Monthly Archives: January 2018

Quality Reporting Season


Post by Josh Schwartz


Healthcare Analytics Program Manager

As you prepare to submit your organization’s clinical quality data, let us take a look back at the changes the Centers for Medicare and Medicaid (CMS) implemented this year and some strategies for success with quality reporting and ongoing quality improvement efforts.

Consolidation and Simplification of Reporting

The end of calendar year 2017 (CY 17) marked the completion of the first year of the Quality Payment Program (QPP). QPP consolidates the various innovative payment models with the intent to move Medicare physician reimbursement away from fee-for-service and towards a value-based care model. As all Medicare physicians move towards value-based reimbursement, a two-year transitionary period (CY 17 & 18) allows reporting providers to ramp up to the ultimate levels of cost savings and quality improvement goals in 2019 that they will be accountable for moving forward. The chart below breaks down the percentages of reporting categories by weight, with payments being adjusted two years following the calendar year of the reporting period. In CY 17 the quality category made up 60% of the payment calculation and after the transition to more cost accountability it will remain equally important, representing nearly one-third of the total cost calculation.


Calendar Year Payment Year Quality Cost
2017 2019 60% 0%
2018 2020 50% 10%
2019 2021 30% 30%

Already during this transition period, CMS has received a lot of feedback in consolidating and simplifying its payment and reporting programs to use the same reporting options. In CY 17 the CMS Web Interface replaced the Group Practice Reporting Option (GPRO) of the Physician Quality Reporting System (PQRS) as the “self-service” reporting mechanism for group practices. It is in this interface that CMS uploads a list of patients for which clinical data points and quality measures must be reported. On January 8th these lists were uploaded, with the submission window running from January 22nd until 5pm PST on March 16th. Providers need to prepare immediately to ensure that their data is validated and reported in a timely manner.

Best Practices for Reporting and Performance Analysis

Quality reporting is an involved process that requires data documentation, data validation, and audits to capture and populate thousands of clinical data fields. Having a plan in place for a systematic approach to completing the web interface template will go a long way towards a successful reporting effort.

  1. Start early. The window from the time the patient sample is provided to the deadline for reporting is 10 weeks. You may have to perform hundreds if not thousands of chart audits to complete this process, so give yourself some extra time.
  2. Divide and conquer. If you have multiple clinics reporting together, make sure to delegate responsibilities in an effective manner.
  3. Develop a timeline. Establish internal check points, milestones and deadlines to ensure progress is on track.
  4. Review your work. Leave time to complete spot checks and conduct self-auditing before submission.

While these steps will guide an efficient and accurate quality reporting effort, regular analysis of clinical quality data remains a keystone of population health. Evaluating quality measure performance at the provider group, facility, and individual provider level enables you to identify areas that need performance improvement and learn from established best practices that can be replicated across provider networks. Incorporating performance review into regular workflows and quality practices will help avoid scrambling at the end of the year to improve performance and serve as the foundation for improvement year over year.

Caradigm Quality Improvement and CMS Web Interface Extract

To facilitate quality management, we have continued to iterate on our quality improvement application, Caradigm Quality Improvement. Leveraging the power of the application’s Advanced Computation Engine, quality measure performance can be evaluated across your organization at all levels. Empowered with this information and the ability to conduct root cause analysis, you can use the application to conduct quality improvement campaigns. The highly configurable solution integrates with the workflows of quality managers and clinicians.

We take our commitment to quality management a step further with the Web Interface Extract. This feature provides an extract of the clinical variables required by CMS for the reporting of quality measures. We do this by running the patient sample list provided by CMS against the Caradigm Intelligence Platform, and then extract and translate the data into the format required by CMS. This extract is then transmitted back to you to serve as the basis for your organization’s reporting.

While clinical quality is top of mind during the reporting period, it is important to remember that quality is the responsibility of everyone involved in the delivery of healthcare for the sake of patients. Good luck with your submission and happy Quality Reporting Season!

 

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