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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

CMS Benchmark Data: Too little, Too Late

by Johanna Georgilas, RN, BSN, MBA, Senior Manager, Clinical Quality Management

CMS recently announced that it will use 2014 benchmark data to measure how well eligible providers performed against 2015 quality metrics compared to their peers nationally. Based on provider performance, CMS will net groups with 10+ providers a downward, neutral or upward payment adjustment on their 2017 Medicare Part B allowables. This is good and bad.

Good news

We want to pay providers based on how well they treat their patients, not how much they treat their patients and the use of that reporting to adjust provider payments help healthcare do just that. Using the most recent quality data to generate healthy competition among providers and physician groups with the opportunity to receive an incentive payment for delivering high quality care is a good thing. When done in a timely fashion, giving providers and physician groups insight into their current performance allows them to define quality improvement goals and set attainable improvement. However, this isn't exactly how things played out this time around.

Bad news

CMS isn’t releasing the 2014 benchmarks until the end of this year, giving providers only a matter of weeks or even days to use the data to improve their quality scores in 2016, assuming providers even have a way to compare their performance to the benchmarks. How can we expect providers to make progress towards an unknown goal? That’s like thinking you passed your college final with an 85 only to have the professor announce after the grades were finalized and posted that the actual passing grade had to be a 95 or higher.

If we want providers to strive for improved quality performance against CMS-determined benchmarks they need access to the benchmark data in a timeframe that helps, not hinders, their improvement. Even after receiving the benchmark data in late 2015, providers won’t learn the impact of their performance until the 2015 Quality Resource and Use Report (QRUR) is released in the fall of 2016… much too late to help them improve their performance. This is where having the right health IT partner is crucial.

At athenahealth, we’re addressing both of these issues. First, we’re helping our providers pick quality measures that we know they have a greater chance of meeting based on their patient population and actual performance data. For example, we just evaluated all of our providers against all available PQRS measures we support (>150) and then identified the optimal reporting method (EHR, Qualified Registry, Registry Measures Group) and the optimal set of clinically relevant measures which will result in each provider contributing the highest quality score for each of their TINs.  Second, we’re providing them with the performance data that will be on their QRUR – real time, at the point of care. Not when it is eight months too late to act/improve upon.

We continue to encourage CMS to recognize that providers cannot improve their quality of care when they don’t know what they need to improve upon. Until then, we encourage providers to lean on their health IT partners to help them gain the insight and real-time data they need.

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Johanna is the Senior Manager of Clinical Quality Management at athenahealth.

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