Now that value-based care is here to stay, practice administrators have a new headache: implementing quality programs. With PQRS and the value-based payment modifier (VBPM) mandatory this year and more private payers implementing their own programs, administrators are taking on a second role of quality manager—and it can be a full-time job.
Without the right workflow, quality programs can become a nightmare. Do these situations sound familiar to you?
As quality programs become more complex, the FFS workflow won’t cut it. Our design team has been out in the field with administrators with this question in mind: how can we design a workflow that meets quality program standards while delighting everyone in the practice? Here’s what we found:
What practices are doing: Manually digging through EHR data when reporting time comes, searching for evidence of e.g. foot exams and tobacco screenings.
Time spent: Huge amount of time invested around reporting time, very little the rest of the year. For PQRS, even medium-sized practices may hire consultants who charge $20,000 for two weeks of work getting PQRS data in order.
Pros and cons: This is a stressful approach (to say the least), and can quickly become costly because of last-minute emergencies. One practice we spoke with had physicians audit each other’s records (yes, doctors going through notes to look for quality data!) and could only ultimately report a small sample of patients. In the absence of an ongoing workflow in many practices, last-minute reporting was a common but often-costly band-aid.
Beyond that, annual reporting doesn’t give a practice the opportunity to address gaps in care before submission. If a high number of patients aren’t getting, for example, biopsy follow-ups, knowing that at the beginning of the year could have made for a relatively easy fix. Now that VBPM is pay-for-performance (not just PQRS, pay-for-reporting), the actions taken against the metrics throughout the year can result in significant extra reimbursement and help you avoid penalties.
What practices are doing: Periodically generating reports from the EHR to check measure status and see lists of patients with poor performance.
Time spent: At a small practice that diligently tracks quality metrics, it wasn’t uncommon for an administrator to spend nearly full-time tracking patients and liaising with physicians to administer just a couple programs.
Pros and cons: If reports are generated regularly enough, this approach can give practice administrators information on the lowest-performing patients, allowing him or her to make changes in clinic workflows (e.g. add a nurse follow-up call to diabetic patient visits) and capture positive outcomes before reporting time comes. Across the board, we have found that these workflow changes are most often driven by ambitious administrators.
However, it’s often hard to get patients back in the office once a report is analyzed, so reports really need to be pulled quite often to be most effective in ensuring proper care. In addition, it’s usually up to the administrator to pull the insights out of tools—many analytics products offer a big data dump and require a couple dozen clicks to generate a useful report. This is especially true of reporting features in EHRs themselves.
At the most high-performing clinics, we saw consistencies in workflow appear over and over again:
At a large, well-resourced chain of practices, Paladina Health, this is the workflow they use. Every day a care manager checks the list of high-priority patients coming in and talks with the physician in the morning about all the patients that need particular attention that day.
At one small clinic, an administrator had hacked together a similar workflow. She printed and annotated a data sheet on each patient coming in with a care gap and placed the annotated note in the physician chart before the visit.
At Able Health, we aim to make this best-in-class approach available to all practices. To do this, we created the Visit Inbox. Able pulls up patients who are coming in soon and are not hitting one or more measures in relevant programs, starting with PQRS, and helps you take action to close their gaps.
We call the Able Health approach Administrative Decision Support. Just as Clinical Decision Support tools put the right information at a doctor’s fingertips at the right time, our Administrative Decision Support tools make it easy for administrators to set priorities and take action based on data.
No more wading through EHR charts and paging through report dashboards. We want to give every administrator the tools to be best in class in the value-based healthcare system.
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