Reasons to Pick Specific PQRS Measures

With deadlines fast approaching for so many quality programs and so much at stake, I’m not doing a “What is it?” today. Today I am going to review some of the PQRS measures I selected and provide reasons why I think they are important and you might want to consider using them.
PQRS #1 Hemoglobin A1c Poor Control: Effective Clinical Care:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care.
• HgbA1c control is one of the criteria many MACs are using as part of hyperbaric oxygen therapy prior authorizations and prepayment reviews
• You don’t have to have ordered this lab yourself; you can utilize results obtained by another provider in order to meet this measure.
• HgbA1c is also part of the Diabetes Measure Group, so there is more than one reason to record this value even if you are not going to report this measure

PQRS # 46 Medication Reconciliation: Patient Safety:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care.
• It is easily met if you are using electronic prescribing (eRx)
• There is another measure you can pass if you are using this measure and that is the Medication Documentation measure (PQRS #130) . It is helpful when one measure helps you pass another measure.
• This is also Objective 7 of Meaningful Use, so selecting this measure actually helps you with an entirely different incentive program.

PQRS # 128 Body Mass Index (BMI) Screening and Follow-Up Plan: Community/Population Health:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care.
• This measure is relatively easy to pass since recording weight and height are common practices in most offices and clinics
• Addressing obesity is one of the factors that MACs are looking at as part of hyperbaric oxygen therapy prior authorizations and prepayment reviews (see a discussion of the difference between these 2 programs).

PQRS #130 Documentation of current Medications in the Medical Record: Patient Safety:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care.
• It is easily met if you are using electronic prescribing (eRx)
• There is another measure you can pass if you are using this measure and that is the Medication Reconciliation measure. It is helpful when one measure helps you pass another measure.

PQRS # 163 Diabetes Foot Exam: Effective Clinical Care:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care, particularly among patients with diabetes
• Evaluating the diabetic patient’s foot with a proper exam is one of the criteria many MACs are using as part of hyperbaric oxygen therapy prior authorizations and prepayment reviews (see a discussion of the difference between these 2 programs).

PQRS # 226 Tobacco Use Screening and Cessation Intervention Community/Population Health:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care
• Getting patients to stop smoking is one of the criteria many MACs are using as part of hyperbaric oxygen therapy prior authorizations and prepayment reviews (see a discussion of the difference between these 2 programs). Some Local Coverage Determinations for cellular products even state that patients must have abstained from smoking in order to be eligible for cellular products.

PQRS # 236 Adequate control of Blood Pressure: Effective Clinical Care:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care

PQRS # 173  Screening for Unhealthy Alcohol Use Community/Population Health:

• This measure is used by many hospitals and organizations as a way to look at provider quality of care across multiple settings of care

CDR #1  Diabetic Foot Ulcer Off-loading: Effective Clinical Care:

• This activity is required by the MACs that are implementing prior authorization for HBOT and is being monitored by the others that are implementing prepayment review. That is because it is required by the national coverage determination (NCD) policy for HBOT in DFUs.
• This process is associated with DFU healing and probably with reduced resource use among patients with DFUs.
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• This is the kind of measure that a wound care clinician should want to have publicly reported on Physician Compare as an indicator of their expertise in wound care.
• Data on USWR QCDR measures automatically becomes part of The US Wound Registry, https://clinicaltrials.gov/ct2/show/NCT02280733?term=Us+wound+registry&rank=1; ClinicalTrials.gov Identifier: NCT02280733
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #5  Venous Ulcer Compression: Effective Clinical Care:

• This activity is required by many MACs in order for an EP to use cellular products.
• This process is associated with VLU healing and probably with reduced resource use among patients with VLUs
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• This is the kind of measure that a wound care clinician should want to have publicly reported on Physician Compare as an indicator of their expertise in wound care.
• Data on USWR QCDR measures automatically becomes part of The US Wound Registry, https://clinicaltrials.gov/ct2/show/NCT02280733?term=Us+wound+registry&rank=1; ClinicalTrials.gov Identifier: NCT02280733
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #8  Appropriate use of HBOT for a Diabetic foot ulcer Efficiency and Cost Reduction:

• This measure tests for many activities that MACs are assessing as they implement both prior authorization for HBOT and prepayment review. It is a composite measure that includes:
  • DFU off loading
  • Vascular assessment
  • Hemoglobin A1C control
• The activities included in this measure are required in order to be in compliance with the national coverage determination (NCD) for HBOT in DFUs.
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• This is the kind of measure that a wound care clinician should want to have publicly reported on Physician Compare as an indicator of their expertise in wound care and hyperbaric medicine.
• Data on all hyperbaric related measures become part of the National Hyperbaric Oxygen Therapy Registry, a registry jointly sponsored by the USWR and the Undersea and Hyperbaric Medical Society (UHMS) https://clinicaltrials.gov/ct2/show/NCT02483650?term=hyperbaric+oxygen+therapy&rank=41; ClinicalTrials.gov Identifier: NCT02483650
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #9 Appropriate use of Cellular Products for Diabetic foot ulcers and venous leg ulcers  Efficiency and Cost Reduction:

• This measure tests for many activities that MACs are assessing as they implement local coverage determinations on the use of cellular products for venous and diabetic foot ulcers. It is a composite measure that includes:
  • DFU off loading and VLU compression
  • Vascular assessment
  • Hemoglobin A1C control in diabetics
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• Data on USWR QCDR measures automatically becomes part of The US Wound Registry, https://clinicaltrials.gov/ct2/show/NCT02280733?term=Us+wound+registry&rank=1; ClinicalTrials.gov Identifier: NCT02280733
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #10 Vascular Assessment of Patients with Leg Ulcers: Effective clinical Care:

• Vascular assessment is required in order to be in compliance with the national coverage determination (NCD) for HBOT in DFUs.
• Vascular assessment is required in order to be in compliance with many LCDs for the use of cellular products.
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• This is the kind of measure that a wound care clinician should want to have publicly reported on Physician Compare as an indicator of their expertise in wound care and hyperbaric medicine.
• Data on USWR QCDR measures automatically becomes part of The US Wound Registry, https://clinicaltrials.gov/ct2/show/NCT02280733?term=Us+wound+registry&rank=1; ClinicalTrials.gov Identifier: NCT02280733
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #20 Nutritional Screening of Patients with wounds: Effective Clinical Care:

• Nutritional evaluation is required by the MACs implementing prior authorization for hyperbaric oxygen therapy and is being assessed by those MACs implementing prepayment review of HBOT.
• This measure can also be used by wound CENTERS to assess the effectiveness of care provided by a wound center.
• This is the kind of measure that a wound care clinician should want to have publicly reported on Physician Compare as an indicator of their expertise in wound care and hyperbaric medicine.
• This measure would seem to be an excellent choice for any healthcare system wishing to select wound care relevant measures that can be implemented across a variety of care settings.
• Data on USWR QCDR measures automatically becomes part of The US Wound Registry, https://clinicaltrials.gov/ct2/show/NCT02280733?term=Us+wound+registry&rank=1; ClinicalTrials.gov Identifier: NCT02280733
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #13 Vital Signs Prior to HBOT: Patient Safety:

• This measure is an excellent way to convey the commitment that programs have to the safety and quality of care of hyperbaric patients.
• This measure can be used by facilities undergoing UHMS facility accreditation to convey the commitment to quality and quality reporting.
• Data on all hyperbaric related measures become part of the National Hyperbaric Oxygen Therapy Registry, a registry jointly sponsored by the USWR and the Undersea and Hyperbaric Medical Society (UHMS) https://clinicaltrials.gov/ct2/show/NCT02483650?term=hyperbaric+oxygen+therapy&rank=41; ClinicalTrials.gov Identifier: NCT02483650
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

CDR #14 Finger stick blood glucose prior to HBOT: Patient Safety:

• This measure is an excellent way to convey the commitment that programs have to the safety and quality of care of hyperbaric patients.
• This measure can be used by facilities undergoing UHMS facility accreditation to convey the commitment to quality and quality reporting
• Data on all hyperbaric related measures become part of the National Hyperbaric Oxygen Therapy Registry, a registry jointly sponsored by the USWR and the Undersea and Hyperbaric Medical Society (UHMS) https://clinicaltrials.gov/ct2/show/NCT02483650?term=hyperbaric+oxygen+therapy&rank=41; ClinicalTrials.gov Identifier: NCT02483650
• Reporting this measure satisfies Objective #10, measure 3 of Meaningful use, which requires clinicians to submit data to a specialty registry

 

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Caroline Fife, MD
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