The last measure in table 1 has been the source of some confusion. Every provider demonstrating meaningful use will report six clinical quality measures (CQMs) to CMS unless exclusions apply. The CQMs are very similar to the recently renamed Physician Quality Reporting System (formerly PQRI). They are quality measures that consist of a denominator (the patient population of interest), a numerator (the quality action) and on occasion exclusions (patients not included in the calculation). As is the case with PQRS, the provider’s performance score for each CQM has no bearing on their ability to demonstrate meaningful use. Satisfying this objective simply requires reporting the CQM. However, in the future the performance scores for the CQMs are likely to make their way into the public domain. One final note, the six CQMs you must report include three core CQMs and three from a menu the provider may select. Certified EHRs are only required to offer three of the 38 CQMs available from the menu. Those of you shopping for an EHR, make sure the applications you are considering support nephrology friendly CQMs.

The introduction of meaningful use has generated a substantial amount of discussion and commentary on a national level. In many respects the framework appears to be designed for primary care providers and in fact one might argue the care delivered within a dialysis facility escaped the attention of the program’s architects. Nevertheless, with an understanding of the work flow within your practice and the information reviewed above you can put yourself in a position to succeed. The important points to remember from my perspective include:

1. Identify and support an internal meaningful use champion.

1. Understand the implications of your encounters within the dialysis facility.

1. Determine whether or not you are eligible for the Medicaid track.

1. Choose your five menu objectives based on the best fit with your existing workflow.

1. Assign responsibility to capture the data required to meet the objectives based on your practice work flow.

1. Eliminate most of the prescription pads in your office.

The above is not a guaranteed recipe for success, but it should bring you much closer to the finish line.