The Health Measures module assists providers to promote best practices related to improving their patients' health. The measures, benchmarks, and decision support statements are based on Quality measures published by nationally recognized organizations such as the Centers for Medicare & Medicaid Services (CMS) or the National Quality Forum (NQF). NextGen® Office uses coding performed by the provider and/or data captured within EHR to match the metrics of the Quality measure to the treatment provided for a specific patient.
This module also facilitates the reporting of electronic clinical quality measures (eCQMs) to third parties such as CMS. For many providers, Quality reporting has been a retrospective process. The Health Measures module enables a real-time process, which can happen when the patient is in the exam room.
To learn how to use the Health Measures module to improve your patients' health or manage MIPS Quality measures, refer to Health Measures.
Contents
Quality Measures
Denominators
Numerators
Exclusions and Exceptions
Due Date and Performed Date
Inverse Measures
Common Questions
Quality Measures
Enroll in Quality measures that are appropriate for your practice in Administration: EHR Reporting and Quality Measures. Enrollment is required because not all measures apply to every practice type.
When a provider chooses a performance period for tracking Quality measures, these eCQMs are managed using the Health Measures module and eventually aggregate reporting on each measure. Measures can be viewed in human-readable format or exported as a QRDA file in Quality Reporting.
Standard Measure Changes
NextGen Office EHR does not support user changes to the standard measurement metrics. NextGen Office does not define standard metrics (for example, the ones used by CMS) either. The metrics are based on published national standards. By conforming to these standards, it makes it easy for the provider to combine reporting Quality measures and real-time health measures with decision support.
Denominators
Quality measure calculations work on a numerator/denominator basis. The denominator helps to identify all of the patients who should be included for a measure and screened for the numerator criteria.
When possible, Health Measures indicates if a patient meets the denominator set defined by the measure and also tries to discover whether the patient meets the numerator criteria. If the patient does not meet the denominator criteria for a measure, the system does not calculate a numerator value and the system will not show the measure on the Health Measures page.
Numerators
There are three ways that numerator values can be created for a patient who meets the denominator set for a specific measure.
- You are prompted to enter a value in a module that is related to the measure.
- Example: You are prompted to enter smoking status in the Social History module. Entering data in a module related to the measure reduces work for you so that you do not have to enter data in both Health Measures and the patient chart.
- Data is extracted from a module and presented in Health Measures.
- Example: You are enrolled with an electronic lab that sends LOINC codes and the latest values are populated automatically in Health Measures.
- You can enter data into a form in Health Measures. This advanced feature prompts the user to choose a value to populate the numerator. This method makes health measures easy for measures where it would not be likely the user would code or enter the data in a machine-readable format consistent with the measure author’s definition of the numerator.
- Example: CMS125: Breast Cancer Screening
It is unlikely that every provider who screens for breast cancer by checking the status of a recent mammogram is the ordering or rendering provider and, therefore, NextGen Office would not see a code that matches the numerator definition.
Note: The system does not add the code to the patient chart (for example, if an appropriate numerator code is an x-ray, the system does not add that code to the orders list).
Exclusions and Exceptions
Some measures support one or more exclusion reasons. Exclusion means that there is a documented reason why the patient did not meet any of the numerator values. Exclusion reasons, when available, are shown in Health Measures. Not every measure is codified for exclusion. Some measures can be manually marked for exclusion in Health Measures and others rely on a code used as part of the patient’s health record. If an exclusion and a measure-related numerator are both in context for the purposes of reporting, we default to the medical exclusion. If a medical exclusion is selected and the reporting matrix supplied by the Quality program entity does not include a medical exclusion, the system may not report a numerator. Creating an exclusion turns off reminders and marks the measure as passed.
Due Date and Performed Date
The system calculates a due date based on the specific measures’ requirements. Some measures are yearly, some are longer than one year, and some may depend on one or a set of treatments or orders performed by the provider. It may be that a provider is trained to measure a value more frequently than the system mandates. For example, CMS22: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented may only require reporting once per year, but a provider for a diabetic patient may feel it is medically indicated to check the blood pressure more than one time per year. The system is based on the measures’ frequency per the published measure guidelines, but the provider can set reminders manually in Health Measures to remind them to repeat a measure more frequently.
If a value related to a measure is repeated during the reporting period, the last value recorded for the patient is the value that is reported in any exported file.
The last performed date is the last date that the system has recorded that a valid value for the measure has been documented. If the performed date is on or before the due date, the measure is considered passed. By default, unless the measure calls for a specific date (for example, flu vaccine due in September – beginning of flu season) the system will set the due date as January 1 of the reporting year if the system does not have a prior performed date. If the user changes or updates the due date, the system compares the due date with the measure’s frequency and reports appropriately.
For more information about entering numerator data or the performed date, refer to Health Measures.
Inverse Measures
An inverse measure is a measure where the numerator value equates to poor clinical quality or higher resource use. For measures with inverse performance logic, a lower performance rate indicates better performance. A zero performance rate for these measures is a good score. Not meeting the performance numerator is the clinically recommended outcome or quality action. If a value for a test or order is suboptimal from a medical perspective, but the measure has been addressed (a valid numerator has been assigned to the measure), the measure is considered passed.
Example
The numerator criteria for CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) is all patients with a HcA1c value >9%. The measure is considered passed if the value is less than the numerator value defined by the measure author since that equates to better care.
Supported Inverse Measures
- CMS75: Children Who Have Dental Decay or Cavities
- CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
- CMS156: Use of High-Risk Medications in Older Adults
Common Questions
Why is there a difference in denominator values between the Health Measures module and the Quality program reporting?
Many Quality measures include an encounter procedure code (e.g., E/M code) as part of the denominator value set. For reporting purposes, the system must check whether an encounter code is part of the denominator calculation. For the purpose of prompting providers for Health Measures reminders, NextGen Office does not include the encounter code value as part of the denominator criteria. This means that even if you do not code, for example, an E/M code, for a visit, the Health Measures module still reminds you about the measure if the patient meets the other denominator values.
Example
If a hypothetical measure denominator set was:
- All diabetic patients based on ICD-10 codes in the Problem List
- All diabetic patients based on active medications that are used to treat diabetes in the Medication List
- All diabetic patients who also have the following encounter codes: 99211, 99212, 99213, etc.
The application would show a reminder for this patient in Health Measures even if an encounter code was not used, but the patient would not be included in the QRDA file. The theory is that the provider should have the opportunity to provide health measures regardless of what procedure code they use to document the encounter.
Why does the patient not show in the numerator in the QRDA file when Health Measures indicates that they are passing the measure?
There are times when the latest value shown in Health Measures is passing yet the QRDA file does not show the patient in the numerator. There are two common reasons why this may occur:
- The measure is an inverse measure.
- The patient passed the measure after the measurement period for the quality reporting program ended.
See Also:Health Measures
