The introduction of value-based care was an enormous adjustment for every health care professional and practice. New value-based payment models require organizations to make significant changes in how they approach patient care, how they use technology to manage data, make broad commitments to coordinate care among other providers and devote attention to quality management. Health care has become an evolving system where your payments are linked to the quality of your care.
Data abstraction and reporting are critical to value-based care for several reasons. Your reimbursements and ability to earn financial rewards (or incur penalties) are dependent upon the data you report. Your accountability, reputation and how consumers judge your organization is based on publicly reported data. Most importantly, data help you identify ways to make quality improvements and provide better clinical care and patient experiences.
There are significant challenges to transform your practice from fee-for-service to value-based care. It requires a major shift in the practice’s culture and exacting new requirements for data collection and reporting. The ability to measure and report health care quality measures grows more critical every year.
However, the mountain of data you are collecting can be crushing. How can you be certain it is being reported correctly? You and your staff may be struggling with an ever-expanding list of measures and multiple model sets that you are required to report.
There are negative financial consequences if your reporting is not done correctly and on time. CMS’ payment adjustments are based on many factors, including quality, meeting submission deadlines and reporting accurate data. This reporting workload can easily overwhelm even the hardest working staff.
Most practices do not have a staff that understands all the nuanced components that comprise an effective quality management team. The health care quality measurement industry has grown from zero to a sophisticated and highly specialized accounting sector in just the last few years.
Adding to the data avalanche is another challenge. Anyone within a hospital that has ever been responsible for abstracting data from medical charts knows the frustration when charts are missing data from required reporting fields.
AFMC and Primaris, one of our quality-improvement partners, can help your practice identify and lower security risks, reduce your staff’s reporting burden and implement best practices for quality improvement.
If you’ve considered outsourcing data abstraction, you may have already done some research on Primaris. Primaris offers data abstraction that includes core measure and registry abstraction, quality measures, validation audits, quality measures education and training, and performance and clinical documentation improvement consulting.
Primaris abstractors maintain 95% accuracy on inter-rated reliability review. Recent averages have been 98%. They configure reporting and feedback processes to meet specific needs. Their extensive experience with providers enables them to suggest clinical documentation changes that can improve scores.
Chart abstraction and quality reporting expertise, via the CMS Web Interface (CWI) is one of the six quality reporting methods under the Merit-Based Incentive Payment Systems (MIPS). The Medicare Access and CHIP Reauthorization Act (MACRA) shifted Medicare compensation to pay-for-performance, or value-based care. MACRA brought value-based care into the mainstream through merit-based incentive programs. Under the MIPS, eligible clinicians can receive either incentive payments or penalty deductions based on how well they do on quality, cost, improvement activities, and the use of electronic health records (EHRs) and other technology.
Annual security risk analysis (SRA) is another quality reporting requirement and a specialty service provided by AFMC. SRAs are required by the HIPAA Security Rule for all practices or organizations that create, receive, maintain or transmit electronic protected health information (ePHI). SRAs evaluate risks and vulnerabilities and guide the implementation of security measures to protect your patients’ ePHI. AFMC has an experienced SRA-specialist team who have extensive knowledge of HIPAA privacy and security rules and the ever-evolving information security technologies. AFMC can provide SRAs either on-site or virtually. There is no cost for an initial phone consultation at 501-906-7511 or SRA@afmc.org.
Data is only useful if it is accurate, complete, and can be used to improve the quality and cost of care. For example, use of low-value resources can result in wasteful spending, unnecessary care and will jeopardize reimbursements for organizations moving to value-based care. Good use of data also helps you keep patients at the center of your care process.
Primaris has a proven record of saving money for health care provider organizations. A recent example is Affirmant Health Partners’ Federation ACO. Primaris helped them achieve a 100 percent quality score in 2018. As a result, Federation ACO achieved nearly $15.4 million in Medicare savings and almost $8 million in bonus payments. Click here to download the Affirmant-Federation case study.
Quality reporting and data abstraction is simply the new, here-to-stay reality. Keeping track of health care reimbursement reporting requirements and changes means also keeping up with a growing list of acronyms, the alphabet soup of quality health care. Physician practices previously participated in PQRS (Physician Quality Reporting System) and now the Quality Payment Program’s (QPP) Merit-based Incentive Payment System (MIPS), as well as the meaningful use program (now rolled into MIPS under the Promoting Interoperability category), and the Healthcare Effectiveness Data and Information Set (HEDIS). Yet, many practices struggle with identifying the appropriate quality indicators in each program and how to measure them. Quality reporting programs are constantly evolving with measures migrating on and off the required reporting lists.
All practices need a strategy for adapting quality management processes to new requirements on an ongoing basis – even as you continue to build on what you’ve done. You don’t want to lose valuable knowledge about how you’re doing and how you can demonstrate value.
With the transition to value-based care, the stakes have never been higher. Managing data is two-fold: Knowing where to find the data and knowing how to report it. Reimbursements, penalties, cost reductions, clinical outcomes and your reputation are on the line. If you’re not sure you have the staff, time and expertise to stay trained and up to date on quality reporting requirements, consider using an outside, expert resource such as Primaris for your data abstraction and AFMC for your annual SRAs. Together, we can translate your data into timely, accurate and actionable, quality improvement initiatives. As payments become more heavily based on quality and cost, and as patients seek providers that meet their growing expectations, managing the data is essential.
AFMC is a non-profit organization that, for 47 years has worked to improve the health through utilization review, quality improvement projects, evaluation and public education.
Primaris is a health care consulting and services firm that works with physicians, hospitals, physicians and nursing homes to drive better health outcomes, improve patient experiences and reduce costs. For more information, visit www.primaris.org and follow their blog at https://blog.primaris.org/quality-talk-podcast/primaris-partners-with-afmc-for-security-risk-analysis-services
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