On March 14, Thomas C. Barber, MD, chair of the American Association of Orthopaedic Surgeons (AAOS) Council on Advocacy; William R. Martin III, MD, AAOS medical director; and staff from the AAOS office of government relations met with officials from the Centers for Medicare and Medicaid Services (CMS) to discuss quality measures required under the electronic health record (EHR) adoption program and other reporting programs.

The meeting was an outgrowth of an AAOS comment letter drafted by the EHR Project Team that was submitted in response to draft recommendations for Stage 3 meaningful use for EHR adoption, set to begin in 2016. The AAOS representatives focused on two main concerns: the lack of orthopaedic-specific measures for quality reporting and the need for more specialty-specific meaningful use criteria.

During the meeting, Dr. Barber described how EHR should be integrated into orthopaedic surgery practices and expressed the AAOS’s willingness to partner with CMS in developing orthopaedic quality measures for inclusion in this and other reporting programs, such as the Physician Quality Reporting System (PQRS).

Kate Goodrich, MD, acting director for the quality measures and health assessment group in the Center for Clinical Standards and Quality at CMS, expressed enthusiasm for the partnership. “We are on the same page” with respect to quality measures and the proper role of EHR in physician practices, she told the AAOS representatives. She also agreed that quality measures should be performance-based and that process-based quality measures should only be used when performance-based measures do not exist or are not feasible.

EHRs for meaningful use
Dr. Barber indicated that the existing quality measurement development and endorsement process through the National Quality Forum (NQF) is expensive and time consuming. The CMS representatives acknowledged the challenges posed by the NQF endorsement process and indicated that the NQF also recognizes the challenges. NQF, they noted, is considering a redesign of its measurement development process that would provide for more feedback to stakeholders to aid them in the measure development process. Feedback for the measure concept and more flexibility in bringing forward measures to NQF are among the steps being considered.

The necessity of having relevant orthopaedic quality measures is of increasing importance to AAOS and its members. Stage 2 of meaningful use for EHR adoption is set to begin in 2014 with increased requirements. Based on CMS data on meaningful use as of March 2013, orthopaedic surgeons are among the highest adopters of EHR who meet meaningful use requirements. However, most physicians have not met meaningful use requirements, leaving considerable room to increase EHR adoption.

Looking ahead
The recent proposal to address the Medicare sustainable growth rate (SGR) formula by the House Ways and Means Committee puts new importance on quality measures. Any new physician payment system that replaces the SGR will likely include quality measures. Although nothing is certain in the current legislative environment, there is increased optimism that the SGR formula will be replaced in the near future.

The meeting between the AAOS and CMS to discuss EHR and orthopaedic quality measures was both necessary and timely. Clearly, Dr. Goodrich and other CMS officials appreciated the AAOS’s comments and look forward to continued dialogue on quality measure development and reporting. By all accounts, the meeting was successful and sets the tone for achieving an increased focus on regulatory advocacy.

For more information on AAOS advocacy activities, visit www.aaos.org/dc

To download an EHR meaningful use toolkit, visit www.aaos.org/emrtoolkit

Kevin Kwon is senior manager, regulatory and government relations, in the AAOS office of government relations. He can be reached at kwon@aaos.org