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E-QUAL Network FAQ

General

What is the Emergency Quality Network (E-QUAL)?

Emergency Quality Network (E-QUAL) is a collaborative-driven, practice change network tailored to the unique environment of emergency medicine. It is designed to achieve higher quality patient outcomes at lower cost by creating and accumulating meaningful tools targeted at emergency clinicians and quality improvement leaders to advance local quality improvement efforts focused on high-impact areas that demonstrate the value of emergency care.

EDs participate in a virtual learning community by joining a learning collaborative offered annually focusing on a single clinical topic. Each learning collaborative has up to a 9-month learning period in which the ED champion interacts with the E-QUAL virtual portal to report on local quality improvement activities. Activities include completing the online portal activities, engaging eligible providers in the QI local project, utilizing the educational toolkits, webinars, podcasts, and submit benchmarking data.

What is the mission of the ACEP E-QUAL Network?

To engage emergency clinicians and leverage emergency departments to improve clinical outcomes, coordination of care and to reduce costs.

What benefits will the learning collaboratives provide to participating sites?

  • Earn Improvement Activity Credit for the CMS MIPS program
  • Receive benchmarking data in real time
  • Feature QI efforts to hospital leaders and payers
  • Gain access to toolkits including best practices, sample guidelines and key talking points
  • Access to high-quality eCME
  • Earn ABEM MOC Credit (LLSA and Part IV Activities)
  • Visibility through the E-QUAL Honor Roll

What is CEDR?

The Clinical Emergency Data Registry (CEDR) is a CMS Qualified Clinical Data Registry (QCDR) designed to accept data from practicing emergency clinicians in order to:

  • Provide a unified method for ACEP members to collect and submit quality data
  • Meet Physician Quality Reporting System (PQRS) reporting requirements
  • Earn MOC, Ongoing Professional Practice Evaluation (OPPE) credit
  • Promote the highest quality of emergency care for our patients
  • Demonstrate the value of emergency care
  • Facilitate appropriate emergency care research

Visit www.acep.org/cedr for more information

Do you have to participate in CEDR in order to be enrolled into the ACEP E-QUAL learning collaboratives?

No. Participation in CEDR is not a requirement to enroll/participate in the learning collaboratives. However, participating in CEDR can eliminate manual data entry and ensure maximal points in the MIPS program.

 Visit www.acep.org/cedr for more information.

Will E-QUAL quality metric scores be used by CMS?

No. E-QUAL metrics are intended for benchmarking and local quality improvement. Actual scores are not reported to CMS.  

How do you join the E-QUAL Network?

Visit the E-QUAL homepage and click on the green ‘E-QUAL Initiatives Portal’ button to begin the enrollment process. For questions on how to enroll contact equal@acep.org and a team member will be in touch withing 72 business hours.

When do the E-QUAL Learning Collaboratives become active for participation?

E-QUAL will offer learning collaboratives on a single clinical topic once a year to maximize participation and to align our offerings with CMS programs, ACEP & ABEM offerings.

How do you gain access the E-QUAL portal?

Once the enrollment form is completed, Champions of the participating site(s) will receive an e-mail invite from “Customer Service” to activate their E-QUAL portal account. Each ED site will need to be activated separately. For details on how to navigate the E-QUAL portal, please reference the E-QUAL Portal Access Guide.

Who is responsible for completing the E-QUAL Portal Activities?

Each participating site is required to have at least one Champion (no more than three) who will be responsible for completing that site's E-QUAL portal activities.

What is the webinar schedule?

All webinars are pre-recorded and posted on the E-QUAL website. Please visit the collaborative homepages for additional information.

Sepsis | Opioid | Stroke

What is the process for accessing E-QUAL's eCME content?

E-QUAL eCME are accessed from each collaborative homepage:

Sepsis | Opioid | Stroke

After clicking an eCME link, you will be asked to sign in with your ACEP ID & Password. If you have not created a free account, please do so here. Once logged in, click the "Launch" button and follow the succeeding prompts to begin your selected eCME.

Are other clinicians (e.g. physician’s assistants) counted in our total group number?

This depends on how you report to CMS. If your site reports as a group (often the preferred and easiest method for emergency clinicians), then all clinicians that charge Medicare (Part B) under the same Tax Identification Number (TIN) should be included in your group number.

On which parameters does CMS base reimbursement?

E-QUAL only submits an aggregate of site-specific data to CMS. Since participation in E-QUAL is aligned with the Improvement Activity (IA) category for MIPS, CMS will base reimbursement only upon participation. Please note that the quality category is based on actual quality measure scores, and participation in ACEP's CEDR can support your quality reporting needs.

How does participation in E-QUAL affect our site's ability to avoid MIPS penalties and gain bonuses?

Completing one of the E-QUAL Learning Collaboratives will meet the CMS IA credit requirement for MIPS. E-QUAL participation does not meet any Quality category requirements. To be eligible for any type of bonus, participation in the Quality category and full participation in Improvement Activity is likely required. For more information, visit the QPP website https://qpp.cms.gov/login

Must our site perform a 90-day “best-practices” intervention aligned with CMS IA guidelines?

While the CMS MIPS program has a 90-day requirement per IA, no IA-specific time requirement exists for each E-QUAL learning collaborative. As the total length of each E-QUAL's learning collaborative exceeds the 90-day requirement, participation is considered sufficient to fully meet all approved IA requirements.

How does our site attest earned IA credits to CMS?

At the end of the learning collaborative, each participating ED site will receive Certificate of Completion for use as evidence for any audit/attestation of the IAs completed by that site and the ECs/NPIs submitted to E-QUAL as working at that site. Current CMS guidance regarding IA reporting is available on the QPP website. Keep up-to-date with the latest QPP information by subscribing to the QPP listserv. Visit the QPP website, scroll to the bottom of the page and click "Subscribe to Updates".

Will our entire group receive eCME credit if only our clinical leaders listen to the webinar recordings?

No. Each provider that is interested in eCME credit will need to review the webinar and take the post quiz. Note that eCME credit is different from IA credit.

Which IA can be earned through participation in the E-QUAL Network?

Please refer to the linked IA Cross Maps for each collaborative:

Sepsis | Opioid | Stroke

Do our site's clinicians all need to be ACEP members to participate in E-QUAL?

No. Participation in E-QUAL is independent of ACEP membership.

Is there a fee to participate in E-QUAL?

No. E-QUAL is FREE!

Does the E-QUAL team review the items we upload in the various Activities to make sure what we have submitted is appropriate and acceptable?

Yes. The E-QUAL team will review all data including uploads that are submitted through the E-QUAL portal. The E-QUAL team will be in contact with the champion if there are any questions or if an uploaded document is incorrect.

If an ED site enters an E-QUAL collaborative, but finds we are unable to fulfill its requirements, can our group back out without incurring a penalty? Additionally, would this hinder our ability to participate in future Waves or other IA activities?

A site can unenroll from an E-QUAL collaborative at any time without incurring penalties or inhibiting participation in other E-QUAL Waves or IA activities.

Does E-QUAL have a non-disclosure agreement for hospital data?

No, we do not have a non-disclosure agreement. However, as stated in our Participation Agreement (available in Activity 1 "Kick-Off"), E-QUAL does not collect data with PHI. All analyses and publications are done with aggregated, de-identified data.

Sepsis

What is the accepted ACEP definition for sepsis?

ACEP does not have an official definition. Your site will apply the definition associated with the method used for data submission in the Benchmarking activities.

Sites using the SEP-1 method will adhere to the CMS definition.
Sites using the CEDR metric or Quick Chart Review method will adhere to the ACEP CEDR Quality Improvement definition. The ICD-10 diagnostic coding logic for these methods can be downloaded in within the benchmark activity.

After trying to construct an Electronic Health Record (EHR) query to identify septic shock cases, we are finding that several patients do not have neither sepsis nor septic shock. Does E-QUAL have any guidance on the construction of EHR queries?

The definition used for the E-QUAL Quick Chart Review option mirrors the definition used for the CEDR sepsis measure denominators. To avoid the capture of cases without sepsis, we recommend you limit your query to cases in which the ED clinical impression (not the inpatient discharge diagnosis) maps to the provided code list. Also, please note that in order to ensure better capture of septic shock and severe sepsis while minimizing capture of general sepsis, the denominator logic should include important Boolean logic:

  • Septic Shock diagnostic code, OR
  • Combination of an Infection AND Hypotension (low blood pressure) diagnostic codes.

Please see the linked data submission guide for Wave IV: Guide (PDF).

Can an ED site still receive a benchmark report if the case minimum is not met?

Yes. You may also go back up to 6 months in order to meet the case minimum.

Does the diagnosis code for sepsis need to be from the ED visit or the admitting diagnosis?

Either is accepted by E-QUAL. You should identify cases based on data available to your site.

Our sites did not receive specific information regarding our performance on blood cultures, antibiotics, fluids, or lactate in our E-QUAL Benchmarking report. Is this information available to us?

Yes. This information is found on the bottom of the 1st page of your site-specific SEP-1 report in the sepsis component compliance table. It should be noted that these recommendations are only conditional.

Can our site use the severe sepsis code R65.20?

The E-QUAL Sepsis Initiative and Toolkit supports using best practices for these patients. Currently, to improve comparability of benchmarking reports, we are asking all sites to only use the codes provided in our Data Submission Guide. At this time, severe sepsis code R65.20 is not included in the E-QUAL Sepsis Initiative.

Are transfer outs excluded from the Sepsis Benchmark Activities?

Transfer outs are not excluded as the Sepsis Initiative seeks to improve initial identification and sepsis care including initial lactate testing, IV fluids, and antibiotics.

Opioids

For determining is other treatments were administered before opioids, does a 2-5-minute difference between treatments qualify as occurring “prior to opioid therapy”?

As this is not likely reflecting a care pattern that is using an alternative to opioid, as opposed to adjunctive treatment with an opioid, we consider concurrent administration of an opioid with a non-opioid as not occurring “prior to opioid therapy.” In this case the visit should be considered as “No”.

If more than one opioid treatment is administered, does our site only select the first one given?

Select the first or primary opioid given:

  • If only two opioids are given, then select first.
  • If more than two doses of opioids are given, select the opioid given the most number of times.

For determining if a benzodiazepine (BDZ) is ordered, does ordering one on d/c, for alcohol withdrawal, qualify as a “Yes”?

Still indicate that a benzodiazepine was administered. Concurrent alcohol and opioid abuse is common. And while BDZ therapy may be indicated for treatment of alcohol withdrawal, such patients may be at higher risk of poor outcomes and should be tracked for quality improvement. Benzodiazapine and opioid co-prescsribing increases risk of overdose, irrespective of the indication for each.

Should our site only consider falls from a certain height as trauma?

For the purposes of this quick review, any fall warranting evaluation for trauma or workup for possible trauma may be considered a fall.

Does our site include patients who have been admitted?

For both the Safe Prescribing and the Overdose chart review options, only discharged patients are to be included. This ensures that benchmarking results are easier to interpret between sites.

Does our site exclude cases in which a patient’s code out and discharge diagnoses are different (e.g. low back pain v. UTI)?

Ideally, such cases should be excluded. We have developed denominator definitions using ICD-10 designed to identify cases with atraumatic low back pain as the primary presentation and need for ED care as opposed to alternative pathologies that may cause back pain. Searching by ICD-10 code should only yield charts with that diagnosis.

Should our site include charts in which patients are coded for more than one type of pain (e.g. back pain and headache)?

Since sites can only select one target first included charts with only one type of pain. If your system can select charts by primary code, then use charts with multiple types of pain can be used.

Stroke

In the Stroke data submission guide, does the data element “last 2 ED SBPs<180” refer to a patient’s prior ED visits?

No. The requested SBP recordings are only relevant for the visit of interest (i.e., the ICH visit that is being reviewed). The data elements requested are intended to be entered per case in order to generate statistically stable estimates of performance for comparison.

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