Category Archives: Quality Improvement

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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Can MACRA and MIPS Move the Needle for Healthcare Analytics?


Post by Corinne Stroum (Pascale)


Director, Program Management – Healthcare Analytics, Caradigm

The Medicare and CHIP Reauthorization Act (MACRA) draft has become a novel I can’t put down. Its 962 digital pages tell a compelling story on the future of healthcare metrics. One narrative I follow in particular, is the next generation of quality measurement that shifts the focus of healthcare analytics to the reporting of patient outcomes.

In MACRA’s first year, most Medicare Part B clinicians will be eligible for the Merit-based Incentive Payment System (MIPS). MIPS will unify existing process-based quality measurement systems into one that promotes diversity of measure types and encourages providers to report on measures which it deems to have more impact.

Here are some examples of measure types that form the performance standards in MIPS:

    • Process measures – These are the most simple measures to report on such as whether a provider successfully completed something, such as an evidence-based best practice. This might take the form of an annual influenza vaccination for an at-risk patient. While process measures formed the meat of early healthcare quality metrics, they don’t tell the whole story.
    • Outcome measures – These measures get to the heart of clinical care by measuring how providers have influenced patient’s health. For example, has the patient’s depression index score gone down over a six-month period? Did an intervention prevent complications? Did a patient attain cancer remission?
    • Intermediate outcome measures – Some outcome measures look at the long term, which may take years to measure performance. Intermediate outcome measures are an important part of the story because they identify other clinical markers to indicate progress along the way. One example is the reduction of fasting blood glucose as part of a larger diabetes management plan.
    • Patient-reported outcome measures (PROs or PROMs) – Championed by organizations like PCORI, these measures are the window into the perspective of the patient: how does the patient feel about his/her health (such as the PROMIS survey) or how does the patient report the outcome of treatment?
    • Patient experience measures Cousins to PROMs, patient experience measures ask patients and caregivers about their perception of their care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) are well known experience measures.

The MIPS quality performance category offers opportunities to achieve bonus payments as well as prevent penalties. CMS will allocate points for quality measure performance depending on a “benchmark decile” – assigning providers level of achievement based on thresholds set during a baseline period. These deciles determine the points that the provider will receive. For measures already with overall high performance – those which CMS deems to be “topped-out” – it will be more difficult to obtain full points, incentivizing providers to explore new healthcare quality measures in which they can demonstrate excellence.

MIPS will require one outcome and high-priority measure as part of a standard submission. CMS deems high-priority quality measures as those which track appropriate use, efficiency, care coordination, or patient safety.   Additionally, CMS will score two bonus points for each additional outcome and patient experience measure and one point for each extra high-priority measure that a physician or group elects to report on.

In the first two years of MIPS, the Quality Performance score makes up about half of the performance score. In the following years, the Quality Performance score will balance out with the Resource Use score and clinicians should move from MIPS to advanced APMs. For the next two to three years, however, MIPS will move the needle on quality measurement. It will incentivize providers to report on impactful measures and measures that have not already “topped out”, and to store and transmit quality performance data electronically. This electronic data sets the stage for future victories in healthcare analytics: more data to work with, and more meaningful data.

I highly recommend beginning the process now to develop your MIPS strategy before the performance period begins in 2017. You shouldn’t underestimate the time needed to implement MIPS data and reporting requirements, identify the measures you can be successful in, and plan for how you will drive improved performance in those measures. If you’d like to talk about how Caradigm can help you with your MIPS Quality Measurement strategy, then please leave us a note here.

Quality Improvement: Going Beyond Retrospective Reporting With Population Health Management


Post by Kendra Lindly


Senior Product Manager, Caradigm

Often, quality efforts in healthcare are focused too much on retrospective reporting of measures, and not on improvement of those measures. It’s important to understand the past, but that alone does not drive improved patient outcomes. To drive measureable improvement, you need to identify the root cause of care gaps and apply the intelligence within clinician workflows to close those gaps. 

As a result of the rise in population health management, solutions have emerged to help healthcare organizations take this next step.  For example, a clinical analyst can quickly drill down in a specific ACO 33 measure to determine the root cause of non-compliance, then guide actions of clinicians to remedy that gap. Advanced population health solutions can track gaps and surface areas of non-compliance within the workflow of the EMR while the physician is still in the presence of a patient.  This enables a physician to address gaps before the patient leaves. Care managers can have a task list automatically generated for them that prioritizes their daily activities. These are just a few of the many practical ways that new solutions are innovating quality improvement efforts.

 Check out this infographic to learn more about the impact of poor quality on patients, healthcare providers and the economy—and how it can be remedied. You can also download our whitepaper entitled ‘Quality Improvement in the Advent of Population Health Management’ by completing this form.