Taking off the MU Training Wheels

Question mark picTom Lee Talks About What Lies Beyond Meaningful Use

By Joy Rios, Managing Partner at Practice Transformation
Twitter: @askjoyrios

To the untrained eye, one might think that an EHR alone has the possibility to largely improve patient care, because it can create efficiencies, house patient data, and connect with other types of technologies. However, technology that connects to multiple EHRs have an opportunity to see a bigger, fuller picture of where we stand as a nation with the implementation of Health IT.

SA Ignite, a company dedicated to simplifying healthcare delivery, connects with tens of EHR technologies and offers meaningful and actionable insight to their healthcare clients. Being in the business of making sense of large, complex amounts of data, it comes as no surprise that the company’s CEO and Founder, Tom Lee, has his finger on the pulse of what many healthcare organizations are experiencing all across the country as the transition to pay for performance advances.

Read on to see for yourself.

SA Ignite’s MU Assistant solution tracks Meaningful Use objectives and quality measures for large groups, and can track individual provider performance within a group. Beyond attesting for Meaningful Use, what value are groups gaining from this service? What actions are they taking with the insight provided through the data?

One favorite story is of a client who saw an interesting pattern in their MU e-Rx functional measure: precisely every 7 days, a particular provider fell out of compliance and then regained compliance the following day. It turned out that the medical assistant assigned to the provider on that day of the week had not been trained on the MU workflow for e-Rx and other tasks. The solution then was straightforward once the root cause was identified. A frequent view of MU performance can deliver insights far beyond regulatory compliance, unlocking quality and cost improvement opportunities that might otherwise go unnoticed.

The broader story is that our most savvy clients are viewing and leveraging the MU program as a training ground to develop and hone re-usable processes and approaches for thriving in an increasingly pay-for-performance world. In fact, as difficult as MU can be, MU is loaded with “pay-for-performance training wheels”, such as the clinical quality measures being pure pay-for-reporting where performance levels don’t impact rewards and penalties. In contrast, the Medicare value-based modifier (VM) program ranks providers (in organizations with 100+ providers) on their quality measure performance and rewards or penalizes providers accordingly. The looming new world of pay for performance across both government and private payers will one day make MU seem easy by comparison.

Do you think providers have an opportunity to fundamentally shift their relationship with their EHR from a documentation and billing platform to one that can generate more timely measures of their actual clinical performance?

Start by remembering that the true ultimate purpose of quality measurement is to serve the patient better. Whereas, quality reporting for pay-for-performance programs is just a tool that helps fund the effort for providers and the delivery system to improve service to the patient. In an ideal world, providers could get real-time feedback on their most important and actionable quality measures prior to or during patient visits where those measures could be improved upon through clinical decisions those providers make. So the ultimate end-game of quality measurement is really next-generation clinical decision support (CDS). As quality measures become easier to calculate and transport across information systems, we will see a revolution in how those measures are used to improve patient care. It is also heartening to see standards bodies such as HL7 and within ONC move towards aligning quality measures with CDS such that quality measurement and clinical decision-making become more closely linked. So there absolutely is massive opportunity for the traditional health IT stack to be re-invented and disrupted for the benefit of patients. As consumers become more educated about the possibilities, they will begin to demand it and make healthcare buying decisions where there will be winners and losers.

Due to the complex nature of some of the quality measures, can you speak to the complexity of capturing the correct information for each measure within an EHR? Since certified EHRs are only required to generate a report for 9 measures, should providers expect their EHRs to eventually be able to report on all eCQMs?

The software development, workflow redesign, and provider training required to correctly capture and calculate clinical quality measures is notoriously complex. For example, a HIMSS Level 6 health system we are familiar with spent more than 90% of its quality measurement efforts simply identifying and closing gaps in the data, prior to carrying out measure calculations. That being said, we are seeing that market and competitive pressures will increasingly grow to push EHRs to support more of the eCQMs. As more pay-for-performance dollars, such as with the Medicare Value-based Modifier, become tied to eCQMs, then the stakes grow even higher. One of the challenges is being able to predict when a particular vendor will actually deliver on eCQMs that an organization may be counting on. That is why, at this juncture of the market, it is important to enlist expert advice to figure out how best to balance measure availabilities, reimbursement impacts, and work involved in choosing any particular set of measures for a given pay-for-performance program.

As Meaningful Use incentives wane and penalties take their place, what challenges (or opportunities) do you anticipate for the coming years? Will PQRS penalties overshadow MU penalties?

We see huge opportunities in removing friction out of the performance monitoring and improvement processes across a broad array of pay-for-performance programs. Interestingly, a number of the opportunities have substantial overlap with the measures and infrastructure we already support or provide for MU. We also see that MU and PQRS are becoming increasingly pervasive throughout both pay-for-performance programs and in-house quality initiatives custom to organizations. Regarding PQRS versus MU penalties, I see them really as additive (as they actually are) and that the ways in which MU is becoming embedded within other programs (e.g. MU is the only double-weighted quality measure in the Medicare Shared Savings Program, aka Medicare ACOs) insures that MU will continue to be a major focus for years to come.