Mission Health Partners, Coin’s ACO, takes a middle course. Its member practices, which have nearly 20 EHRs, generate electronic clinical quality measure (eCQM) reports and send them to the ACO, notes Fields. This process does not require interfaces, he says. The ACO then aggregates the data, formats it correctly and submits it to Medicare and the Medicare Advantage plans it contracts with.
While this approach is easy for the practices, which don’t need software beyond their EHRs, “the quality of these [eCQM] reports is highly suspect,” Fields says, because some of the data may be missing or inaccurate. So the ACO has to send people into the practices to do random chart reviews to validate the reports.
Brull and her colleagues, in contrast, manually enter the majority of the data required for their ACO’s quality reports. Their EHR interfaces with the ACO’s system, but the practice is “responsible for ensuring that the information obtained through our EHR is valid and that any data gaps are filled in,” Brull says.
The interface automatically populates about 20% of the required quality reports—an amount that will soon rise to 50%, she says. The data that automatically goes to the ACO also populates a quality dashboard that shows gaps in patients’ preventive and chronic care.
In order to improve their quality scores in MIPS and other programs, physicians need feedback on their performance.
CMS provides some feedback on quality, but it comes several months to a year after the data is submitted, according to Zetter. In contrast, ACOs usually supply feedback quarterly or monthly, Teske and Mastagni say. Zetter notes, however, that some ACOs provide infrequent or no feedback. He advises physicians to avoid those ACOs.
CMS compares the data on individual clinicians and groups to that of other entities reporting to MIPS. ACOs are supposed to pass that information onto their members, and they may also provide comparisons of practice scores with those of other ACO member groups.
Mission Health Partners supplies feedback only at the group, not the individual provider level, Fields notes. Each quarter, the ACO publishes spreadsheets on its member practices, and aggregates the data by tax identification numbers. The data are based primarily on MSSP metrics, he says.
The ACO is in the process of transitioning to an interactive scorecard that will incorporate both quality and financial performance. Practice managers will be able to click on various areas of utilization such as emergency department and inpatient usage. (Some of this information will come from Medicare claims data.)
At present, Coin doesn’t feel that the ACO’s feedback is very useful, because her group is “a well-oiled machine” on quality measures. But in the future, she anticipates, it will become more important, especially in the area of costs. She’d like to see the utilization data derived from Medicare claims information, she says.
Brull, who is her ACO’s quality director, says that her practice uses the ACO’s feedback on quality every day. “We continuously are examining the data that is available and working through potential gaps in care,” she says. The group uses the data to close care gaps for patients without pneumonia shots and those who have abnormal HbA1c’s and elevated blood pressure, among others.