By Patrick K. Wier, MBA
Part 2 in a Series
A clarion call to healthcare providers has been issued by congress in the continuous struggle to improve quality of healthcare. In our previous article we explored an element of patient care utilized to challenge providers to leverage big data at hand. Electronic health records (EHRs) are an ever growing asset for a medical practice. The latest attempt from CMS (Center for Medicare and Medicaid Service) incentivizes providers to draw a larger dividend from this asset in the form of Merit-based Incentive Payment System (MIPS).
Taking effect in 2017 MIPS has four components for providers to consider with varying levels of weight: Quality (60%), Advancing Care Information (25%), Improvement Activities (15%) and Cost. In each component the overarching goal asks the individual or group of providers to select activities from their existing data in which to focus their care. They select their focus from an existing EHR with the goal of improving their care based on their population’s data. As each year moves on the provider, based on the level of reporting, will either receive an increased payment, flat payment or reduced payment from CMS.
Let’s take a high level view of what a provider has to consider:
1) Quality: a practice shall select 6 measures out of a possible 271 measures with varying levels of priority. For example, a primary care physician identifies his or her population has a higher priority to improve quality in the condition of diabetics with a hemoglobin A1c (HbA1c)1 greater than 9%. Achieving greater scale of improvement the provider will realize a greater compensation through reductions in required medications.
2) Advancing Care Information: practices shall be required to report one of two options either a) 2015 CEHRT (Certified Electronic Health Record Technology) or b) 2014 CEHRT edition. Lacking CEHRT disqualifies the provider from compensation. After qualification of either option they must select a measure which comes with different weights. Such as, Provide Patient Access to their health records in a timely fashion carries a composite score weight of up to 20%.
3) Improvement Activities: this category focuses on coordination between provider and other system participants with a maximum score of 15%. For example, 24/7 coverage for eligible providers to allow greater flexibility of patients with real time access to medical records.
4) Cost: the final component considers all Medicare claims an eligible provider makes to incentivize them improve quality of covered claims over quantity of claims. There is no weight considered here.
The new guidelines that have been laid out attempt to simplify and focus a provider’s practice. Leveraging technology in the form of EHRs modernizes healthcare delivery by emphasizing how data can achieve economies of scale at the individual practice level. However, does the current system give align business objectives with quality of care? Are there similar efforts in your industry to incentivize and monetize Big Data to achieve business objectives? We would love to hear your thoughts?
1 Hemoglobin A1c is a test to measure the average level of glucose, or blood sugar, over a two or three month period.
Source: WebMD
