AQC (BCBS OF MASS ACO ALTERNATIVE QUALITY CONTRACT) CANCER CENTER
WELL-CHILD VISITS
CLINICAL TRIALS
MU CQMS, INPATIENT & OUTPATIENT STAGES I + II (GOV’T CERT)
SPINE
ASTHMA
STROKE
DIABETES
VALUE BASED PURCHASING
medCPU ADVISOR™
RADIOLOGY
OBSTETRICS
INPATIENT-ONLY PROCEDURES
VTE PROPHYLAXIS
ICD-10
READMISSIONS REDUCTION
NUTRITION
CHF
IMMUNIZATION
COMPLETE JOINT REPLACEMENT (CJR)
COPD
COLORECTAL & BREAST SCREENING
A single solution for your enterprise-wide decision support n medCPU Advisor | Expanding Suite of Customized Clinical Modules ›› Delivers precise decision support, in real-time, at the point of care ›› Customized to your organization’s best practices ›› Incorporates national and international standards for care
OBSTETRICS
Assesses, treat and manage a broad spectrum of low- and high-risk pregnancies, starting with outpatient pre-natal care and continuing through delivery and post-natal care. Utilizing ~4,200 protocols and ~800 pages in the medCPU Advisor™ Obstetrics Rule Book, the module improves compliance with guidelines from the American Academy of Obstetrics and Gynecology, the American Board of Obstetricians and Gynecology, the Centers for Medicare & Medicaid Services, and other institutions.
RADIOLOGY
Assists clinicians in complying with the CMS imaging utilization guidelines, by prompting providers at the point of ordering when imaging selection for the specific clinical case is not in accordance with a unique compilation of CMS Appropriate Use Criteria (AUC), other industry accepted best-practices and the organization’s specific imaging utilization guidelines.
STROKE
Improves patient care and safety during acute and subacute phases of stroke, and target reductions in readmissions by validating proper discharge procedures in the ER and inpatient settings. The module follows an organization’s best-practice guidelines and stroke quality measurements required by the Centers for Medicare & Medicaid Services. Developed in collaboration with the American Heart Association, the American Stroke Association, the Brain Attack Coalition, and other governing boards, the module includes ~800 protocols and rules from the medCPU Stroke Rule Book.
VTE PROPHYLAXIS
Monitors compliance with an organization’s guidelines and protocols for Venous Thromboembolism prevention and treatment. The module follows six VTE Prophylaxis measures endorsed by the National Quality Forum, aligned with Centers for Medicare & Medicaid Services, and used in the Joint Commission’s ORYX hospital accreditation program.
CHF
Tackles the problem of 30-day readmissions, in-hospital adverse events and mortality of patients with congestive heart failure. medCPU’s CHF module ensures adherence with the New York Heart Association Functional Classification and guidelines established by the Centers for Medicare & Medicaid Services for proper diagnosis, evaluation and management of patients in outpatient and inpatient settings.
COPD
Provides appropriate early treatment and proper outpatient care to COPD patients by providing decision support that aligns treatment with Prevention Quality Indicator scores. Implementing PQI metrics can lead to better community health care and reductions in hospital admissions.
DIABETES
Assists in point-of-care compliance with Diabetes care pathways by providing associated best practice decision support in the broad spectrum of inpatient and outpatient settings.
IMMUNIZATION
Assists clinicians with guidance on pneumococcal vaccination in the outpatient setting by flagging risk factors and finding the right vaccine based on a patient’s vaccination history.
CANCER CENTER (ONCOLOGY)
Assesses, treat, and manage cancer patients across all service lines and disposition, in accordance with guidelines from the National Cancer Institute, the Centers for Disease Control and Prevention (CDC), and other institutions.
needs: one platform + customized evidence-based modules NUTRITION
Provides early identification of nutrition issues that impact disease, therapies and recovery. The module aids physicians and nurses in identifying patients in need of dietary help, allocates patients in need of a dietitian consult, and prompts clinicians to prepare blood work needed prior to a dietitian visit. The module incorporates best practice guidelines outlined by the Centers for Disease Control and Prevention, including strategies to help improve patient acuity based on nutritional status and better utilize nutritional assessments in the organization.
CLINICAL TRIALS
Helps the Organization and providers identify and select appropriate candidates and followup throughout the entire trial so protocols are followed correctly, including adherence to guidelines specific to the U.S. Department of Health and Human Services notice of proposed rule-making (NPRM) describing proposed requirements and procedures for registering and submitting trial results, adverse events, and more.
SPINE
Addresses issues of red flag identification, proper analgesics treatment, physical therapy, steroid use, and adequate use of imaging during the acute phase of back pain in outpatient and inpatient settings. The module utilizes guidelines from the American Neurological Surgeries Association, the Centers for Medicare & Medicare Services (CMS) and other governing bodies. In 2017, the module will include eight additional CMS codes, in accordance with the International Society for the Advancement of Spine Surgery.
COLORECTAL & BREAST CANCER SCREENING
Ensures patients receive necessary screenings for breast cancer and colorectal cancer in outpatient settings. The module assists providers in complying with guidelines established by the Centers for Disease Control and Prevention and those recommended by the U.S. Preventive Services Task Force.
WELL-CHILD VISITS
Provides guidance for appropriate and thorough exams in the outpatient clinic setting, including testing and nutrition in accordance with Centers for Disease Control and Prevention recommendations and guidelines from the American Academy of Pediatrics.
ASTHMA
Confirms diagnosis of asthma, assess quality of symptom control and select plans of care, including recommendations on steroid treatment, whether to admit patients and prevention of readmission. As the mainstay of asthma management remains pharmacotherapy, the module helps in recommendations regarding the most appropriate medication and possible drug interactions.
ILÚM Insight - Infectious Disease Modules Currently being piloted and delivered in partnership with ILÚM Health Solutions
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ANTIMICROBIAL STEWARDSHIP*
Supports the core prospective audit strategies for antimicrobial stewardship, including helping to reinforce opportunities for intervention such as bug-drug mismatch, IV-PO conversion, de-escalation, use of targeted antibiotics, and redundant therapy avoidance.
PNEUMONIA*
Assists in point-of-care compliance with Pneumonia care pathways by providing associated best practice decision support in the broad spectrum of inpatient and outpatient settings.
URINARY TRACT INFECTIONS*
Promotes recognition and appropriate intervention for patients with urinary tract infections based on institution-specific care pathways by delivering point-of-care decision support to clinicians.
SEPSIS*
Promotes early recognition and intervention for sepsis based on institution-specific care pathways for Sepsis by providing point-of-care decision support to clinicians in the ER, MedSurg and ICU settings. The solution supports adherence to established protocols, including key elements of the 3 and 6-hour sepsis bundles. *Infectious Disease modules from ILÚM Health Solutions (powered by medCPU) are not yet commercially available
medCPU
medCPU Advisor | Expanding Suite of Customized Compliance Modules ICD-10
Reduces deficiencies in documentation associated with incorrect ICD-10 coding. Through precise prompting in real time, the module ensures correct diagnoses by guiding clinicians through appropriate and thorough documentation of the complete clinical case. The module is updated to include 2017 ICD-10-CM information on the ICD-10-CM updates for FY 2017. These 2017 ICD-10-CM codes are used for patient encounters and discharges occurring from October 1, 2016 through September 30, 2017.
INPATIENT-ONLY PROCEDURES
Minimizes financial losses by helping clinicians ensure accurate identification of inpatient-only procedures. The module prompts in real time in pre-op setting, and in the post-op if the nature of the surgery changes during the procedure requiring a change in the patient class. With more than 1,700 CPT codes for inpatient-only procedures, hospital coders may not be aware what the Centers for Medicare & Medicaid Services consider an inpatientonly procedure.
COMPLETE JOINT REPLACEMENT (CJR)
Meets the required bundled payment and quality measurements for care related to hip and knee replacement, as required by the Centers for Medicare & Medicaid Services. The module’s coding and protocols align with improving quality and costs of care for CJR surgeries aligned with the CMS bundled payment program by encouraging hospitals, physicians, and post-acute care providers to work to improve the quality and coordination of care from initial hospitalization through recovery.
VALUE-BASED PURCHASING
Adheres to Medicare’s Clinical Process of Care VBP Measures by prompting clinicians when non-compliance is identified. The module includes the Hospital VBP Program’s 8 quality measures that hospitals report to Medicare via the Hospital Inpatient Quality Reporting (IQR) program. The measures are in 5 clinical areas that Medicare is focused on improving through better care and containment of costs.
READMISSIONS REDUCTION
Addresses readmission reduction goals enterprise-wide with decision support before and during the first 30 days post-discharge for acute myocardial infarction, heart failure and pneumonia.
MEANINGFUL USE CQMS, INPATIENT AND OUTPATIENT, STAGES I + II (GOVERNMENT CERTIFICATION) Achieves the Meaningful Use (MU) Clinical Quality Measures (CQM) for inpatient (ie, stroke, VTE) and outpatient (44 CQMs) settings. The module can be customized to an organization’s best practices and is based on guidelines from the Centers for Medicare & Medicaid Services used to determine if providers qualify for payments for stages I and II MU and standards for safe and efficient care.
ALTERNATIVE QUALITY CONTRACT (AQC) (BCBS OF MASS ACCOUNTABLE CARE ORGANIZATIONS) Assists providers in meeting Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC) Measures, as part of the BCBS ACO contracts with providers. The module enables clinicians to remain aligned with AQC, which has been shown (New England Journal of Medicine, 2014) to improve quality of patient care and to lower costs.
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