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0
Q

What are the 5 National Priorities for MU.

A
  1. Improve quality, safety, and efficacy of care while reducing health disparities
  2. Engage patients/families in their care
  3. Promote public/population health.
  4. Improve care coordination.
  5. Promote the privacy and security of EHR
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1
Q

CQM

A

Clinical Quality Measure

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2
Q

HIPAA

A

Health Insurance Portability and Accountability (1996)

Requires payors and Medicare to comply with EDI standards.

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3
Q

HITECH

A

Health information technology for economic and clinical health

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4
Q

ONC

A

Office of national coordinator for health information technology

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5
Q

What is the HITECH act?

A

2009 law signed under ARRA which created MU

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6
Q

What is Pay for Performance? (P4P) (Value-Based Purchasing)

A

A payment model that rewards healthcare providers for better health outcomes.

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7
Q

what are categories of care?

A

they align with the 5 national priorities

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8
Q

what does INTEROPERABILITY refer to?

A

Using technology to exchange key pieces of health information securely with a goal of obtaining the right information in the right context.

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9
Q

what are the ONC defined framework for a set of building blocks that support system interoperability?

A 
vocabulary and code sets
content structure
transport
security
services
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10
Q

CCHIT

A

certified commission for health information technology - independent, non profit with a public mission of accelerating the adoption of robust, interoperable HIT

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11
Q

Define MU

A

A qualification to receive federal funding for HIT (emr)

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12
Q

2015

A

Last year of eligibility to achieve MU incentives.

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13
Q

CAH

A

Critical Access Hospital

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14
Q

MU 2 - How long to meet requirements.

A

2 full years

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15
Q

Eligible hospitals vs Eligible professionals in schedule?

A

EPs = Calendar year

Hospitals and CAH = federal fiscal year

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16
Q

MU General requirements

A

Menu set + Core set of objectives specific to EPs or hospitals and CAHs

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17
Q

CMS MU specification sheet

A

Single sheet per objective:

  • Meeting the measure for each objective
  • How to calculate the numerator and denominator for each objective
  • How to qualify for an exclusion to an objective
  • In-depth definitions of terms that clarify objective requirements
  • Requirements for attesting to each measure
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18
Q

CQM requirements for EPs

A

Eligible professionals must report on 6 total clinical quality measures:

3 required core measures (or 3 alternate core measures) and
3 additional measures (selected from a set of 38 clinical quality measures).

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19
Q

what are the financing and insurance mechanisms for US healthcare?

A

Private: Employer-based or Privately purchased insurance
Public: Government Programs
1. State Employees
2. MC (elderly and certain disabled)
3. Medicaid and CHIP (indigent poor/children)

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20
Q

NHI (national health insurance) example

A

Canada, Great Britain

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21
Q

NHI Description

A

Government finances through taxes but care is rendered by private providers.

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22
Q

Socialized Health Insurance Examples

A

Germany, Israel, and Japan

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23
Q

Socialized Health Insurance description

A

Financed through government-mandated employer/employee contributions and delivered by private providers.

Government has overall control.

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24
What is an HIE
a network that shares EHRs across a community
25
What are the benefits of an HIE?
1. Reduce duplicate test orders. 2. Avoid adverse drug interactions. 3. Reduce time spent looking for records.
26
4 data types of an HIE
1. Lab results 2. Meds data 3. Allergy data 4. ED discharge summaries
27
HIE Main Standards
``` HL7 SNOMED ICD9/10 CPT LOINC RXNorm ```
28
what does PACS stand for?
Picture Archiving and Communication System
29
What does PACS do?
$$$$$ Stores images from different modalities, indexes them for fast retrieval, has its own db plus metadata, and allows for transfer of images to different network locations. Multiple site/Simultaneous access.
30
Example of an analog imaging modality
plain film/fluroscopy/ultrasound/angiography
31
Example of digital imaging modality
MRI/CT
32
CT xray
digital, sliced xray images like a loaf of bread, shows structure only
33
Xray
Short, tight wavelength, one slice image
34
PET
Positron emission Tomography - uses gamma rays | measures body functions like metabolism of an organ, blood flow, O2 use
35
MRI
Uses magnets, radiowaves, and computer. no radiation.
36
DICOM
Digital Imaging and Communications in Medicine
37
EDI
Electronic Data Interchange
38
HIPAA 5010
New standard set around a billing transaction foundational to ICD-10 coding standards.
39
Mapping ratio of ICD9 to ICD-10
One ICD-9 code can map to 100 ICD-10 codes.
40
ICD-10 Code structure
Category - Etiology - Extension Code
41
What is E&M?
Evaluation and Management
42
How many levels of E & M are there?
4
43
What are the 3 components of an E & M code?
1. History 2. Examination 3. MDM
44
NCQA
National Committee for Quality Assurance
45
HEDIS
Healthplan Employer Data and Information Set
46
What does HEDIS do?
71 measures comparing the quality of care between different health plans.
47
How does an INTERFACED SYSTEM work?
Separate software and databases linked to a computer network and exchange information with other HC Systems. Can be from different vendors.
48
How does an INTEGRATED SYSTEM work?
Shared common database. Same Vendor.
49
RAC
Recovery Audit Contractors
50
What is the purpose of an AGING REPORT?
To monitor Accounts Receivable.
51
PCE
Partially Compensable Event
52
What is PCMH stand for?
Patient-Centered Medical Home
52
What is a PCMH?
A patient-centered medical home is a way of organizing primary care to emphasize care coordination.
52
What does NCQA do?
This private, not-for-profit organization provides programs and services to improve care quality through quality standards and performance measures.
52
How is NCQAs performance measured?
Statistics that track quality of care as delivered by the nation's health plans.
52
What is the MEDICARE PAYMENT ADVISORY COMMITTEE?
A group of experts that advise Congress.
52
What drove many of the recent doctor-hospital mergers?
Medicare's disparate pay policies.
52
What is VBR?
Value-Based Reimbursement.
53
What is Wellcentive's population health management technology?
* Cloud-based, scalable, customizable technology and services. * For providers, health organizations, and payers * To help measure and report performance toward VBR (value-based reimbursement).
54
In Value-Based Payment, what does VALUE equal?
Value = Quality/Cost

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