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Five Strategies for Easing the Burden of Clinical Quality Measures

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Healthcare systems need to view regulatory measures in a different light. Rather than approaching them as required processes that burden the system, they should be viewed as quality improvement opportunities that lead to best practices. It helps to have a strategy to get there:

Prioritize measures that truly impact patient care
Have a line-of-sight to reimbursement
Understand measure alignment across programs
Involve the right people
Get involved in measure development upstream

The right tools also help, but a plan for success is advised for healthcare system administrators and clinicians who need to ease the reporting burden and take advantage of every measure in a positive way.

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Five Strategies for Easing the Burden of Clinical Quality Measures

  1. 1. Five Strategies for Easing the Burden of Clinical Quality Measures ̶ Britney Rosenau
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Current Healthcare Quality Landscape To receive top reimbursement from payers, Healthcare organizations must collect and submit data on an increasing number of clinical quality measures across programs and across the care continuum. These requirements are compounded by also having to perform at a certain level to get the highest reimbursement and gain recognition in external ranking programs, like the Truven Top 100 Hospitals study.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Current Healthcare Quality Landscape We should not think of measures as regulatory, but as quality measures that happen to be required by regulatory bodies. Perhaps it’s a nuanced difference, but the primary message is that regulatory measures don’t have to be solely check-the-box requirements. Rather, we can think of them as standards for best practice in clinical areas that CMS and other organizations deem so important, they need to be publicly reported and are worthy of additional reimbursement dollars.
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures A hospital system can easily top 1,000 measures on which it must report regularly, and many factors go into prioritizing those that are most important. Performing poorly on some can lead to reduced reimbursement, while ignoring others can put a hospital at risk of shutting its doors. At the same time, regulatory measures don’t always align perfectly with a health system’s overall mission.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures It helps to have a strategy around which ones to give the lion’s share of attention. It’s easy to think that required means required and there’s no room for strategy, but here are five ways of looking at regulatory measures that would indicate otherwise. 1. Prioritize measures that truly impact patient care 2. Have a line-of-sight to reimbursement 3. Understand measure alignment across programs 4. Involve the right people 5. Get involved in measure development upstream
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 1: Prioritize measures that truly impact patient care We all work to keep patients safe and improve their outcomes. Thankfully, we see trends in required measures shifting from process to outcome measures to align with this focus. Outcome measures, like mortality and re- admission rates, are important. Additionally, patient safety measures, such as surgical site infection (SSI), Catheter Associated Urinary Tract Infection (CAUTI), and Central Line Associated Blood Stream Infection (CLABSI) are part of multiple pay-for-performance programs with considerable visibility.
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 1: Prioritize measures that truly impact patient care When complications arise, a surgery or procedure can end up with a different DRG depending on coding, and contribute to decreased reimbursement through both the CMS Value-Based Purchasing and Hospital- Acquired Condition (HAC) Reduction programs. Most importantly it could worsen a patient’s satisfaction and health outcomes. Performing poorly on patient safety measures means not doing well by patients and leaving reimbursement dollars on the table.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 1: Prioritize measures that truly impact patient care Continue to include patient safety and patient harm measures on your organizational scorecards, but be aware of how your internal goals align with benchmarks and thresholds identified in the pay-for-performance programs.
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 2: Have a line-of-sight to reimbursement Financial considerations need to be monitored in addition to those related to quality and safety. We learn this from the adage “no margin, no mission.” It’s important to look at the alignment of measures across programs, understand the reimbursement tied to each one, and then make informed decisions about which ones to support the most.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 2: Have a line-of-sight to reimbursement To further illustrate the importance of certain measures from the financial perspective, consider the HAC Reduction program that says CMS will reduce payments by one percent for hospitals performing in the worst quartile with respect to certain infection and patient safety measures. These same hospitals are involved in the Value- Based Purchasing Program, a CMS program funded by a two percent reduction in participating hospitals’ DRG payments and redistributed based on quality performance.
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 2: Have a line-of-sight to reimbursement Figure 1: A performance tracking tool showing status of multiple measures and the financial impact of that performance.
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 2: Have a line-of-sight to reimbursement Sometimes great clinical improvement work isn’t tied to any reported measures, but it still deserves financial recognition. For example, reducing spine complications is obviously good for patients, but when viewed from the value perspective, the improvement program may have a net-negative financial impact. Having this awareness and connection between quality reporting and reimbursement can help to then tie spine complication measures to a commercial pay-for-performance program and do the right work for our patients.
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 3: Understand measure alignment across programs Health systems are on the hook for too many measures to count. It is critical to understand their similarities to optimize improvement efforts and gain efficiencies in data collection and reporting. There may be differences in measure numerators and denominators between programs, but the bottom line is to find the common ground that improves care in order to do well across program requirements, then integrate and align them so clinicians aren’t saddled with additional work while improving outcomes.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 3: Understand measure alignment across programs While many measures are fixed by program, others allow selecting a subset from a larger list (e.g., Electronic Clinical Quality Measures in the Inpatient Quality Reporting Program (IQR) or the Quality Payment Program in the Medicare Access and CHIP Reauthorization Act (MACRA). In the cases where there is choice in measure- ment it is helpful to keep an inventory of all organization-wide measures reported both internally and externally to see which ones fulfill reporting requirements across multiple programs, and then prioritize those.
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 3: Understand measure alignment across programs There may be a lot of a nuanced technicalities to all the rating systems, but ultimately, hospital systems want healthcare consumers to associate them with lists that rank for quality. Although it may seem like the tail wagging the dog, studies show that performance ratings reported to the public improve hospital quality and reputation. Focus on measures that are included in the various national rating systems, like Truven, Leapfrog, Healthgrades, and U.S. News & World Report.
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 3: Understand measure alignment across programs In larger organizations, certain physicians need to report on specific measures for their professional societies (e.g., Society of Thoracic Surgeons and American Academy of Pediatrics). It is more important than ever, when devising a strategy around regulatory measures, to consider how they fit into the existing quality landscape and prevent them from being an extra burden for clinicians.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 4: Involve the right people For starters, include financial and clinical leadership—the former so they can budget based on performance in these programs, and the latter to track and monitor performance, and deliver the outcomes improvement work. This includes the department within an organization that is responsible for payer contracting. A strong connection with this team is critical to set measure goals with commercial payers that align with the efforts required of govern- ment programs.
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 4: Involve the right people Additionally, involve frontline nursing staff. I had an interesting conversation with a clinical nurse specialist who had attended classes for frontline nurses to explain the rationale behind certain measures and why they were being asked to document in a certain way. Until I met with her, I underestimated how much frontline staff value understanding this rationale.
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 4: Involve the right people Work with physicians to define and align internal measures with publicly reported measures. This has multiple benefits: optimized patient care, and improved forecasting and monitoring of performance in programs like the IQR.
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 5: Get involved in measure development upstream The Measures Under Consideration process exposes all proposed measures for a 12-month period. This is the first opportunity for public comment and a way to impact rules far upstream. Then rules are released as proposed, which presents another period for public comment. These are two opportunities to work with your regulatory affairs team or government and public policy team to draft letters, including clinician feedback, to CMS.
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Five Ways to Manage Clinical Quality Measures 5: Get involved in measure development upstream Feedback may not be incorporated 100 percent of the time, but change is affected by following this strategy and it is a process that gives a voice to healthcare organizations. Develop a feedback loop for selecting measures and rules. Everyone feels greater ownership when they are allowed input into the process. Create opportunities in the measure development cycle and how rules are adopted for people to provide feedback on measures which should ensure that measures dovetail into clinical priority areas.
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Tools that Help Prioritize Measures Inventory Tools A quality measure inventory helps select measures and rules. Many programs have fixed measures, such as value-based purchasing, while others allow for some choice, such as the Merit-based Incentive Payment System (MIPS) within MACRA. This depends on the regulating body. An inventory tool can find measures that fulfill a reporting requirement across multiple programs, which eases the reporting burden and creates efficiencies.
  23. 23. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Tools that Help Prioritize Measures Scorecards A pay-for-performance scorecard can take measures, by program, and include both performance monitoring as well as projected payment impact. This provides all the pieces of the puzzle for executive leadership to make decisions on those measures that deliver the highest impact to patient care and the bottom line.
  24. 24. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Tools that Help Prioritize Measures Measure Management Tools Some tools help with managing measures, estimating payment impact, and can integrate hundreds of measures across financial, regulatory, and quality departments. An ideal measure management tool supports accountable care organizations (ACOs) that participate in the Medicare Shared Savings Program (MSSP), which need to monitor and manage actual performance against CMS required measures.
  25. 25. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Tools that Help Prioritize Measures Figure 2: An ideal measure management tool can display a dashboard to support health systems involved in an ACO.
  26. 26. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Plan for Success with Regulatory Measures Regulatory measures can add value across the organizational spectrum. Hospitals and physicians can be more strategic about which ones to implement to improve care quality, increase patient satisfaction, and reduce costs. When making decisions about quality priorities for the organization, consider not only required measures, but also those with the greatest financial ROI, optimize productivity, and ultimately do right by patients through improving safety and outcomes.
  27. 27. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Plan for Success with Regulatory Measures MACRA presents a unique set of organizational challenges as it impacts the quality performance of hospital-based physicians. As the regulatory landscape continues to shift and reshape, a strategy for managing measures becomes more and more valuable.
  28. 28. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  29. 29. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Five Strategies for Easing the Burden of Clinical Quality Measures The Unintended Consequences of Electronic Clinical Quality Measures Laura Dietzel The Who, What, and How of Health Outcome Measures Josh Ferguson, Clinical Advanced Application Content and Deployment Director Why We Need to Shift Healthcare Quality Measures from Volume to Value Jarod Crapo - VP MACRA Solutions Health Catalyst Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern: Capturing Compliance Measures – Paul Horstmeier, Senior VP
  30. 30. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Britney joined Health Catalyst in January 2015 as a Program Manager for Regulatory Reporting and Operations through the Allina Health partnership. Prior to Allina Health she worked for the CDC’s Prevention Research Center, in Minneapolis, conducting a program evaluation on adolescent health. Britney has a Master of Public Health degree from the University of Minnesota. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Britney Rosenau

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