The Centers for Medicare and Medicaid Services (CMS) is increasingly tying physician and group reimbursement to participation in its quality programs.
However, physicians who deliver exceptional care can still feel the sting of penalties. The culprit: the high — and often prohibitive — cost of quality reporting.
Burden of Proof
A 2016 paper published in Health Affairs estimated the cost of CMS reporting at $40,000 and 785 staff hours per physician. It's a financial and administrative burden that many independent physician groups simply can't meet.
But opting out of reporting programs also carries a heavy cost. Physicians and groups that fail to participate in the Merit-Based Incentive Payment System (MIPS) may now forfeit up to 5 percent of their CMS reimbursements. This number is scheduled to rise to 9 percent by 2020.
In summary, participation in quality reporting is a lose-lose scenario for many independent practices. But one company is working to change that.
Our team at Vituity has found a cost-effective solution to the quality-reporting conundrum.
In 2015, we launched two QCDRs, or qualified clinical data registries:
- H-CPR, which reports on hospital medicine, critical care, and post-acute care measures
- E-CPR, which reports on emergency medicine and urgent care measures.
Both of our QCDRs were among the first in their respective specialties.
A QCDR is a relatively new type of reporting mechanism that was approved by CMS in 2014. In addition to aggregating data and transmitting it to CMS, QCDRs also serve as a vehicle for quality improvement.
Unlike traditional reporting mechanisms that only deal with Medicare data, QCDRs gather quality information on patients of all payers. And in addition to the existing Quality Payment Program measures (largely former PQRS measures), they can create and report on new, specialty-focused measures, so long as these are preapproved by CMS.
This means physicians and groups participating in QCDRs save a huge amount on reporting costs. They also receive a wealth of data on quality measures that are more relevant to them. This detailed feedback can help to drive quality and improve performance.
Vituity has already realized significant savings through our QCDRs. And now we're opening our registries to like-minded groups who want to both meet the CMS requirements and also use more meaningful measures to improve patient care.
As a physician-owned and -managed practice, Vituity understands the needs of independent groups. We believe all physician practices should have access to the best reporting infrastructure in the world — one that levels the playing field with corporate competitors.
Here are some of the benefits of participating in our QCDRs:
Some QCDRs require a direct feed from your hospital's EHR. But this can be expensive and time consuming to implement, particularly for smaller groups.
The good news is that Vituity's QCDRs can be configured to receive your quality data from your billing company's database. For most groups, this option is much faster and easier to set up.
Once the system is synchronized and running, there will be little additional administrative burden for your providers (other than quality documentation, of course).
One complaint about QCDRs is that some registry owners opt to share or sell physician and group data to hospitals. But at Vituity, we can assure you that this is not the case.
To share your info without your authorization would go against our goal of supporting independent practice. Therefore, we only share your data with hospitals, health systems, and other third parties when you request us to do so.
One of the most exciting aspects of QCDR participation is the opportunity to create and report on new measures. Rather than following the government's lead, we can actively shape the direction of quality for our specialties.
In 2018 alone, Vituity had eight new specialty-specific metrics accepted by CMS. We created these metrics based on emerging evidence and feedback from our quality directors, frontline physicians, and registry clients.
For example, we've created four new measures to help providers treat acute pain responsibly in light of the national opioid epidemic:
- Avoidance of long-acting or extended-release opiates
- A three-day limit on opiate prescriptions for acute pain
- Avoidance of opiate therapy in certain conditions (lower back pain, migraine)
- Avoidance of tramadol and codeine in pediatric patients.
Vituity's registry staff has the autonomy to propose new measures with no complicated governance or voting required. This lean approach has likely contributed to our success in promulgating new metrics.
We also benefit from owning two of the larger QCDRs in their respective specialties. The more often a measure is reported, the more weight CMS assigns it.
Visit our website to read a full list of Vituity's specialty-specific measures for hospital medicine, critical care, and post-acute care (H-CPR) and emergency medicine and urgent care (E-CPR).
Our registries provide physician groups with a wealth of data to track their quality program performance and drive improvement. We can also create customized reporting plans to help you track the measures most important to you.
By understanding your group's strengths and weaknesses, you'll be better positioned to remedy them through incentives and education. And as a Vituity QCDR participant, you'll have access to tools and expert coaching to help you reach your quality goals.
An example of how we use data to transform practice:
- In 2016, Vituity providers were 59 percent compliant on MIPS Measure #116 (Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis).
- Seeing room for improvement, we launched an enterprise-wide awareness and education program.
- By the end of 2017, our providers had boosted their performance on the same measure to over 93 percent.
In 2017, Vituity QCDR clients received millions of dollars in Medicare positive payment adjustments based on their reporting and performance. Not only did 100 percent of Vituity providers avoid penalties, 80 percent actually received bonus dollars.
When you participate in Vituity's QCDR, our success becomes your success. Again, this is why we provide our registry clients with the coaching and tools they need to improve quality and report successfully.
Could participating in our QCDR help your group avoid penalties, maximize reimbursements, and transform care? If so, we invite you to email our CMS team at email@example.com.
Thanks for considering us. We look forward to speaking with you further about this exciting opportunity for your practice and patients.
Originally posted March 28, 2018. Updated Jan. 29, 2019.