Quality Reporting Compliance Program- QRC-Assessment Overview
Incentive Program Analysis and Strategic Planning offering is targeted to clients who may not be aware of all the incentive/penalty based programs that exists today and to ensure clients they are capturing all the potential incentives they can based on their patient population and region. This is strictly an assessment to identify current state and provide an analysis of gaps and a strategic road map to the client.
- Clients who may be interested in the full QRC program but need further proof or documentation.
- Clients who are not participating in MU or PQRS today.
- Clients who are small-medium size or have had recent staff turnover who may or may not have the knowledge in this area (this includes MU assessments)
Questions to ask your client
1. Are you reporting on PQRS today?
If yes, great! Do you report as individual or as GPRO? If as individual we can assist you in GPRO (GPRO means Group reporting for their providers versus reporting individually for each provider) reporting which does reduce the total number of measures required and depending on size requires a survey but we could assist in streamlining work for the reporting staff and potentially the providers.
If no, were you aware that original PQRS was an incentive program however now it is penalty based up to 2% for Medicare beneficiaries. What’s your payer mix in regards to Medicare Part B (outpatient is Part B) and would this be a big hit to your organization? If you haven’t reported yet for 2015 for PQRS there is still time and we can assist you to ensure you don’t face penalties in 2017. Unfortunately, if you weren’t aware of this penalty and didn’t report in in 2014 you will face penalties in 2016 but let’s ensure you don’t in 2017 and get this moving. Here's an example just for an internal medicine provider:
- Let's say 1 year for Medicare FFS total payments for Part B was $175,000.
- Now, you'd face 2% decrease in that payment and $3,500 less. If we take that number and multiply by all your providers for scenario sake let's say you have 100 providers we are talking about $350,000 less.
- This can be huge in an organization and we aren't even looking at specialty providers that would typically have a larger Medicare population.
2. Do you participate in an HMO or Medicare Advantage like program?
If yes, that’s great! I presume you likely report on HEDIS measures then, are you having any issues in coordinating/capturing that from the appropriate systems such as your practice management or electronic health record system? How much time do you spend on gathering that information to meet those requirements?
If no, are you aware of all the commercial based programs such as Medicare Advantage that could be available to you based on your payer mix? We can help and I understand this may fall into the revenue cycle management area but ensuring both your revenue and EMR teams are aligned are important to ensure these programs are being captured like PQRS, HEDIS, etc. as often that data is coming from a combination of both systems and not just one.
3. Are you reporting on HEDIS measures today?
If yes, how many do you different measures do you report on? Are there issues gathering that data from the appropriate system (PM/EMR). Many of them overlap with other programs such as Meaningful Use, PQRS, etc. and have you evaluated any overlap among them or considered based on specialty to expand to walk down the path of improving patient outcomes across the board?
If no, why not? There may be some value to you and your organization to investigate this area and our team can perform and analysis and provide this information for you and your team.
4. Do you have a designated staff or team to handle all incentive reporting programs?
If yes, are they full time dedicated to all incentive/penalty based programs or is this part of their overall job description? I ask because many of these programs can have mid-year adjustments/changes and make it hard to keep up with to ensure compliance. Meaningful Use for a quality measure recently changed for NQF 0028- Smoking measure and the downstream that CMS change prompted not only for the vendors such as your EMR vendor to re-code ultimately that measure required an altered workflow change and I know this can be difficult to stay on top of all the different programs. Our assessment/analysis can not only identify that it will also provide any additional revenue options that aren’t being realized today.
If no, how do you handle keeping up with all the different programs available not only at the federal but the local/state level that could be very advantageous. We recently had a client who was involved with a State Program that was offering a large quantity of incentive money to an organization to meet certain quality measures. We can assist in identifying those opportunities.
Suggestions for selling:
1. Ultimately we want to sell the service of the full QRC program that includes are technical ETL/DataMart/Quality Measure reporting along with our validation/configuration/workflow optimization around QRC. Proposing: if a client starts with this assessment and actually signs for the full QRC package then we would use this assessment as a credit to that endeavor
2. Clients who are NOT participating in PQRS now, would be considered HOT targets to sell immediately with a PROMISE to get them to file by 2015 if they sign by 11/15.
3. Clients who are small/medium or have had staff turnover, ideally we’d like them to become part of our Managed Services- QRC program therefore we could consider another credit if we need to leverage this opportunity.
Service Offering Description: Incentive Program Analysis and Strategic Planning
Project Name: QRC: Assessment
Pricing: 20 hours total at 195.hr: $3900 (Consider a flat fee of 4K, no less than $3500 to be offered)
Package: sold individually or used as leverage credit to full QRC or Managed Service QRC Program
- Provide access or actual reports for Practice Management Reports to include: patient population to include general demographics (age/gender), top diagnosis, top insurer, top referring provider, and top procedure report.
- Provide access to or actual reports for Electronic Health Record Reports for at least 3-6 months of current incentive programs data for review.
- Provide current list of incentive program enrollments and selected measures being tracked for each incentive program.
- Complete QRC assessment questionnaire.
- Formal report of findings and strategic roadmap.