A Note From Our CEO: Health care Quality in 2018

Another year is coming to a close. It seems that every year at this time, I think that we are headed into a pivotal year for the health care quality industry. And indeed, we are. Each year brings new disruptions and challenges to the space. But it’s not all doom and gloom. While uncertainty remains around regulatory reporting to CMS, there are some consistent themes I can point to that have remained true for many years. For instance, the focus on the quality of patient care is certainly not new, but the way in which we measure that quality is what continues to change.

This year, I’ve highlighted for you five themes that I believe will be relevant for you in the health care quality space in 2018. Keep these in mind as you dive into the new year.

1. The Silver Tsunami Rolls on

Every day, 10,000 more people enroll in Medicare.[1] This trend, which started in 2014 as the first of the Baby Boomers hit age 65, will continue on for many years to come. As more people enroll in Medicare each year, the largest payer for these enrollees – CMS – is obviously very interested in the quality and cost of care for their patients.

As such, CMS continues to evolve the metrics by which they measure whether a hospital or practice is providing quality service to their beneficiaries. What does this mean to you? Don’t expect the regulatory reporting requirements to disappear altogether. CMS may attempt to lower the burden or come up with alternative forms of measurement, but they will never remove the regulations altogether. Too many people rely on Medicare as their primary insurer. And more rely on them each and every day.

2. CMS is rethinking how hospitals and Providers report their Quality performance

CMS has committed itself to reducing the burden placed on hospitals and practices for adhering to regulatory requirements. As a result, they have launched the “Patients over Paperwork” initiative.[2] Their goal is to simplify what and how quality measures are reported to CMS. They want to ensure they have meaningful measures calculated while reducing the administrative burden placed on physicians. This means they aim to have providers and hospitals report once and get credit for multiple programs.

CMS has also made it very clear that they intend to increase the fee-for-service payments linked to Quality and try to move to Alternative Payment Models. In fact, CMS’ stated goal is to have 50% of their payments to be linked to Alternative Payment Models by 2018 and 90% of fee-for-service payments directly linked to Quality in the same time frame. This is part of their strategy to shift from volume to value, which at its core, is modeled after the Triple Aim.

In any event, I must say that the reality of dealing with Quality measurement is complex in the least. To achieve that vision of aligning the programs and measures it will take time. We should all be prepared to deal with a very complex ecosystem while we wait for that vision to be full.
 

3. EHR adoption is at its highest, but the full potential of this data is not realized

In no time in history has EHR adoption been as high as in its current state. There is a wealth of information that is now stored electronically. With this treasure of information, you would think it would be easier than ever to understand the full picture of a patient’s care. Unfortunately, that is not the case. All of that data must be normalized before it can be augmented to gather any meaningful information for an end user. This is not always as easy as it may seem.

Not only must it be cleaned up, but the data must flow seamlessly between EHRs to gather the full picture. The word interoperability continues to dominate discussions in the quality space. If a system is to measure quality they must be able to incorporate data from multiple source systems which is something an EHR cannot accomplish. Every year, we here at Medisolv work to combat this problem by finding ways to gather all of that data, normalize it and present it to clients in a way that gives them a full picture of the quality of care a patient received at their hospital.
 

4. The future of Quality measures is a hybrid

Let’s review the Quality data that Quality professionals have learned to measure over the last decade and look at the future of Quality measures.

Paper Records

Those of you who have been around for a while know that in the old paper record, Claims measures provided the easiest way to get your hands on some meaningful data. There were some nuggets of clinical information in those claims measures. Enough that some level of Quality reporting could be done.

Chart-Abstracted Measures

To create more robust clinical measures, especially the process measures, chart abstraction was introduced, which provided very reliable and valid measures. Abstractors meticulously followed all of the guidelines, however, this method is labor intensive and unsustainable if you want to do a lot of Quality measurement. Additionally, over time, process measures started topping out and being reduced or eliminated altogether.

Over the last five years, the EHR is now becoming more and more of the digital data store. And the first attempt at using the data for Quality was to supplement the chart-abstracted measures. Technology (like our ENCOR product)  pulls in the data elements to supplement and hasten the abstraction process. Or, if a hospital does not have something like our ENCOR product, their EHR has made accessing the information needed for their charts a little bit easier.

Electronic Clinical Quality Measures (eCQMs)

Meaningful Use introduced the concept of Electronic Clinical Quality Measures (eCQMs). With these measures, the data was not just coming from the EHR, but the whole specification and all of the associated calculations are completed by machines. It is a more or less a machine to machine interaction. If it is defined properly and the data captured properly it will produce accurate results. This has been a part of Meaningful Use program and is being transitioned over to the Inpatient Quality Reporting (IQR) program. These eCQMs have caused a fair amount of difficulty in capturing the data in a structured, codified way.

Hybrid Measures

So, what can you expect next? The latest entrant in this entire picture is the Hybrid measure. This is concept where Claims measures are being supplemented with clinical data. There was an effort underway over the last several years to define certain core clinical data elements that would be expected as structured data capture in most of today's EHRs. So, after a process of consensus building and feasibility testing, 22 data elements were defined as core clinical data elements. These elements contain information that reflect the patient’s clinical status when first presenting to an acute care hospital. Expect to hear more about these core elements and the hybrid measures in the future. 

In 2018, the hybrid measure, Hospital-wide all-cause readmission, is being piloted. Hospitals may voluntarily submit this hybrid measure as a part of the IQR program. CMS will use Claims data paired with the core clinical data elements for each patient to risk adjust the population.

As you can see, there is a fair amount of complexity in the data that is being pulled in. Quality professionals must be prepared to understand each of these types of measures and how they factor into a complete Quality strategy.
 

5. Proving value of care should be a hospital's top priority, but not seeing the full picture makes it difficult

What a year it’s been. Of course, if you ask a hospital if quality and patient safety is a top priority for their hospital they will undoubtedly say yes. But when it comes down to providing resources toward that goal – both financial and human capital – the answer is not as clear.

That’s because hospitals have so much to think about. Expenses continue to rise every year, while payer reimbursement declines. Hospitals are worried about appropriate staffing levels and resource utilization more than providing accurate eCQMs to CMS at a time when regulations can change from one month to the next.

For instance, this year, hospitals went from thinking they would have to report eight eCQMs for a full year, to six eCQMs for two quarters, to finally four eCQMs for one quarter of 2018. And the requirements for the Quality Payment Program in its first year, allow providers to submit the smallest amount of data and still get credit. These changing priorities from CMS make it more difficult to justify the need to establish a comprehensive quality program.

And here is where I will leave you. In the course of my year, I have spent a lot of time educating people on, learning about, talking about and technically analyzing the measures that make up the CMS quality programs. I can tell you this much, it will all matter soon. Slowly, CMS is crawling toward a solution that will measure the quality of care at your organization without overburdening your providers. The sooner you can get your Quality program in place and running efficiently, the better off you will be. Having access to your data will allow you to enhance your hospital’s ranking among the nation’s hospitals and empower you in the Quality department to lead the charge for your organization. Take ownership this year of your Quality reporting program and see how you can drive forward quality improvement.

I wish you all a very happy, healthy and prosperous New Year!

Sources:
[1] https://www.forbes.com/sites/dandiamond/2015/07/13/aging-in-america-10000-people-enroll-in-medicare-every-day/#75d595e93657
[2] https://www.beckershospitalreview.com/quality/cms-rolls-out-meaningful-measures-initiative-to-curb-burden-of-quality-reporting.html