COVID-19 has drastically changed everything. Yet it has certainly uncovered some learnings, particularly for healthcare. The truth of the matter is, chaos breeds opportunity. And when budgets are cut and resources are constrained, like they are now due to the pandemic, organizations are forced to think differently and adopt innovation.
Over the last 20 years, quality measurement has been widely-adopted within the healthcare industry due in large part to the mandate to improve quality of care and, by extension, clinical outcomes. As a result, the U.S. healthcare industry now has thousands of quality measures to choose from, many of which are duplicative, overlap, or do not cover critical disease burdens that should be managed. This results in a lot of confusion and chaos for organizations as they choose which measures are important to their reporting and clinical quality improvement needs (sometimes these are the same, but not always). Choosing measures that are mis-aligned with their patient population can cost provider organizations upwards of millions of dollars annually in potential reimbursement. In addition to potential opportunity costs in the form of lost reimbursement, measure reporting costs the industry billions of dollars annually in direct and indirect costs. In fact, a 2016 Health Affairs study revealed that providers from four specialties spent over $15.4 billion dollars annually to report quality measures, resulting in an estimated 785 hours per physician time spent on quality reporting...and this doesn’t even include the time spent by measures vendors or EHRs.
Providers typically prioritize the implementation and use of quality measures based on the following: the measure's expected effect on patients and healthcare, the potential for promoting improvement, scientific evidence and usability, and feasibility. Measurement vendor (e.g., HEDIS, MIPS, EHRs) organizations typically prioritize their measure implementation based on the needs of their provider customers. Some providers might even choose measures based on what is available to them through their EHR or measurement vendor. Yet, a critical factor not considered prior to implementation is cost. In a time as critical as now when there is ever-growing pressure in the healthcare industry to tighten the belt, it’s a major oversight to not consider cost in the prioritization of measures. However, due to a lack of transparency in the industry, costs associated with measure implementation, measure execution and maintenance are not widely available or easily discernible. As a result, organizations are left to grapple with the costs retrospectively, after implementation.
The good news is industry leaders have recognized the need for change in quality measurement. Both the Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) have made significant strides in making the transition to digital quality measures and more precise measurement a reality. CMS has made their future strategy for digital measurement clear with the regular rollout of new digital measures each year for both eligible professional and eligible hospital measures. Additionally, earlier this year, NCQA stated, “Moving to dQMs is essential to reduce burden, improve accuracy, produce more clinically relevant knowledge and measure what matters using rich data collected from multiple sources.” The transition to dQMs will not only allow for multiple sources of electronic data but also empower organizations to have more transparency into the costs for implementation. In a recent comparison, Apervita found utilizing dQMs reduced measure implementation time by 90%.
The transition to digital quality is inevitable and organizations would be wise to adapt now in order to realize cost savings immediately.
The transition to digital quality is inevitable and organizations would be wise to adapt now in order to realize cost savings immediately. As stated by Dr. Michelle Schrieber, CMS Director of the Quality Measurement and Value-Based Incentive Group, at the 2020 CMS Quality Conference, "Value means improved cost and quality, and we need to be looking at the data performance of both to continuously examine our performance and improve our care." A critical component in measuring the value of quality measurement should also include the cost associated with the actual measure implementation, in addition to the costs of care.
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Cost Data to Improve Quality Reporting, Value-Based Purchasing. https://revcycleintelligence.com/news/cost-data-to-improve-quality-reporting-value-based-purchasing
Measuring the cost of quality measurement. https://www.sciencedaily.com/releases/2017/08/170831151249.htm
It's All About the Data. https://qioprogram.org/quality-conference-day-2-recap
NCQA Comments on ONC Health IT Strategic Plan. https://www.ncqa.org/comment-letter/ncqa-comments-on-onc-health-it-strategic-plan/
The Core Quality Measures Collaborative: A Rationale And Framework For Public-Private Quality Measure Alignment. https://www.healthaffairs.org/do/10.1377/hblog20150623.048730/full/