CMS Quality Improvement and Designing eCQM Program

CMS Quality Improvement and Designing an ECQM Program
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CMS Quality Improvement and Designing A ECQM Program
In 2016, the Center for Medicare & Medicaid Services (CMS) updated the Medicate Access and CHIP Reauthorization Act of 2015 (MACRA). The 2015 version of MACRA aimed to introduce new approaches in which physicians could be reimbursed, increase reliance on technology, and transition from the traditional fee-for-service to a new pay-for-performance method (Kauffman, Borden, & Choi, 2020). In contrast, the 2016 updates tie Medicare payments to cost and quality of care and accelerate the transition to value-based payment (VBP) by expanding pay-for-performance incentives. This change, also known as the Quality Payment Program (QPP), was expected to streamline, among other aspects of healthcare, the increase in the utilization of Electronic Medical Records (EHR). According to Hersey et al. (2019), the goal of QPP is to provide incentives emphasizing care quality and value instead of volume. Some of these incentives are based on the extent to which physicians achieve Meaningful use of EHR in clinical quality measure (CQM) reporting. In this view, the current paper analyses a case study. It discusses how a nurse leader can use a quality improvement process to analyze the issue presented in the case.
Case Overview
A group of family practice physicians is struggling to meet stage 2 requirements of meaningful use of EHR. A key observation is that the staff often forgets to provide patients with essential information like accessing the portal. The staff members have raised two complaints about the issue: insufficient time to explain the process to patients and that printed information is stacked in the utility room, hampering access. Analysis of this problem requires nurse leaders to adopt a quality improvement process. The quality improvement process acts as a lens through which this group of physicians can understand the problem, solve it, and take advantage of EHR incentives as prescribed under QPP.
Meaningful Use (MU) and EHR Incentive Programs
Meaningful use, according to Anumula and Sanelli (2012), is the utilization of resources in a manner that has a positive impact on patient care. In terms of EHR, meaningful use is an incentives program coordinated and run by the CMS. In other words, the CMS provides financial incentives to health organizations and physicians for the meaningful use of EHR technology. Aside from incentives, compliance with the guidelines of MU also results in reduced medical errors, automated refills, and improved access or availability of patient medical records. As they enter stage 2 of MU, the group of physicians must enhance their utilization of EHR or miss out on the benefits entailed in this stage. These benefits include avoidance of penalties, qualifying for incentives, coordination of care, increased safe access to information, enhanced patient engagement, and improved population health outcomes.
The key problems faced by the group of family practice physicians (GFPP) include staff having insufficient time to explain to patients how to ac...