Clinical Quality Measures Management
SCG Core Value 3
Maintain a Sense of Urgency: Maintaining a sense of urgency equates to getting things done with efficiency. By approaching each idea and task with fresh enthusiasm and a motivation for progress, we keep both energy and productivity at high levels.
Healthcare Performance Measurement and Quality Improvement
Currently, we are in the midst of a measurement revolution in healthcare, and Signature Consulting Group (SCG) is proud to be at the cutting edge of this effort as the Physician Quality Measure Management (PQMM) and Center for Medicare and Medicaid Innovation (CMMI) Quality Management Data Collection contractor.
SCG integrates and manages Clinical Quality Measures (CQMs) and eMeasures in Health IT system in the tracking of the quality of healthcare services. SCG conducts Physician Quality Measurement Management (PQMM) and stewardship of CQMs used for Accountable Care Organizations, Meaningful Use, and Value Based Modifiers.
Physician Quality Measure Management (PQMM)
As the PQMM contractor, SCG leads a diverse and experienced team that facilitates creation, maintenance, and retirement of clinical quality performance measures specific to healthcare delivered by Physicians. These 250+ measures serve as the basis of the Center for Medicaid and Medicare’s Physician Quality Reporting System (PQRS).
Working with measure owners and stewards, SCG develops performance measures ideas into precise, evidence-based measure specifications, which clearly describe the data to be captured and how the measure is calculated. We facilitate this process throughout all of the stages, starting with the initial idea, to the measure development, followed by public comment and review, and ultimately through to the rule making and measure finalization process. By collaborating with medical societies, stakeholder groups, and patient advocates, we are able to create measures that rigorously measure the broad spectrum of clinical care delivered by physicians.
Measure specification include:
- Measure Description: an overview statement describing the measure.
- Numerator Statement: a precise statement of the quality parameters delivered
- Denominator Statement: a precise statement of the eligible population for the service.
- Coding guidance (ICD 9, ICD 10 & CPT coding for measure definition)
- Exclusion criteria – guidance on individuals that should be excluded from the denominator population
- Exception criteria – guidance on when individuals should be included in the numerator in exceptional circumstances
Physician Quality Measures are developed and codified though the rule-making process. SCG facilitates ad hoc updates (when the clinical guidance on which a measure is based changes), annual updates, and comprehensive tri-annual reviews of measure specifications to ensure that measures are up to date, evidence-based, and valid. As the standards of clinical practice change and measures top out (high performance with low inter physician variance), measures must be retired in order to ensure that PQRS is driving improvements in healthcare delivery. As the PQMM contractor, we facilitate the process of retiring measures and keeping CMS’s entire PQRS and CMMI measurements current and state of the art. Due to the complexity of performance measurement, there is a great need to respond efficiently an accurately to inquiries from the regulated community and stakeholder community.
Our PQMM Help Desk answers over 2000 inquiries annually regarding measure specifications and compliance with PQRS guidelines. As the PQRS moves from a reporting-based system to a performance-based systems in terms of CMS payment, the importance of the validity of the measures in the PQRS system will become paramount.
Clinical Performance Measure for Care Delivery Improvement
SCG is proud to play a vital role in ensuring the validity of these clinical performance measures, which will inform and impact all Federal Healthcare management spending and CMMI incentive payments. SCG realizes that the purpose of clinical quality measurement is to provide practitioners feedback on their performance; thus, allowing them to change care processes and gauge the impact of those changes for either improvements or detractors. Team SCG is committed to developing quality improvement tools, strategies, and systematic approaches to the care delivery associated with each clinical performance measure; thereby, allowing practitioners to improve their care delivery processes and clinical performance.