A new report based on a survey of 120 health systems and integrated delivery networks indicates that most healthcare organizations are relying on electronic health records (EHRs) and population health management (PHM) solutions for quality performance management. However, survey respondents also report low satisfaction with these solutions, and most respondents said their vendors do not offer specific tools for quality reporting programs.
This lack of preparedness indicates that healthcare organizations are at risk of falling short of their goals for maximizing payment incentives, the report authors state.
The survey, conducted by Atlanta-based Porter Research and sponsored by Chicago-based SA Ignite, a consulting and software services firm, surveyed 120 medical, quality and operations executives and directors from large health systems and integrated delivery networks (IDNs), and found that the majority (64 percent) of healthcare providers intend to maximize payment incentives associated with the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP). The survey also found that almost all the respondents (97 percent) rely on their EHR or PHM solution as their primary tool to manage performance in the QPP.
However, the survey responses also indicated low satisfaction scores (39 percent average) for the EHR and PHM tools that health systems are using, which indicates that these ambitious goals may be at risk, the report authors state.
Three factors surfaced in the study that threaten the providers’ ability to maximize QPP incentives using these tools, including lack of system preparedness, poor customer satisfaction rates and limited focus on program complexities, according to the report.
In 2015, the Medicare Access and Chip Reauthorization Act (MACRA) passed with bipartisan support. Under MACRA, CMS applied learnings from existing payment programs to design an umbrella Quality Payment Program (QPP) that combines Meaningful Use, PQRS, and the Value-based Modifier, and ends the Sustainable Growth rate formula for Medicare part B.
Two reimbursement paths under MACRA – the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) – are intended to give providers options for participation, and time to comply. According to the research, 94 percent of respondents are actively participating in the QPP, with 63 percent of respondents choosing to take the MIPS path and 31 percent choosing the APM path.
Value-based programs are rapidly expanding, and survey responders seem to recognize this, as 80 percent of respondents stated that the QPP is part of a broader value-based initiative within their organization.
However, according to the report, responses to the survey reveal that healthcare providers are not in alignment organizationally, and don’t have the right tools to achieve their self-stated goal of maximizing payment incentives in the QPP.
Responses indicated the management of MIPS and APMs reside in the quality department (42 percent), however the rest (58 percent) were scattered across clinical, administrative, IT, and population health. There were a range of responses for the number of full-time resources organizations are utilizing to manage the QPP, with clusters around 1 person, 2 people, 5 people, and >10 people, indicating inconsistencies in organizational approaches to program management, the report authors wrote.
From a tools perspective, 83 percent of respondents said that their EHR solutions are their primary method of managing QPP performance, yet 72 percent reported that their EHR vendor either doesn’t offer a specific MIPS solution, or they don’t know if the vendor offers a solution. What’s more, 94 percent of respondents said their EHR vendor does not offer a specific APM solution. PHM systems faired about the same, as 91 percent reported that their PHM vendor did not currently offer a MIPS solution and 79 percent said their vendor does not offer an APM solution.
The survey results indicate a misalignment of satisfaction with health IT tools and the performance capabilities of those tools, as survey participants were asked to rate the importance of critical functionality to manage performance in MIPS and APMs, along with their satisfaction for leading EHR and PHM vendors. The average satisfaction level across capabilities was 38 percent, ranging from a low of 18.8 percent to a high of 53.2 percent.
“For those who ranked each functional area as important or very important, the satisfaction levels dropped even more,” the report authors wrote.
The rules governing MIPS, advanced APMs, and other value-based payment programs are complex, which makes program management a challenge from both a system and resource perspective. Most respondents are unsatisfied (81 percent) with the level of guidance and access to regulatory experts that they have through their EHR vendors. What’s more, 71 percent are not satisfied with their EHR/PHM’s ability to compare scores for groups and individual reporting, and most are not satisfied with their EHR/PHM solutions' audit documentation capabilities.
“This misalignment between satisfaction and performance on capabilities that are deemed high importance demonstrates the risk that many organizations are facing today," the report authors wrote.
The report also offers guidance on what providers need to consider today to effectively manage performance and maximize payment incentives in the QPP, and other value-based programs, in the future. With 13 ACI measures, 200+ quality measures, and 40 IA measures for the 2017 performance year, each with different weights, benchmarks and exclusions, it can be challenging for organizations to know which measures will have the biggest impact. “Having the right tools in place to identify hidden opportunities, predict scores, proactively address shortcomings and select the optimal reporting method is a must,” the report authors wrote.
The report authors also recommend that organizations create a multi-year plan. While QPP and incentive-based payment models will continue, CMS continuously looks for ways to simplify regulations and streamline the program. Having a multi-year plan supported by predictive analytics tools specialized in regulatory compliance will give healthcare leaders fact-based insights to achieve their goals and better chart their own financial outcomes, the report authors wrote.