Understanding the specifications of the quality measures you select will help you determine if calculated performance rates are accurate.
Denominators identify the patients that should have had the quality action performed.
- The patient must have had at least one eligible visit with the provider during the reporting period to be included in the denominator. Only certain encounter codes constitute “eligible” visits.
- The PQRS reporting period is always the calendar year (e.g., 01/01/2012 – 12/31/2012).
- For measures that are diagnosis-specific, applicable diagnosis codes must be in the patient’s problem list or captured in the chart through a template. For example, “Hypertension” must be in the patient’s problem list or visit note for PQRS Measure #236: “Hypertension: Controlling High Blood Pressure” to apply. This measure won’t include patients that simply had high blood pressure readings without a diagnosis of hypertension.
- Some measures also look at procedures to determine if the patient will be part of the denominator. For example, Measure #6 “CAD: Antiplatelet Therapy,” looks for either a diagnosis code or prior cardiac surgery.
Numerators indicate which patients actually had the desired process (service) or outcome.
- For most measures, it doesn’t matter which provider performed the service, as long as the patient received the service. For example, if Dr. A gave a flu shot to a patient, all providers reporting on that patient will get credit for the flu shot–as long as the information is captured appropriately in the provider’s EHR.
- Some measures look outside the reporting period for services (e.g., colonoscopy within 10 years).
If your numerators are low resulting in poor performance rates, consider the following common documentation remedies:
- Make certain your labs, immunizations, preventive services and medications been correctly mapped to standard master codes (such as CPT, LOINC, RxNorm, SNOMED or CVX codes). Lab linking is an ongoing maintenance requirement.
- Run updates and fixes in a timely manner as they are released by your vendor.
- Verify where your particular EHR looks for data for each measure (e.g., in the notes? Billing module? Flowsheet? Past medical history?)
- Identify which date is being associated with an actionby your EHR. This may be the date the test was done, the date you recorded it in your EHR, the date the result came in, the date you ordered it, or the date captured in a template.
- If you’ve customized templates, make certain the fields are correctly linked to updated standard codes.
Clinical quality measures have been carefully designed by experts in healthcare and engineered for electronic application. Effective use can help you improve the health of your patient population and lead to high provider and patient satisfaction.
PQRS EHR-based measure specifications can be found here: “Accept” the CPT User Agreement. Questions may be directed to Sandy Pogones, Program Manager Physician Services, spogones@primaris.org.