Reporting of Structured Quality Data

As we move to a value-based reimbursement model under the new Medicare Quality Payment Program, the use of discrete and codified data is crucial.

Healthcare initiatives such as Accountable Care Organizations, Patient Centered Medical Homes, etc. are requiring structured data, in order to demonstrate improved outcomes and decreased cost. This data is structured and captured by using templates, drop-down lists and check boxes; free text is not structured.

Quality data reporting is a major component of MACRA and a risk assessment of accuracy and completeness can help you and your organization succeed.

These are the steps to follow for conducting a risk assessment:

• Determine how data is collected and submitted for the organization: Create process maps representing the reporting process, including timeframes for data collection and submission. Inquire about policies and training programs.

• Coordinate Interviews: There are three main groups of individuals that are part of the quality reporting process:

• Physicians and staff in the clinical setting

• Data entry staff that respond to error messages related to accuracy and integrity of data

• Documentation auditors

As part of the interviews, find out the type of training received; whether formal classroom training or on-the-job and if there are experts available to answer any questions.

Discuss the process for addressing errors and reducing their frequency in the future. Emphasize the importance of coordination across all departments when identifying problem areas and establishing a tracking method to resolve the issues.

The organization might utilize a third party vendor to report patient satisfaction with care. An individual or group needs to be responsible for monitoring vendor’s timely data reporting.

When data is collected by the EHR, determine if the organization has reviewed processes to address functionality that may impact the accuracy of reported data.

• Validation Audits: Select a sample of records and extract data used for quality reporting and check for accuracy. The sample should be a combination of randomly selected records and those with high risk points.

These audits may include verification of required timeframes and organization-specific policies.

The data selected is compared to the data submitted, and a percentage of agreement is calculated which can be utilized as an error rate for future monitoring.

• Training Programs: These programs are based on the functions that each individual has in the quality reporting process. Important topics to include are:

• Responsibility for submission of accurate data.

• Timeframes for completion of a task

• Procedures related to accurate data collection and correction

• Review of Policies: The objective is to determine if they represent the procedures discussed in the interviews as well as to evaluate the expectations across departments regarding accurate and timely data submission.

References

Asher, L. (September 2016). Reporting quality data: Getting it Right. Compliance Today, 29-32.

POSTED IN INDUSTRY NEWSTAGGED HEALTHCARE INITIATIVES, MACRA, MEDICARE, TI