Regulatory Compliance Made Easier with CDQM and CDeQM

Anil Konur
Head of IBM Watson Health Enabled Solutions
Article

Each day, healthcare organizations and hospitals confront the formidable task to comply with a growing amount of federal regulations in the U.S. The American Reinvestment and Recovery Act (ARRA) and the Health Information Technology for Economic and Clinical (HITECH) Act of 2009 has changed how healthcare is delivered and measured by tying it with technology, efficiency, quality of care, and the financials around incentives and reimbursements. Overnight, dozens of software companies started their mission to help providers and hospitals solve the challenges associated with adhering to these regulatory acts. Almost 10 years later, there are a few companies that account for most of the market share.

As an organization continues to mature, it’s critical that they regularly review their tools to ensure they are efficient and cost effective for their constantly changing business processes.

Strong compliance programs essential to improve healthcare

As part of the regulatory acts, the Center of Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) are the organizations that define the federal regulatory requirements and hospital accreditation standards, respectively.

These regulations and standards guide hospitals in delivering safe, high-quality care for their patients. Managing regulations requires hospital staff, nurses, and doctors to devote more time for regulatory compliance rather than their primary focus on patient care. This results in an increase in cost.  In fact, the healthcare industry spends about $39 billion annually on the administrative facets of regulatory compliance with an average-sized hospital accounting for nearly $7.6 million annually.

Partly, the increased costs result from inconsistent and repetitive efforts across departments and functions in a healthcare ecosystem. Therefore, it’s imperative for hospitals to invest in, and to implement effective quality and compliance initiatives to meet their regulatory requirements and optimize cost.

What Is Measured

  • Electronically Reporting Clinical Quality Measures (eCQMs): A set of measures based on the data received from EHRs, that’s used to measure healthcare quality as per the requirements in the CMS quality program. They are updated annually by the CMS based on changes in evidence-based medicine, code sets, and measured logic.
  • Clinical Quality Measures (CQMs): These measures assess if the healthcare system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. CQMs measure many aspects of patient care, including patient and family engagement, patient safety, care coordination, population/public health, efficiency of healthcare resources usage, and clinical process/effectiveness.

Enabling Providers – My View

The use of the appropriate technologies can positively impact the entire ecosystem by helping hospitals to provide high quality of care and save on cost. If used and implemented correctly, it can provide business process efficiencies that can help hospitals improve patient care at the time of episode.

Virtusa, with IBM Watson Health, has a solution to help. We offer a robust compliance and reporting solution for hospitals that can help them more successfully with their regulatory requirements and their delivery of patient care, all while optimizing costs that can otherwise be substantial. Interested in knowing more about the offerings? Learn more here.

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