Radiology Quality Measure Compliance Reporting: an Automated Approach. 2016

Marc Kohli, and Duane Schonlau
University of California San Francisco-Radiology, 505 Parnassus Avenue M-391, San Francisco, CA, 94143, USA. marc.kohli@ucsf.edu.

As part of its ongoing effort to improve healthcare quality, the Center of Medicare and Medicaid Services (CMS) has transitioned from monetary rewards to reimbursement penalties for noncompliance or nonparticipation with its quality measurement initiatives. More specifically, eligible providers who bill for CMS patient care, such as radiologists, will face a 2 % negative payment adjustment, if they fail to report adequate participation and compliance with sufficient CMS quality measures in 2015. Although several methods exist to report participation and compliance, each method requires the gathering of relevant studies and assessing the reports for compliance. To aid in this data gathering and to prevent reduced reimbursements, radiology groups should consider implementing automated processes to monitor compliance with these quality measure standards. This article describes one method of creating an automated report scanner, utilizing an open source interface engine called Mirth Connect, that may facilitate the data gathering and monitoring related to reporting compliance with CMS standard #195 Stenosis measurement in Ultrasound Carotid Imaging Reports. The process described in this article is currently utilized by a large multi-institutional radiology group to assess for report compliance and offers the user near real time surveillance of compliance with the quality measure.

UI MeSH Term Description Entries
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D011787 Quality of Health Care The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. Pharmacy Audit,Quality of Care,Quality of Healthcare,Audit, Pharmacy,Care Quality,Health Care Quality,Healthcare Quality,Pharmacy Audits
D011871 Radiology A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease.
D012052 Reimbursement, Incentive A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered. Incentive Reimbursement,Pay for Performance,Incentive Reimbursements,Performance, Pay for
D006278 Medicare Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976) Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D058996 Quality Improvement The attainment or process of attaining a new level of performance or quality. Improvement, Quality,Improvements, Quality,Quality Improvements

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