Quality and value seem to be two of the most elusive words in health care today. The debate over how to define, measure, and achieve quality and value, stretches from shore to shore, across all specialties and to the top reaches of our government. While definitions and rules change with startling rapidity, one thing is certain, in order to survive in today’s health care environment you must have a quality improvement strategy in place within your practice.
One thing is clear: tying payment to value is not going away anytime soon. Practices face up to a four percent cut on Medicare Part B claims, under the Merit-based Incentive Payment System (MIPS) program, for poorly demonstrated performance. However, practices that can demonstrate high quality and value have an opportunity for incentives up to 37 percent. In addition, many insurance companies have incentive programs with significant bonuses based on demonstration of high quality and value in your practice.
As I speak with independent providers across the country, I hear the same statement over and over, “quality is for the big guys, and I am just trying to survive.” Creating a quality improvement team, even in the smallest physician practice, can give your practice the ability to remain viable in today’s changing health care marketplace.
When practices think of starting a quality team they often tell me that they do not know where to start. My advice is to start with a basic structure and build from there.
If you have a small practice, your team may consist of everyone that works within the office. If your practice is larger, select a representative from each department to be a part of the team. This person will be responsible for bringing information from their area of expertise to the meetings and for disseminating information and leading change in their department.
It is best to ensure that team members are apprised of all areas of the practice through the implementation of monthly meetings. Set your meeting at a time when your team can all attend and will not be distracted by other impending issues, and hold them accountable for participation.
During your meeting, it is best to set focus around the four areas in the MIPS program: Quality, Resource Use, Clinical Practice Improvement Activities and Meaningful Use of Certified EHR Technology. An example of a good starting point would be to use your EHR data to review Meaningful Use and clinical quality data. In addition, discuss health plans to gather utilization data and perform your own tracking for transitional care management visits and referral completion. Knowledge of current value based programs will help your team decide where to focus your efforts.
In order to successfully meet value and quality standards, it is vitally important to review past performances and tweak any area that could be improved. Have your team review the collected data from surveys and patient satisfaction reports and analyze the areas with lower scores and create improvement plans for those areas. Work with your team on the best approach to improve this area and discuss the progress during the next meeting.
One of the best practices in tracking improvements points is through implementing the Plan Do Study Act methodology. Developed by the Institute for Health Care Improvement, this methodology allows practices to document their improvement efforts and to track what did or did not work. In addition, it provides a framework for ongoing improvement to create clarity and structure to track the success or need for a change of direction in a project.
In both government and payer designed programs, requirements are changing regularly. It is important to designate at least one person to stay up-to-date on these changes and to modify your quality improvement program accordingly. Additionally, this person should also be tasked to work with payers to identify incentive payment opportunities for demonstrated quality and value.
While the creation of a quality team may seem like a daunting task at first, the rewards in terms of both financial gain and pride in practice make it worth the effort. Quality teams tend to take on a life of their own as members begin to take ownership of the process and pride in seeing the practice flourish.
Lynn Guerrant is the Director of Quality Compliance at R1.