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Friday, October 28, 2011

Half of ACO Quality Measures are in MeaningfulUse

I was doing a review of the ACO Quality Measures yesterday.  One thing I noted was that at least half of them are also in Meaningful Use.  The cool thing about that is that this team has already reported that most MU measures can be computed from the HITSP C32 with the addition of procedures section, and that nearly all can be addressed by adding smoking status and vitals (see pages 4-6 of their paper).

What about the other half?  Well, six of them come from what will now be a CMS supported survey, three of them come from claims data, and another one comes from Meaningful Use attestation reports.  So, of the remainder, what isn't in Meaningful Use Stage 1, and can it be computed from the HITSP C32?

These are the remaining measures:

  1. Medication Reconciliation at Discharge (NQF #97)
  2. Fall Risk Screening (NQF #101)
  3. Depression Screening (NQF #418)
  4. Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding 2 years (CMS)
  5. Diabetes Measures (NQF #729
  6. Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control (NQF #75)
  7. Treatment for CAD w/ Diabetes/LVSD (NQF #66)
Looking at each of these:
Fall Risk (#2) and Depression (#3) screening assessment scores can be recorded in the HITSP C32 Results section.  So, if you find an assessment result, you can tell that these have been done.

The diabetes measures (#5) are from the MN Community Measurement instrument.  These account for five separate measures in the ACO rule and are very simple to compute from CCD medications, results, vital signs or social history (for tobacco use) sections:
  1. HgA1C < 8
  2. LDL < 100
  3. BP < 140/90
  4. Tobacco Non-Use
  5. Aspirin Use
The IVD (#6) and CAD (#7) measures can also be readily computed, as they are very similar to other computable results in Meaningful Use stage 1.

That just leaves #1, Medication Reconciliation on discharge.  Because the CCD is not a discharge summary, you'd really want to look at a different document to compute that measure.  But if you did open up a discharge summary, and found one of the required entries of the IHE RECON profile, you could be assured that medication reconciliation was performed at discharge.

So, half of ACO measures are meaningful use measures, and you should be able to compute nearly all of the the other half from the standards already required for Meaningful Use stage 1.  And it could even get better under stage 2 when we have other documents supported for Transitions of Care.