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Now Available: 2017 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals, Schematron, and Sample Files

The Centers for Medicare & Medicaid Services (CMS) has published the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) Version 1.0 (7/07/2017) for Eligible Clinicians and Eligible Professionals (EPs) Programs with Schematron and sample files. This version replaces the 2017 CMS QRDA III IG for Eligible Clinicians Reporting v0.1 (12/29/2016).

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs provides technical instructions for QRDA III reporting for the following programs:

  • Merit-based Incentive Payment System (MIPS)
  • Comprehensive Primary Care Plus (CPC+)

The 2017 CMS QRDA III IG for Eligible Clinicians and EPs contains the following high-level changes compared with the reporting specifications in the 2016 CMS QRDA IG:

  • The 2017 IG is based on the Health Level Seven (HL7) QRDA Category III R1, Standard for Trial Use R2.1
  • For MIPS, Advancing Care Information (ACI) measures and Improvement Activities (IA) can be reported using the two new section templates: ACI Section and IA Section, respectively
  • A performance period must now be specified using the Reporting Parameters Act template that is contained within each section template for Quality (electronic clinical quality measures), ACI, and IA

The 2017 CMS QRDA III Schematron provides rules that enforce the conformance statements of the IG. QRDA III submissions to CMS for the 2017 performance period will be submitted through the new Quality Payment Program submissions API or via file upload on the Quality Payment Program website. CMS will provide immediate, clear, and actionable feedback at the time of submission which will enable submitters to be confident that they successfully submitted their data. If there is a problem with the submission, submitters will get the issue specifics right away – and be able to address them immediately. Exact validation feedback provided by the Quality Payment Program may differ, but this Schematron file will validate that a QRDA III file is properly structured and will help with file submission through the Quality Payment Program submission system.

The new Schematron and sample files for this IG replace the 2017 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians Programs v0.1. For more details regarding the changes, visit the “Change Log” sections of the IG.

Additional QRDA-Related Resources:

You can find additional QRDA related resources, as well as current and past implementation guides, on the eCQI Resource Center and the CMS eCQM Library. For questions related to the QRDA Implementation Guides and/or Schematrons, visit the ONC QRDA JIRA Issue Tracker. For questions related to Quality Payment Program/MIPS submissions, visit the Quality Payment Program website or call 1-866-288-8292.

View Recent Quality Payment Program Webinar Recordings Online

Were you unable to participate in a recent Quality Payment Program webinar?

There’s good news: You can view webinar recordings, presentations, and transcripts on the CMS Quality Payment Program Events webpage.

Recent Quality Payment Program webinars include:

CMS encourages you to stay up to date on the Quality Payment Program by visiting the website regularly and subscribing to the Quality Payment Program listserv. To subscribe, visit the Quality Payment Program website and select “Subscribe to Email Updates” in the footer.

For More Information

If you have questions on other topics related to the Quality Payment Program, please contact the Quality Payment Program Service Center at qpp@cms.hhs.gov or 1-866-288-8292.

New Special Publication from the NAM Now Available: Effective Care for High-Need Patients

Today, only 5% of patients account for nearly half of the nation's spending on health care. How do we improve care management for these patients while also balancing quality of care and costs?

To advance insights and perspectives on how to improve the care of these high-need patients, the National Academy of Medicine, with the guidance from an expert planning committee, convened three workshops to explore opportunities for improving care and outcomes for high-need patients.

Summarizing and building upon the workshop discussions, Effective Care for High-Need Patients, identifies key characteristics of the high-needs population and introduces a new patient taxonomy that segments high-need patients based on the care they need and how often they need it to help provide better care management to improve their health. It also includes insights into successful models of care and opportunities for a path forward.

Improving care for high-need patients is not only possible--it also contributes to a more sustainable health system. But progress will take a coordinated effort from policy makers, payers, providers, and researchers, as well as patients and their loved ones.

Read the NAM Special Publication.

What do we know about preventing dementia and cognitive decline?

With the rise of dementia and cognitive impairment as national health concerns, there have been a wide range of programs and products, such as diets, exercise regimens, games, and supplements, which claim to keep these conditions at bay. But, how do we know what actually might prevent or reduce risk of cognitive decline or dementia as we age?

To help sort through the data and to understand the current evidence for possible interventions, NIA commissioned a committee of experts through the National Academies of Sciences, Engineering and Medicine to conduct an extensive scientific review and provide recommendations.

The committee did not find sufficient evidence to recommend specific interventions to prevent cognitive decline or dementia. However, they did note “encouraging” evidence for three types of interventions: cognitive training, blood pressure control for people with hypertension, and increased physical activity.

Visit our website to read more about these findings.

Comment on National Quality Forum Framework to Measure Diagnostic Safety

A proposed measurement framework for diagnostic quality and safety developed by the National Quality Forum has been posted for public comment. Comments will inform recommendations for the development of priority measures to address measurement gaps in diagnostic accuracy. Public comment on this draft report and measurement framework is open through July 12. Please submit your comments on the project page or contact the NQF project team at diagnosticaccuracy@qualityforum.org with any questions.

Shining a Spotlight on the Opioid Crisis Through the Power of Data

By Anne Elixhauser, Ph.D.

As an AHRQ researcher, I get to dive into topics that matter to the American people using one of the most comprehensive health care databases—AHRQ's Healthcare Cost and Utilization Project, or HCUP. HCUP is the Nation’s most complete source of hospital-based data, including information on hospitalizations and emergency department (ED) visits for all patients, including those paid by government and private insurance as well as the uninsured.

Learning about data trends to help improve lives can mean swimming through very scary waters. Take the opioids crisis, for instance. There has been widespread attention given to opioid-related deaths in the media. A New York Times article recently estimated that nearly 60,000 people died from using an opioid drug in 2016 Link to Exit Disclaimer. On the other hand, the New York Times also wrote that opioid prescriptions have declined for the first time in two decades Link to Exit Disclaimer. These articles illustrate two very important aspects of the opioid crisis. But what about the people who don't die or are still being prescribed too many pills? And what about those who turn to heroin or other illicit opioids and overdose, but survive thanks to a visit to the hospital or emergency department (ED)?

It's hard to defeat a problem like the opioid epidemic until you know how bad the problem really is and what subgroups are affected disproportionately. That is what AHRQ is uniquely suited to provide—data on opioid hospitalizations and ED visits for specific population subgroups from our HCUP Fast Stats database. HCUP allows Secretary Price, other HHS agencies, policymakers, and frontline providers to best define the challenge, and ultimately, begin to measure how opioid addiction treatment and reduction efforts are working.

So what are the numbers? We highlighted some in a press release that is based on data in a new statistical brief on opioid-related hospitalizations and ED visits, by patient sex and age (PDF, 343 KB). The data are sobering:

  • Men and women were hospitalized at virtually the same rate nationwide in 2014—about 225 hospitalizations per 100,000 people. That's a 75 percent increase for women between 2005 and 2014, compared to only a 55 percent increase for men.
  • An infographic shows that in three-quarters of all States with available data, women had a higher rate of an opioid-related hospitalization than men in 2014.
  • However, men were still more likely to make opioid-related ED visits in 2014.
  • Individuals 25–44 years had the highest opioid-related ED visit rate in every State. But people 65 and older had the largest increases in opioid-related hospital stays and ED visits.

In July, we plan to release another statistical brief on opioid-related hospitalizations and ED visits by patient residence and income. This may also be a disturbing read, as the data will show, for example, that opioid-related ED visits increased the most in the lowest income communities from 2005 to 2014.

While none of these data are very encouraging, it is critical to have a better idea of why women are being hospitalized more than men or why 25–44 year-olds are visiting the ED more than other age groups, especially since we have 2015 and 2016 data for many States in the database and we are continuing to see the trend line for hospitalizations and ED visits going up.

That's why I am heartened by Secretary Price's request for additional funding for opioid abuse research. Recently, the Secretary awarded more than $70 million in grants to help prevent opioid overdose deaths. About $28 million of the grant money will go to medication-assisted treatment (MAT). AHRQ is investing about $12 million over 3 years in grants to explore how best to deliver MAT opioid abuse in rural areas and remove barriers to using MAT. Also, the recently enacted 21st Century Cures Act authorized the Substance Abuse and Mental Health Services Administration to award $485 million in grants for opioid abuse prevention, treatment, and recovery.

All these grants show HHS' dedication to halt the opioid epidemic. AHRQ will continue to play an important role monitoring the national and State data for opioid-related hospitalizations and ED visits—because that's our job.

Dr. Elixhauser is a Senior Researcher at AHRQ. She has worked with HCUP data for more than 20 years and is the author of more than 200 articles and reports.

CMS Releases 1991-2014 Health Care Spending by State

Data details health care spending for residents by service and major payer

Today, the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014. The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.

David Lassman, the lead author of the report noted that, “recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal health care expenditure growth; however, during the 2009 to 2014 period, the variation in spending between the lowest and highest states was virtually unchanged.”

The report, published as a web first in Health Affairs, offers vital context for understanding how health spending varies across states. The analysis updates previous estimates published in 2011 and examines personal health care spending (or the health care goods and services consumed) through a resident-based view. These estimates are also presented both by type of goods and services (such as hospital services and retail prescription drugs) and by major payer (including Medicare, Medicaid, and private health insurance) for the individuals who reside in a state.

The topline findings from the report include:

  • Considerable regional variation on personal health care spending:
    • In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26 and 16 percent higher than the national average ($8,045).
    • In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita in 2014 ($6,814 and $6,978, respectively) with average spending roughly 15 percent lower than the national average.
  • Similar growth in Medicaid expansion and non-expansion states: While most states experienced faster growth in 2014 compared to 2013 due to Medicaid expansion and enrollment in Health Insurance Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates, 4.4 and 4.5 percent respectively. The similar growth in per capita spending for expansion and non-expansion states was due largely to two effects:
    • Faster growth in the use of healthcare goods and services in expansion states relative to non-expansion states due to a larger increase in the percent of people insured in those states.
    • Faster growth in spending per insured person in non-expansion states relative to expansion states.
  • Impact of recent economic recession and recovery: The most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage.
    • For 2010-2013, per capita personal health spending grew at a rate of 2.8 percent per year on average, substantially slower than during 2004-2009, when spending averaged 5.2 percent growth per year.
    • During 2010-2013, every state experienced slower growth in per capita personal health care spending with an average deceleration of just over two percentage points compared to the 2004-2009 period.
  • Three Major Payers:
    • Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States.
      • The State with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15 percent above the national average ($10,986).
      • In 2014, Montana was the State with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25 percent below the national average per enrollee).
    • Medicaid: The recent trends in per enrollee spending were driven by the Medicaid coverage expansion, which increased the share of relatively less expensive enrollees relative to the previous Medicaid beneficiary population mix in expansion states.
      • Total Medicaid spending increased 12.3 percent from 2013 to 2014 for states that expanded Medicaid, compared with 6.2 percent for states that did not expand Medicaid.
      • However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1 percent) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1 percent.
    • Private Health Insurance: Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3 percent since 2009 ($3,872).
      • Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8 percent and 4.6 percent, respectively.
      • A majority of this difference reflects faster private health insurance enrollment growth in non-expansion states (3.2 percent) compared to that for expansion states (1.9 percent).

The OACT data and analysis will appear at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsStateHealthAccountsResidence.html

An article about the study also being published by Health Affairs here: http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2017.0416

NOW AVAILABLE: Driving Action and Progress on Obesity Prevention and Treatment: Proceedings of a Workshop

Driving Action and Progress on Obesity Prevention and Treatment: Proceedings of a Workshop

After decades of increases in the obesity rate among U.S. adults and children, the rate recently has dropped among some populations, particularly young children. What are the factors responsible for these changes? How can promising trends be accelerated? What else needs to be known to end the epidemic of obesity in the United States?

To examine these and other pressing questions, the Roundtable on Obesity Solutions, of the National Academies of Sciences, Engineering, and Medicine, ...

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