS CQMs & eCQMs. The onus is on the Qualified Registry to determine if a telehealth visit and their data standards are an equitable match. If you have a specialty registry, that you are using to report MIPS Quality, be sure to consult with them about this.

Going Forward

CMS has said that this list of CQMs for 2020 is final. However, they did also release a list for 2021 which has FEWER (39) measures allowed. Fortunately, those three extra measures are not common. It is important to note that this list is not final and may change between now and Jan 1, 2021.

As the 2021 list is updated we will provide you our analysis if anything significant changes. At this point, however, we do not believe that it will change radically.


The rush to telehealth brought about questions that almost no one was asking: “What Quality Measures can be done outside the clinic?” CMS has responded with a well-crafted list of measures.

As always, CMS reserves the right to change the MIPS program to adapt to the health community’s needs. Though it appears that they are finished changing the program for 2020. Historically, in late July, CMS releases a Proposed Rule that becomes final in late-Oct/early-Nov. Therefore, SHP anticipates additional changes to the MIPS program for 2021, but no further major changes to the program for 2020.

Practices, particularly those who are relying on Telehealth, should re-evaluate their Quality Measures against this list. If you find that you were using a measure that is not eligible, you may want to consider requesting an Extreme & Controllable Circumstances Exception for the Quality Category.

If you are not sure if you should file an ECCE, or if you want assistance with picking your eCQMs, contact your SHP Representative and they will get you in touch with our MIPS expert.

Simplified Core Quality Metrics

The Center for Medicare and Medicaid Services (CMS) released the first set of “Core Quality Measures”  this Tuesday, in which CMS and private payers agree to utilize in value-based payments. The collaborative includes members from America’s Health Insurance Plans (AHIP), as well as both Aetna and UnitedHealth Group. This initial set of metrics includes a comprehensive clinical comparison in the following categories:

  1. Accountable Care Organizations, Patient-Centered Medical Homes, and Primary Care
  2. Cardiology
  3. Gastroenterology
  4. HIV and Hepatitis C
  5. Medical Oncology
  6. Obstetrics and Gynecology
  7. Orthopedics

These standardized metrics aim to assist patients, physicians, employers, and payers in:

  • Promoting of evidence-based Quality Improvement
  • Consumer Decision-Making Processes
  • Value-Based Contracting, Purchasing, and Reimbursement
  • Reducing Variance
  • Decreasing Redundant Reporting Burdens

The collaborative agrees not to include only these metrics in Value-Based contracts as current contracts expire, they also introduce future metrics to be included, and only after considering open comments.  CMS Acting Administrator Andy Slavitt pledges “patients and care providers deserve a uniform approach to measure quality,” aligning with Harold D. Miller’s critique on the potential impact of “Implementing Alternative Payment Models Under MACRA.”

This step represents a major transition towards simplifying the burden of redundant measurement that adds little value to the patient, a shift heavily encouraged by Dr. Don Berwick, President Emeritus of The Institute for Healthcare Improvement. Though wary professionals recognize unintended consequences are often plentiful in transitional periods, it is important to recognize CMS is aggressively pursuing Quality Standardization in both Advanced Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS).  As healthcare providers continue operating on a FFS basis above the surface, it is unquestionably vital to monitor the “simplification process,” virtually all major payers are embarking on.

CMS proposes overhaul to discharge planning, requires follow-up procedures

The Centers for Medicare and Medicaid Services on Monday proposed new rules to discharge planning requirements for long-term care hospitals, inpatient rehabilitation facilities, critical access hospitals and home health agencies.


Under the proposed rule, hospitals and critical access hospitals are required to develop a discharge plan within 24 hours of admission.

CMS hopes to improve outcomes by reducing complications and readmissions.

[Also: CMS to cut Medicare payments to home health agencies by 1.4%]

The proposed rule also takes into account the Improving Medicare Post-Acute Care Transformation Act of 2014 requiring hospitals and providers to use data on quality and resource use measures when patients are being discharged and to include their preferences.

“CMS is proposing a simple but key change that will make it easier for people to take charge of their own health care. If this policy is adopted, individuals will be asked what’s most important to them as they choose the next step in their care – whether it is a nursing home or home care,” said CMS Acting Administrator Andy Slavitt.

The rule applies to all inpatients and certain types of outpatients, including patients receiving observation services; those who are undergoing surgery or other same-day procedures in which anesthesia or moderate sedation is used; and emergency department patients who have been identified as needing a discharge plan.

Hospitals and critical access hospitals are also be required to provide discharge instructions to patients, have a process for medication management and have a post-discharge follow up process.

For patients who are transferred to another facility, specific medical information is required to be sent to the receiving facility.

Hospitals and critical access hospitals would be required to consider  the availability of non-healthcare services and community-based providers that may be available to patients post-discharge. There is also a mandate that they use and share data, including data on quality and resource use measures.

“This rule puts the patient and their caregivers at the center of care delivery,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway. “Patients will receive discharge instructions, based on their goals and preferences, that clearly communicate what medications and other follow-up is needed after discharge, and pertinent medical information will be communicated to providers who care for the patient after discharge. This leads to better care, smarter spending, and healthier people.”

There is a 60 day comment period on the proposed rule.


Source: www.healthcarefinancenews.com

ACHE Survey: Top Issues Confronting Hospitals in 2014

Survey: Healthcare Finance, Reform Top Issues Confronting Hospitals in 2014

CHICAGO, January 12, 2015—Financial challenges again ranked No. 1 on the list of hospital CEOs’ top concerns in 2014, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals. Healthcare reform implementation and governmental mandates ranked next in a tie for second, closely followed by patient safety and quality.

“The survey results show that these are challenging times for CEOs and leadership teams, and we are all expected to do more with less,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “Taking care of patients and improving patient safety and quality in their organizations is job No. 1, but CEOs acknowledge they must do so in a climate of complex payment reform, dwindling reimbursement and government mandates.”

In the survey, ACHE asked respondents to rank 10 issues affecting their hospitals in order of importance and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,118 community hospital CEOs who are ACHE members, of whom 338, or 30.2 percent, responded. The issues in the following table are listed by the average rank given to each issue, with the lowest numbers indicating the highest concerns.





Financial challenges 2.5 2.4 2.5
Healthcare reform implementation 4.6 4.3 4.7
Governmental mandates 4.6 4.9 5.0
Patient safety and quality 4.7 4.9 4.4
Care for the uninsured/underinsured 5.5 5.6 5.6
Patient satisfaction 5.9 5.9 5.6
Physician-hospital relations 5.9 6.0 5.8
Population health management 6.8 7.6 7.9
Technology 7.3 7.9 7.6
Personnel shortages 7.4 8.0 8.0

Within each of these 10 issues, respondents identified specific concerns facing their hospitals. Following are those concerns in order of mention for the top three issues identified in the survey. (Respondents could check as many as desired.)

Financial Challenges (n = 338)1

Medicaid reimbursement (including adequacy and timeliness of payment) 69%
Bad debt (including uncollectable emergency department and other charges) 67%
Decreasing inpatient volume 63%
Medicare reimbursement (including adequacy and timeliness of payment) 57%
Competition from other providers (of any type—inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) 55%
Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) 55%
Increasing costs for staff, supplies, etc. 55%
Revenue cycle management (converting charges to cash) 39%
Managed care payments 37%
Other commercial insurance reimbursement 37%
Inadequate funding for capital improvements 32%
Emergency department overuse 26%
Other n=22

Healthcare Reform Implementation (n = 338)1

Reduce operating costs 78%
Shift to value-based purchasing 66%
Alignment of provider and payor incentives 65%
Align with physicians more closely 54%
Develop information system integrated with primary care MDs 48%
Regulatory/legislative uncertainty affecting strategic planning 47%
Study avoidable readmissions to avoid penalties 46%
Hire one or more primary care physicians 35%
Obtain funding from the American Recovery and Reinvestment Act for electronic records (meaningful use) 32%
Study avoidable infections to avoid penalties 26%
Other n = 17

Governmental Mandates (n = 338)1

CMS audits (RAC, MAC, CERT) 80%
Implementation of ICD-10 68%
CMS regulations 64%
State regulations 34%
Increased government scrutiny (e.g., IRS, Sarbanes-Oxley Act) 32%
Other n = 35

About the American College of Healthcare Executives

The American College of Healthcare Executives is an international professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE offers its prestigious FACHE® credential, signifying board certification in healthcare management. ACHE’s established network of 80 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery. The Foundation of the American College of Healthcare Executives was established to further advance healthcare management excellence through education and research. The Foundation of ACHE is known for its educational programs—including the annual Congress on Healthcare Leadership, which draws more than 4,000 participants—and groundbreaking research. Its publishing division, Health Administration Press, is one of the largest publishers of books and journals on health services management including textbooks for college and university courses. For more information, visit ache.org.

Lisa M. Freund, FACHE
Vice President
Communications and Marketing
American College of Healthcare Executives
One North Franklin, Suite 1700
Chicago, IL 60606
(312) 424-9420


A special Thank you to The American College of Healthcare Executives for this useful resource.

Source URL: http://www.ache.org/pubs/Releases/2015/top-issues-confronting-hospitals-2014.cfm