Howard Graman, vice president of AMGA Consulting Services, formerly the CEO of PeaceHealth Medical Group and formerly executive director and medical director at Cleveland Clinic, writes about hospitals’ need to make sure that their reporting is right as they move to value-based care. Among his observations in an piece for Hospital Impact:
1. ACO reporting
“Currently, there are more than 400 Track 1 Accountable Care Organizations that are required to report on more than 30 measures—which, in the aggregate, determine whether an organization will be eligible to share in any savings. The higher the aggregate quality score, the greater share of savings that can be retained by the respective provider organization.”
“A critical element of reporting through the group practice reporting option is how the health system selects its ‘groupers,’ that is, the denominator of patients who should be included in any given metric. If the groupers are too broad, there is a risk that patients in the attributed group are included even though they do not have the related diagnosis.”
2. Compensation plan value metrics reporting
“Increasingly, more and more medical groups are incorporating value metrics into their compensation plans, with the average group putting at least 5-10 percent of physician compensation at risk for quality.”
“As opposed to ACO reporting, which includes claims-based metrics and is population-based, most compensation plan reporting depends on visit-based metrics, which measure those patients actually seen in active management. Here, the reporting data is derived directly from the electronic medical record. The creation of reports depends on a careful analysis of the practice workflow and building the report to ensure that credit is given for achievement of the desired endpoints.”
“Repeated testing prior to going into production for all compensation-related metrics is crucial, as it creates a trusting relationship between the medical group and the reporting team.”
3. Guideline adherence monitoring
“As groups become more sophisticated, a next logical step is to move into the realm of guideline-based care. As an approach that has the potential to both improve outcomes and reduce cost, there is much to be gained.
“While most medical groups employ a joint effort between informatics/IT and practicing clinicians to create the evidence-based order sets, it is not unusual for the reporting team alone to create the scorecards for reporting how often individual providers use the preferred pathway. Here again, clinician input is crucial—and its absence can be catastrophic.”
To read his entire commentary, please hit this link.