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HIEs see themselves as an engine to help practices report on MACRA measures, but there are a few drawbacks.
Regional and state health information exchanges (HIEs) have played an important role in delivering pertinent data at the point of care to better inform clinicians about their patients. This, in turn, has helped cut down on the number of unnecessary tests and treatments. Now many of them are building on the trust they have established to help physicians with their MIPS reporting under the Center for Medicare & Medicaid Services' Quality Payment Program (QPP), under the Medicare Access and CHIP Reauthorization Act (MACRA).
"When the MACRA legislation first rolled out, I thought, here is our opportunity to step up to the plate," said Deb Bass, executive director of the Nebraska Health Information Initiative (NeHII).
In response, the HIE set out to become a qualified clinical data registry (QCDR) and offer MIPS calculator tools to allow providers to report to the QPP through NeHII in 2018. After that, it plans to become a "qualified entity," which will allow it to combine clinical and claims data for a more complete picture of patients. NeHII also plans to help providers report on advanced payment models such as Comprehensive Primary Care Plus.
"The No. 1 strategic element is lowering the quality-reporting burden for providers," said Jaime Bland, NeHII's director of business development.
"We have an extraordinary amount of data we can align to providers, and through the qualified entity process, we can look at the attribution taking place for providers at CMS, giving them a much more complete picture of what they want to report, how they want to report it, and what would be most beneficial."
NeHII is not alone in going down this path. The Health Collaborative, a regional HIE in the Cincinnati area, has received approval from the CMS to act as a QCDR as well.
Dan Porreca, executive director of HEALTHeLINK, an HIE in upstate New York, is evaluating whether his organization should become a QCDR to offer reporting services to its member organizations. He says there are compelling reasons why the HIE should play this role. In earlier grant-funded quality improvement efforts to create diabetes registries, HEALTHeLink ran into data quality issues either because of problems with the EHRs or because providers were entering data into unstructured notes fields that weren't being captured for analytics purposes. "We created a data quality scorecard to help providers understand how good the data is that is being captured and extracted for measures and calculations," Porreca said. That same approach could prove valuable to providers trying to improve their MIPS scores, he said.
One of the drawbacks at the practice level is the risk of incomplete data when patients go elsewhere for treatment, said Marc Falcone, a project manager at the Chesapeake Regional Information System for Our Patients (CRISP), the statewide HIE in Maryland. Physicians usually don't get that information into their EHRs in a coded way so it can be used for quality reporting. The HIE, on the other hand, has multiple clinical and administrative data feeds. "If you are able to aggregate all those data feeds and run quality measures off that data set, you are going to have a more accurate and complete clinical quality measure (CQM)," he said.
To help Maryland providers with quality reporting, CRISP built an open source tool called CAliPHR, which stands for "CQM Aligned Population Health Reporting." Initially it was used to support providers reporting to the Medicaid EHR incentive program. Providers use it run calculations, and with a click of a button they send their CQM results to the state government attestation website.
CRISP plans to use the same tool to help providers with MIPS reporting. "Providers can get up to a 10 percent [of the denominator] bonus for end-to-end electronic reporting of CQMs, and HIEs can play a role there in supporting that," notes Kory Mertz, a MACRA/QPP advisor to CRISP. In addition to the quality reporting, HIEs also can support practices with a number of Advancing Care Information and Clinical Practice Improvement Activities, including sending care summary documents, public health reporting and participation in prescription drug monitoring programs, he added.
"We want to serve as a one-stop shop for quality reporting needs," Falcone said, "and reduce the reporting burden on providers who are being asked to report the same CQMs multiple times or different measure sets for different programs."