Quality matters: mid-year considerations for value-based care
By Erin Ward, product manager of analytics at Greenway Health
Roughly halfway through 2018, many clinicians are participating in value-based programs that rely heavily on quality measures to determine physician reimbursement. Many of these programs allow clinicians to choose quality measures that fit their practice’s unique circumstances, and require them to submit a full year’s worth of data. For example, the Merit-based Incentive Payment System (MIPS) has more than 250 quality measures to choose from. This is a good time of year to review your quality performance, make sure you’ve selected the best measures for your organization, and assess performance to make proactive adjustments ahead of reporting deadlines.
Start by understanding how the measures you selected are scored. The Center for Medicare & Medicaid Services (CMS) publishes performance benchmarks for quality measures in MIPS each year. (CMS takes prior years’ data and calculates average clinican performance, and then breaks each measure’s score into deciles. The bottom decile is the lowest 10% of performers, and the highest decile is the top 10%. However, because each quality measure assesses a unique clinical indicator, the same percentage or number doesn’t mean the same thing across measures. Some measures focus on whether patients receive appropriate preventive care, while others measure actual clinical metrics such as blood sugar levels.
Even among process-oriented measures, the meaning of percentages can vary significantly. For example, Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention, Falls: Screening for Future Fall Risk, and Diabetes: Eye Exam, all are measures that focus on screening procedures. Imagine that a clinician looks at a dashboard and sees a score of 82% for each measure. Not bad, right? In truth, though, 82% puts you at the third, eighth, and second deciles, respectively, for those measures. The clincian does quite well for one of them, but underperforms for the other two. Understanding these benchmarks is crucial. You can download them at qpp.cms.gov each year. How your practice performs on these measures should determine which you report to Medicare or other payers.
Improve documentation workflows
Additional considerations for quality measure selection are measure documentation requirements and workflow. Each Clinical Quality Measure (CQM) has a measure specification document that maps out the codes the clinician is required to document, so the numerator of the measure will be populated when you report. Look at the measures you are considering reporting on and work with your clinicians to include the required documentation into their clinical workflow or the workflows of their supporting staff. You want to make sure you capture the right data for your quality measures, such as the procedure, lab, and diagnosis codes.
We often find that clinicians are taking the appropriate actions needed to successfully perform on a quality measure but are not documenting the workflow appropriately for the data to be captured by the reporting tools. It is important to review the workflow documentation for the EHR to understand how the data is captured and adjust workflows where needed to ensure all required information is being documented and reported appropriately.
After you have assessed your quality measure performance and selected the right measures, it’s time to assess individual clinician performance — some clinicians may do remarkably well, while others may struggle. Using data and analytics can help. You can see which clinicians do well, and you can match them with clinicians who underperform. For example, a clinician could be taking the actions that a quality measure is looking for, such as closing a referral loop, but not documenting the actions properly. Matching that clinician with one who is doing well on the measure can create a learning opportunity, and an opportunity to improve your quality scores.
Finally, make sure your clinicians aren’t in the dark throughout the year. Have regular reviews with them to adjust focus and maximize performance. Sharing the relative performance of clinicians is one way to encourage friendly competition between them . Set goals for your clinicians and your organization and track your organization’s measure performance against those goals throughout the year. Now is a great time to start these initiatives because there are still plenty of opportunities left in the year to influence behavior and move the needle on your performance.
For more information, click here to schedule a conversation with a Greenway representative.