Small healthcare providers: The challenge of quality measure reporting

How is your hospital, healthcare system, or clinic measuring up to national standards? Are your patients receiving proper and timely care? For many small and rural systems, these are difficult questions to answer without proper (and often third-party) support.

In late 2017, the Centers for Medicare and Medicaid Services (CMS) introduced the Meaningful Measures initiative, with a goal to improve the delivery of care while also reducing costs for both patients and providers through the culling and prioritizing of existing quality measures. Part of this initiative aimed to reduce the burden of reporting for providers. For large hospitals in urban settings, it is likely there are employees whose roles are dedicated to the encumbrance of quality reporting. When new quality initiatives come down the pike, adjusting priorities may take some time, but these teams are largely equipped to handle it. For smaller clinics, measuring success—let alone demonstrating it—under complex and shifting quality standards is a huge challenge. Small clinics are also less likely to have adequate health information technology, which adds another layer of difficulty. There are several options that should be considered as small providers look to improve their quality performance.

Health information exchanges

As healthcare has moved more toward patient-centered care, health information exchanges (HIEs) have increased in popularity. If a patient had an emergent event at Big Hospital A but a follow-up appointment at Small Clinic B, does Small Clinic B have access to the medical records completed at Big Hospital A? HIEs help to improve the timely sharing of medical information among providers, aiding in record completeness and informing better decision making at the point of care. Many HIEs are free to join and work with a wide variety of electronic health record (EHR) vendors. Additionally, these HIEs will often provide analytics tools designed to help providers keep tabs on their quality metric performance.

Upgraded EHR systems

The American Recovery and Reinvestment Act of 2009 saw the call for nationwide adoption of EHR systems by all eligible providers. With additional funding and incentives made available, a veritable swarm of EHR vendors suddenly appeared, and today we’re left with hundreds of EHR platforms. As time has passed, several large players have emerged, and these vendors, though expensive, can offer up enhanced quality measure reporting at the click of a button. Unfortunately, some of the price tags of the bigger EHR platforms make them unfeasible for practices with small budgets. Still, grants may be available for those who are in desperate need of an upgrade, and benefits beyond quality measures are frequently seen.

EHR vendor support

It could be that a small clinic’s EHR vendor already has quality measure capabilities, but the clinic lacks the staff or knowledge to successfully retrieve and analyze the data. This is where an EHR vendor contact can come in handy. Check your EHR vendor’s website or manual for contact information, and fire away. They should be happy to show you the more advanced features of your EHR, including quality measure reporting. It is also worth reaching out to other clinics and practices that utilize the same EHR. Sharing challenges and accomplishments in using an EHR vendor is a good way to learn.

Third-party contractors and software

Many smaller organizations choose to “outsource” their quality measure tracking to third-party vendors who specialize in such calculations. This is a wise choice for many, given that these third parties can provide the technology and manpower that is lacking within the organization. However, it’s prudent to thoroughly vet these types of vendors, as the options are extensive within the healthcare industry. Some questions to keep in mind include:

  • How will quality measures be reported?
    • On an aggregate level, or on the patient level? Will individual physicians or clinics be able to see their overall performance?
  • How are quality measure reports delivered?
    • Is it a web-based dashboard? Is it interactive? Will we need separate software to view results? Can I easily share the results with others?
  • How often will results be updated?
    • Monthly? Daily?
  • How often is the measure logic updated to conform to specifications?
    • Is there an extra annual fee for these updates?
    • Is the vendor certified by the National Committee for Quality Assurance?
  • What other health plans use this technology?
  • Is the vendor compliant with HIPAA regulations?
    • How will data be transferred to you?
    • How will data be stored?

It’s important to find a vendor that will help your organization reach and exceed its own unique goals. Do your research and you will see benefits.

Start small

Keeping track of the myriad quality measures can be overwhelming. Many small practices have found success in focusing their efforts on a few measures, which can be a great way to build confidence and momentum among staff. For clinical quality measures, diabetes, high blood pressure, and tobacco use are popular for beginners to focus on, as well as high-impact for patients. Using internet searches to find examples of workflows and processes other small clinics have been successful with can help to ease the initial burden.

While small providers and clinics face challenges unseen by larger organizations when it comes to tracking their quality performance, these challenges are not insurmountable. Small providers and clinics will be able to succeed by utilizing the options above and several more support options available to them.

This blog post was first published by Katherine on LinkedIn.