More hospitals reporting eCQMs

Just 34 hospitals voluntarily submitted electronic clinical quality measure (eCQM) data to the Joint Commission in 2015. For 2016, the number reporting skyrocketed to 436 hospitals, according to the commission’s annual report.

Hospitals accredited by the Joint Commission could select and report performance data on 23 different eCQMs in eight measure sets in 2016. The goal was to align requirements “as closely as possible” with CMS’s Hospital Inpatient Quality Reporting Program. According to surveys of accredited hospitals, most facilities were aware of the requirements and were ready to report to CMS this year.

“In 2017, we expect that the number of reporting hospitals will increase to more than 2,000,” the report said.

The required reporting of eCQMs has been controversial. The American Hospital Association asked CMS to suspend the measures earlier this year as part of a deregulation push by the new administration, with the AHA arguing eCQMs “do not accurately measure the quality of care provided.”

According to the Joint Commission’s own surveys, however, hospitals were more willing to voluntarily report on the measures before it was required by CMS and more confident about the accuracy of their eCQM data. They also reported increased physician engagement, with one hospital saying 90 percent of its eCQM data elements were documented by physicians.

“Hospitals that voluntarily shared information with the Joint Commission over the past year are helping the entire industry move forward by showing others how to utilize electronic clinical quality measures to improve care and ultimately achieve better health and save lives," said David W. Baker, MD, MPH, the commission’s executive vice president of healthcare quality evaluation.

The majority of hospitals (314, or 66.7 percent of those reported) submitted two eCQM data sets in 2016, and 109 (23.1 percent) submitted one data set. Only 10 hospitals submitted four or more. The most common measure sets were those for the emergency department, called eED, venous thromboembolism (VTE) and stroke (STK), which are the eCQMs hospitals have been reporting for the longest time.

On individual measures, the most commonly reported were the two ED measures dealing with how long patients spending waiting and being treated in the emergency room:

• 270 minutes was the average time admitted ED patients spent in the department from arrival to departure, according to more than 660,000 records submitted by 403 hospitals.
• 60.5 minutes was the average time admitted ED patients spent in the department from the time of the admit decision to departure.

Despite the increased adoption of eCQMs—and the expectation that trend will have continued in 2017—hospitals did say the reporting could be made more efficient by completely aligning Joint Commission measures with what has to be reported to CMS.