In this episode of Ask Dr. Mingle, Dr. Dan Mingle explains eCQMs, MIPS CQMs, Digital Quality Measurement, and the differences between the three.
The questions in this episode came from the NAACOs 2022 Fall Conference, where Dr. Mingle and colleagues gave a presentation on the APP Transition and MIPS CQMs.
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Question One: eCQMs
Patricia asks: “What is an eCQM?”
- eCQM stands for “Electronic Clinical Quality Measure,” and the specifications for eCQMs are exclusively electronic.
- eCQM specifications are published in coding language to be automatically inserted into any quality management software. Although in many cases, these specifications are read by developers and interpreted before creating a custom insertion into their software.
- Besides an electronic pathway, there is no other way to collect the data required to calculate an eCQM.
- eCQM submissions must be produced with end-to-end certified software.
- “End-to-end” means that once the data is collected from a patient, it’s documented in an EHR, then calculated and aggregated through an automated process. There can be no manual chart abstraction or correction of data or scores in the process.
- eCQM submissions can be uploaded to CMS by the practice, by the eCQM vendor, or by a qualified registry.
- Certification standards of entities involved in the extraction and calculation of eCQMs are set by the Office of the National Coordinator of Health IT.
- Typically, eCQM submissions require strict compliance with a specific documentation workflow. Deviation from the specific workflow often diminishes performance.
Question Two: MIPS CQMs
John asks: “What is a MIPS CQM?”
- A MIPS CQM is a Clinical Quality Measure designed for use in CMS’s Merit-Based Incentive Payment System (MIPS).
- Specifications for MIPS CQMs are typically provided in natural language. The qualified registries that use and submit these measures tend to interpret these specifications into processes in their software.
- CMS sets the requirements for qualified registries, and CMS does the initial qualification and maintenance of that qualification.
- Data for MIPS CQMs can come from any valid source, an EHR, an electronic registry, or even a paper chart. The data can be manually or electronically abstracted – but it must come from a valid data source.
Question Three: Differences Between eCQMs and MIPS CQMs
Liz asks: “What’s the difference between an eCQM and a MIPS CQM?”
- eCQMs are collected from EHR data and calculated using ONC-certified technology.
- MIPS CQMs are collected from any valid data source, including EHR data, and are calculated by a qualified registry.
- There are some crucial distinctions to clarify between the two as they relate to the APM Performance Pathway (APP) submission workflow:
- eCQMs tend to be exclusive: they can be EHR-exclusive, documentation workflow-exclusive, and even exclusive to a specific instance of an EHR.
- MIPS CQMs tend to be inclusive: they can cast a broader net to accommodate multiple EHRs, documentation styles, alternative data sources, and manually generated or manually abstracted data.
Question Four: Digital Quality Measurement
Joan asks: “What is Digital Quality Measurement?”
- CMS introduced this term in the rulemaking process for the 2022 Performance Year.
- Although there hasn’t been additional usage of the term in official rulemaking since it was introduced, a spokesperson for CMS did clarify some confusion about the term at the NAACOS Fall 2022 Conference.
- During a session called “The Transition to eCQMs: Multistakeholder Round Table Discussion”, a spokesperson for CMS described the concept as signaling an intention to embrace quality measurement that incorporates a wide variety of digital sources, not just EHR data. These digital sources could include remote patient monitoring, wearable technology, and direct patient input technology.
- Currently, this is not a measure type like eCQMs or MIPS CQMs.
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As the Web Interface sunsets, ACOs must prepare to transition into the APM Performance Pathway (APP) reporting method by Performance Year 2025. For many ACOs, this task is daunting - with data challenges, technical hurdles, and a completely new reporting workflow. To help with this, we've created the APM Performance Pathway Checklist - a two-page resource to assist your organization in understanding and preparing for this challenge.