Tuesday, 29 May 2012 08:39

A word about Clinical Quality Measures (“CQMs”)

Written by  Admin

There are times and places we can all remember when the smallest detail made the biggest difference.  This is the thought I have when I think about Clinical Quality Measures.  As defined by CMS, “A clinical quality measure is a mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal timeframe.” Among the reasons why these measures are important to CMS, “CQMs help identify areas that require improvement in care delivery, identify differences in care among various populations, and may improve care coordination between health care providers.” [i]

The irony is that CQMs have a very small role in Meaningful Use Stage 1: CQMs do not have any bars to jump.  All that is required is data on these measures be reported.  CQM numbers, or lack thereof, do not affect incentive payments and are generally not the first topic discussed when the Meaningful Use Measures are discussed – but oh are they making a big difference!


While physicians are busy documenting their patient visits, technology is at work in the background amassing structured data that will become evident when reports are generated.  CQM data appears on dashboards, in the form of percentages with numerators and denominators highlighting information that was not consciously checked by the physician as he went about his task of charting patients.

Take for example, Clinical Quality Measure NQF0064.  This is a two-part report to measure Diabetes:  Management and Control.  The measure is to report on the percentage of patients 18-75 years of age with diabetes (type 1 or type 2) whose LDL–C is less than 100mg/dl.  In general terms, we are looking to identify type 1 and type 2 diabetic patients whose cholesterol is in control.  While the doctor is busy charting his patients, the EHR is collecting information on patients that fit a certain criteria.  In this case, this particular CQM has two numerators and one denominator – I say one because the denominator is going to be the same for both numerators.   The denominator then, is going to be all patients seen by the provider once during the reporting period who have type 1 or type 2 diabetes.  Numerator number one is going to be, out of this number (denominator), count 1 for each patient that had an LDL test recorded during the reporting period.  The second set of numbers, same denominator as above but the numerator here is going to be all the patients in the denominator whose last LDL-C test result, within the reporting period, was less than 100 mg/dl.  Patients that fit the criteria, but have extenuating circumstances that will exclude them, are also tracked.  The numerators and denominators are then compiled into Meaningful Use Dashboard reports generating percentages of patients who are in control and blatantly pointing at all those who are not.

When the MU dashboards are examined, many practices are finding that their percentage of diabetic patients whose cholesterol levels are specifically outside of the control range is high.   Physicians are examining the data and looking over the numbers and becoming alarmed.  “No, it is not possible,” said one physician recently.  “I know all my diabetic patients are in control,” yet the data spoke loud and clear.  This practice has a very high number of diabetic patients with an LDL-C > 100Mg/dl.

Armed with this knowledge, the physician is able to channel resources in an area that will make a difference.  He can identify the problem: “I have too many diabetic patients whose cholesterol measures are out of range,” target the problem, and works towards a solution by using the certified EHR to run reports on all of his diabetic patients who are out of control.  Those who show up and have not been in for an office visit are added to a recall list to be contacted and brought in for a visit.

More and more often, as physicians take the time to interpret the numbers on their dashboards, they are responding to the meaning behind the numbers.  They are looking at their practice in perhaps a new way -- the numbers are proving meaningful to the practices themselves.

This is a win-win:  patients are receiving more focused care and practices are generating income by bringing in patients who have not made or kept appointments within a specified time. This is “Meaningful Use”.