Improving Quality Measures for MACRA Reporting

Author: PrognoCIS Marketing | April 13th, 2015 | Improving Quality Measures for MACRA Reporting

The Centers for Medicare and Medicaid services (CMS) recently announced that it has extended the submission deadline for 2016 Physician Quality Reporting System (PQRS) Electronic Health Record (EHR). The new deadline is March 31, 2017 for eligible professionals, PQRS group practices, qualified clinical data registries (QCDRs), and qualified EHR data submission vendors to report their electronic Clinical Quality Measures (eCQMs) for the Medical EHR Incentive Program. Submissions will not be accepted after 8:00 p.m. eastern time.

MACRA seeks to move the healthcare system toward quality-based payment, rather than quantity, and this transition comes with its own set of challenges. Before making your eCQM submission, let’s take a moment to consider a few important points about quality measures as well as the role EHR software plays in quality reporting.

Keeping Track of Clinical Quality Measures

Practices often struggle to keep track of which quality measure reports payers expect in a given year. The most effective way to deal with this problem is to stay in touch with payers. Constant communication with payers can help practices get a better feel for the payer’s long-term priorities and future measures. If payers share their plans, practices can be more certain that their investments in performance improvement will be adequately rewarded.

Deciding Which Quality Measures to Report

Payers target the measures they want providers to meet based on the areas that appear the most financially beneficial. If a payer feels that a practice is weak in a certain area, they can construct performance-based measures that provide incentive for improvement.

It has become increasingly common for payers to use the patient-centered medical home (PCMH) designation to demonstrate a practice’s commitment to measuring quality and outcomes. The payers then calculate reimbursements accordingly. Payers know that a practice has to have strong patient management capabilities in health problems such as diabetes and asthma in order to become accredited so many payers are rewarding practices that have attained these designations.

Recognizing the burden of quality and outcome measurements, payers are adding financial incentives such as per-patient per-month payments in addition to fee-for-service reimbursements. Practices can use these incentives to hire nurses or other providers such as case managers.

The Role of EHR in Quality Reporting

An EHR system makes it much easier to record and report data, increasing the likelihood of meeting quality measures and receiving reimbursement.

While certified EHR systems are able to collect data for submitting clinical quality measures, development of a dashboard requires a customization that typically comes at a high cost. Unfortunately, these costs are a significant obstacle. To make things even more complicated, small practices are often unaware of the level of functionality they need in their EHR. The vendor will give them what they ask for, even if it’s not what they actually need.

However, working with one of the regional extension centers from the Office of the National Coordinator for Health IT can help. They can provide detailed specifications before purchasing an EHR. Vendor user groups can also provide assistance. Members of these groups can offer insight into workflow, IT touch points, and outcome improvement.

PrognoCIS EHR offers training for providers on proper reporting for the Physician Quality Reporting System (PQRS).

Making a Smooth Transition to MACRA

Some practices may have become overwhelmed by the growing need to demonstrate and report on quality measures while still operating in a fee-for-service healthcare environment. In order to cope with these demands, practices should approach health care as a team effort. A strong support staff can go a long way. By coming together as a team to address these operational challenges, practices can smooth their transition to value-based care and MACRA with significantly less hassle.