Accountable Care Organizations (ACOs) must leverage sophisticated data quality management tools as they navigate regulatory reporting changes, including the CMS Merit-based Incentive Payment System (MIPS) that requires complete data, accurate submissions, and excellence in clinical practices to maximize provider incentives.
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Editor’s Note: This article is based on a webinar entitled, Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond, presented by Hazel Morrison, Product Manager, MeasureAble, and Shannon Campbell, CPHQ, Sr. Manager, Regulatory Measures Program, both of Health Catalyst.
The Quality Payment Program (QPP) measures are sometimes said to be unnecessary and burdensome tasks imposed by the Centers for Medicare and Medicaid Services (CMS) on Accountable Care Organizations (ACOs). They should, however, be understood as tools allowing ACOs to maximize benefits resulting from the quality care they are likely already giving their patients.
The QPP measures are designed to promote better clinical outcomes using evidence-based care standards and protocols – standards and protocols QPP participants are likely already practicing. Rather than seeing the QPP measures as a burden, why not leverage the best practices already implemented within your ACO? Using these measures to maximize an ACO’s clinical performance can result in increased financial incentives and cost savings to fund additional quality improvements and feed the progression to clinical excellence.
In recent years, the Medicare Shared Savings Program Accountable Care Organizations (ACOs) have been modifying their quality data reporting to meet MIPS requirements and improve program reporting. By implementing effective quality management tools, ACOs and their participants can streamline MIPS reporting, elevate their quality processes, overcome common reporting obstacles, expand their quality improvement initiatives, and ultimately maximize the rewards of their quality enhancement efforts.
Engaging in MIPS can lead to financial rewards for exceptional clinical quality, but it also carries the possibility of reduced payments for poor performance. CMS evaluates ACOs and ACO participants submitting via the APM Performance Pathway (APP) across three performance categories:
The Cost performance category is weighted at 0% for ACOs in the APP.
Some ACOs only engage with MIPS measures once each year when they submit to CMS. While this is technically permissible, it does not align with the spirit of the program or its objectives and is a poor use of the resources an ACO has dedicated to the EHR and data collection. Most importantly, it risks patient care as the ACO does not identify and close care gaps that might otherwise be identified during the year.
This approach also means the ACO denies itself unclaimed incentive funds available from CMS. Instead, ACOs and ACO participants should actively monitor their data throughout the performance period to promptly identify and address any gaps. By doing so, they can enhance the quality of care provided to patients, exert greater control over performance scores compared to previous years, and consequently increase financial incentives.
ACOs would benefit most from fostering a culture that aligns with QPP principles, emphasizing proactive monitoring of ACO performance and quality measures. This approach empowers an ACO and its clinicians to address performance gaps effectively, enhancing agility in CMS quality reporting and enabling swift adaptation to program changes. For example, one clinician in the ACO may not meet a measure, yet another ACO clinician may close an identified care gap during a subsequent visit.
An ACO has committed to sharing in the accountability of its patients’ care. The data-sharing aspects within an ACO inherently support this commitment and align with the QPP quality requirements, providing an ACO with the EHR tools needed to maximize the financial incentives available.
Numerous ACOs have already standardized clinical care, and leveraging these initiatives can result in performance incentives under the QPP. Over a third of webinar participants said they track their quality performance throughout the year.
ACOs can enhance their quality improvement efforts by utilizing a comprehensive quality management tool to optimize performance and clinical outcomes. Data completeness, data quality, and actionable healthcare analytics are crucial for implementing evidence-based clinical practices to succeed in the MIPS program.
MeasureAble is an advanced tool for healthcare providers, including ACOs, to manage quality measures efficiently. This application integrates complete data, measures, visualizations, and workflows into a single system for measurement, improvement, and submission processes.
It calculates data completeness and performance rates while offering a dashboard to track performance. With MeasureAble, ACOs can easily submit data to CMS or export it as QRDA III files, saving time and resources. Additionally, this application utilizes actionable data to enhance CMS reporting, boost quality performance, and drive financial success.
“We want you to use your performance, monitor it continuously, and dig into the insights that will help you and your organization perform those important improvement activities to ultimately receive better compensation.”
– Hazel Morrison, MeasureAble Product Manager, during Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond webinar
Upon integrating MeasureAble, organizations are equipped with a singular, actionable repository for MIPS data. This quality performance solution empowers organizations to evaluate optimal submissions through in-depth data analysis. Organizations can proactively monitor performance metrics at various organizational tiers by utilizing the robust measures engine and intuitive data visualization dashboard.
With features that are specifically tailored for ACOs, the tool provides an estimated composite score for a proactive quality performance strategy and instant submission validation and feedback.
Additionally, the solution facilitates the establishment of performance targets and aids in identifying and addressing care gaps to qualify for exceptional performance incentives. Through this tool, organizations can visually track performance across different measures and delve into provider-specific, population-based, and individual patient levels to extract actionable insights to continuously improve MIPS performance.
Indeed, the tailored features for ACOs ensure seamless monitoring, enhancement, and data submission to CMS. Therefore, embracing MeasureAble today can elevate an organization's performance and drive continuous improvement in healthcare delivery.
“That is the benefit of the Health Catalyst platform. Our absolute bread and butter is pulling together multiple data sources, standardizing and normalizing that data, and then providing that in a cohesive way to our measures engine.”
– Hazel Morrison, MeasureAble Product Manager, during Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond webinar
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
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