PPC in HIT Consulting on Quality Measure Reporting

Quote from PPC in HIT Consulting on Quality Measure Reporting: "Quality will continue to play a more significant role in healthcare organization compensation and overall success as the industry continues its shift to value-based care"

Quality measure reporting facilitated by CMS and commercial health plans provide critical funding to support healthcare operations. They require diligent data collection and end-of-year reporting that is often left to the last minute and leads to a mad scramble as the due date approaches. Not only does this just-in-time approach place tremendous stress on everyone involved in the process, but it often results in organizations doing the minimum possible to meet the measures instead of delivering an optimal solution that improves end-user adoption, patient outcomes, and scales year-over-year. Healthcare leaders can learn a lesson from professional athletes. They don’t just show up at the venue at the last minute and walk onto the court or the field. There is a tremendous amount of preparation, planning and practice to make sure they are ready to play.

Pre-event Planning for Quality Measure Reporting

A professional athlete starts by asking the right questions:

  • What do I know about my opponent?
  • What do I need to focus on to win?
  • What skills should I work on and finetune?
  • Once the right questions have been asked and answered, it’s time to prepare.

Healthcare organizations can adopt a similar approach. At the beginning of the quality measurement cycle, they should evaluate:

  • Learn how circumstances have changed: investigate and understand any new measurement specifications they need to incorporate.
  • Proactively review the situation: determine how the changes may impact patients, clinicians, operations and analytics.
  • Review existing capabilities: perform a functional and workflow gap analysis of EHRs.
  • Room for Improvement: assess what new data needs to be captured to satisfy quality measure reporting.

Healthcare organizations then need to take action to revise their systems and workflows based on their findings. If there are gaps or other issues, the EHR should be updated to meet the new specifications. This may require technical EHR changes to add data capture elements to telehealth visits, logic adjustments to reports and dashboards, changes to quality measure rule logic and modifications to decision support tools. Once changes are complete, they should be tested and validated in a “scrimmage-like” scenario. Testing should include gathering user feedback to confirm new processes and data capture methods secure the appropriate information without impacting workflows. Be prepared to make revisions based on the test results. Updates and adjustments to the technology are just one step. Organizations also need to train their users (especially clinicians) on the new specifications and workflows to ensure that data is entered in a way that makes quality measurement easy, accurate and comprehensive. Workflow changes are particularly important to reiterate with leadership and physicians since user adoption directly impacts the bottom line through quality measure reporting incentives.

Game Day

Every quality measurement reporting period is comparable to game day. Once changes are completed, continuously monitor for accurate data capture and the derived performance improvement throughout the period. The goal is to create an automated, self-correcting process that enables improvements in quality of care delivery. The more automated this process becomes, the faster the organization can react and the better its reporting will be. You can support automated and self-correcting processes by focusing on data transparency, clear organizational goals and an agile approach. Like athletes, statistics can provide stakeholdess with a real-time view of what’s happening within the organization. Just as coaches monitor performance levels, an effective dashboard contains benchmarks to help each user understand what adjustments are needed. Benchmarks provide clear organizational goals to keep clinicians, management and the C-suite in alignment. Dashboards can also be used effectively to encourage the adoption of quality measures by clinicians. Enabling clinicians to review their performance is an effective way to encourage self-regulation and adoption of new tools and processes. Attaching bonuses or other compensation elements to quality measure performance drives even greater adoption and compliance. Some organizations display the performance of physicians so everyone knows who the “MVP” of quality measures is. Physicians do not like to lose and are quick to report any perceived inaccuracies in their performance data. Therefore, this feedback provides an opportunity for the organization to validate workflows, documentation tools and reporting logic throughout the year. If an organization uses agile methods to address feedback, they’ll be rewarded with increased trust and input moving forward. These efforts bring them closer to a more automated and self-correcting process. Thus, it is essential to remember external data streams can impact the outcome. Likewise, stay on top of all external data streams that could impact quality measure outcomes.

Post-race Activities and Evaluation

After a game, an excellent team will evaluate every aspect of the game to learn from mistakes and improve on its performance for the next one. Healthcare organizations should do the same at the end of the quality cycle. Like coaching staff, use the data to audit quality program failure points and inefficiencies once the data is extracted and has been sent to the necessary parties. Every quality measure should be audited multiple times by selecting random patients, reviewing their charts and other data to determine if anything was misreported or missed. Accuracy becomes particularly important for quality measures like Colorectal Cancer or Diabetic Foot Exams, where the necessary results are often stored in images or free-text blocks of physician notes. The organization should be looking to see if issues are systemic or restricted to specific departments or individuals and then remediate them accordingly. Among the areas that teams should consider for optimization are:

  • Workflow changes
  • Build requirements
  • Measure logic updates
  • Training requirements
  • Policy changes

Sustainable Victories in Quality Measure Reporting

Quality will continue to play a more significant role in healthcare organization compensation and overall success as the industry continues its shift to value-based care. If quality programs are treated as a once-a-year “get it over with” project, organizations will find it increasingly difficult to meet their obligations. Organizations that adopt an approach that promotes continuous and automated self-correction can avoid last-minute panic projects, increase revenue and deliver scalable, optimal solutions that improve end-user adoption and patient outcomes. The original article published by HIT Consultant can be read here.