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The Moral of the Data Story: Translating Performance into Payment for the Quality Payment Program

Jun 26, 2017 09:09AM ● By The Hood Magazine

 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 report data.

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 ( for public review.  Interested in a data proofread?  Contact Holly Arends, CHSP, CMQP, ([email protected]) at 605.660.5436 or take advantage of the Quality Payment Program Service Center’s ( 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