Navigating the Maze of Ambulatory Clinical Quality Reporting in 2015

Balancing short-term workload and resource increases with long-term benefits

CMS has implemented multiple quality reporting programs to assess the quality of care provided in the ambulatory setting, which include:

  • Physician Quality Reporting System (PQRS)—Aims to enable better quality performance comparisons across provider groups
  • Value-Based Payment Modifier (VBPM)—Takes PQRS data and layers on cost performance to appropriately reward high-value providers and penalize low performers
  • The EHR Incentive Programs or Meaningful Use (MU)—Promotes adoption and use of an electronic health record (EHR) as part of the care delivery process via incentive and penalty mechanisms
  • Medicare Shared Savings Program (MSSP) and Pioneer ACO (accountable care organizations)—Creates innovative payment models to focus on values and quality of care
  • Comprehensive Primary Care Initiative (CPCI)—Fosters collaboration between primary care practices and both public and private payers to deliver high quality, coordinated, and patient-centered care

While these programs vary in their specific requirements, their shared characteristic is the tie to financial incentives or penalties, and clinical quality measure (CQM) reporting requirements. To help reduce the CQM reporting burden, CMS allows EPs to report once and meet the quality reporting requirements across these multiple programs. However, EPs and their practices must contemplate the multiple reporting options and decide whether they should and can take advantage of the CQM reporting alignment.

Clinical, meaningful use, quality, and IT leaders of a medical group or a physician practice need to collaborate to make critical decisions on the following:

  • Should and can they leverage the reporting alignment opportunity?
  • What resources are available and would be required to take on this initiative?
  • What are the benefits and challenges of the aligned CQM reporting?
  • Which CQM reporting option is most suitable for EPs within the organization?
  • Do their health IT developers/EHR vendors commit to ongoing support for electronic CQM data submission?

This research report provides guidance to help the relevant stakeholders determine answers to these questions.

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