The Moral of the Data Story: Translating Performance into Payment for the Quality Payment Program
Jun 26, 2017 09:09AM
● By Digital Media Director
By: Holly Arends
As the healthcare paradigm continues to shift toward quality
of care over quantity of services, the practice data submitted to Centers for
Medicare & Medicaid Services’ (CMS) for Quality Payment Program (QPP)
participation will tell the story of each practice and provider.
Some will follow the Merit-Based Incentive Payment System
(MIPS) storyline while others will go the way of the Advanced Payment Model
(APM). All will be written in the language of Quality measures, Advancing Care
Information measures, Improvement Activities measures and Cost measures. Each
will consider the elements of patient outcomes, service cost, scientific-based
practices, technology utilization and optimization, care coordination and
patient engagement. Given the current health care setting, many practices and
providers may be crafting a mystery novel.
The Meaningful Use program’s beginning chapters of building
the technology infrastructure and advancing care processes. The plot thickened as it became apparent that
despite documentation, the ability to show improved outcomes is lacking.
Resolving the conflict for a happy ending will require a fully developed
strategy for embracing the Quality Payment Program.
A vast majority of South Dakota providers utilize electronic
health records (EHR) for point of service data collection. While providers have
adopted EHR for clinical documentation, the urgency to optimize and fully
integrate the technology into the clinical workflows is lacking. As characters in this tale, successful
providers and practices must have the ability to collect, monitor, analyze and
Realizing the potential of the EHR requires ongoing
training, quality improvement testing and progress evaluation. The standard
health information management mantra, “if it’s not documented, it didn’t
happen” certainly applies to the electronic environment. The extraordinary
advantage comes with the ability to collect data once for multiple
applications. Data from a patient’s health history can be used for billing,
quality measurement, quality improvement, population health management,
research, condition trending and many others.
Vendors and superusers can play a pivotal role in application by
assisting with data mining; for example, analyzing patient interventions data
or the efficacy of a new drug.
Patient data is sifted through the electronic Clinical
Quality Measures (eCQMs) to determine denominators and numerators for
calculating measure performance scores.
Collecting data allows program participants to monitor performance on
the quality measures against the QPP benchmarks. Several benchmarks for
measures are modified based on the way data is submitted. The statistics below
illustrate how the QPP benchmark changes by the submission method selected.
Measure # 111: Pneumonia Vaccination Status for Older Adults
Score to get min 3 pts
Score to get max 10 pts
Submitting data electronically, using EHR or QCDR, is beneficial for achieving a higher point score. Electronic submission offers bonus points and is an applicable measure for optimization of health information technology in the Improvement Activities measure. EHRs have been certified for quality measure data compliance for electronic data collection, reporting and communication such as quality measure feedback, dashboards or quality measure performance scores. Reviewing performance measure scores and comparing them to benchmarks provides perspective for the practice or provider’s role in the bigger CMS patient care story.
As a supporting character, the Great Plains Quality
Innovation Network (Great Plains QIN) has authored a comprehensive MIPS
Calculator to translate performance into payment through tracking all
performance categories and measures. The process of clinical documentation
impacts the morale of the data story published at CMS Physician Compare
(https://www.medicare.gov/physiciancompare/) for public review. Interested in a data proofread? Contact Holly Arends, CHSP, CMQP,
(firstname.lastname@example.org) at 605.660.5436 or take advantage of the
Quality Payment Program Service Center’s (http://greatplainsqin.org/qpp)
telephone, online or live chat support options.
Holly Arends, CHSP,
CMQP is Program Manager with Great Plains Quality Innovation Network
This material was prepared the Great Plains Quality
Innovation Network, the Medicare Quality Improvement Organization for Kansas,
Nebraska, North Dakota and South Dakota, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of
Health and Human Services. The contents presented do not necessarily reflect
CMS policy. 11S0W-GPQIN-SD-D1-225/0717