Annette Antos; Benjamin Westlake; Matthew T. Popovich, Ph.D.
ASA Monitor 06 2017, Vol.81, 24-25.
As more practices are steered by federal payment programs to report quality data electronically, practices preparing to meet the criteria established by the Medicare Access and CHIP Reauthorization Act (MACRA) may wish to consider a range of techniques to operationalize workflows within their practice.MACRA is a complicated payment program that requires practices and individual eligible clinicians to collect and report a significant amount of data to the Centers for Medicare & Medicaid Services (CMS). Over the past few years, the Anesthesia Quality Institute’s (AQI’s) National Anesthesia Clinical Outcomes Registry (NACOR) has successfully submitted data to CMS on behalf of thousands of anesthesia providers through the Qualified Registry (QR) and Qualified Clinical Data Registry (QCDR). Through our conversations with these practices, we have identified several key characteristics that aid in successfully reporting.
A key component in operationalizing reporting in a practice is to designate a physician anesthesiologist or practice administrator who is responsible for the management and oversight of the practice’s reporting activities. Known as the “practice champion,” this person often coordinates physician and staff training on data collection, quality assurance, data submission and timely review of the practice’s AQI reports.
Practice champions, in successful practices, are typically well-versed in regulatory requirements and reporting thresholds. ASA provides a number of educational materials related to regulation (www.asahq.org/quality-and-practice-management/macra) and AQI staff has held, for the past two years, monthly office hours where practice champions and others can learn about recent activities and ask questions of AQI and ASA staff. As a single point of contact, the practice champion also cultivates relationships with AQI and ASA staff as well as AQI’s contracted vendors.
Oftentimes, the practice champion must sort out complex and local problems associated with data submission. In many cases, practices expend resources to coordinate activities with their vendors, acquire necessary hardware and software and obtain information technology (IT) support to automate data flow to NACOR. Some practices have in-house services and expertise while others rely on outsourced or contracted services.
Preparing and aggregating disparate data for submission to NACOR can get complicated as the practice champion may need to connect different vendors with one another and AQI. Data required for submission begins with billing and administrative data. Oftentimes billing systems do not have or understand a key value needed to submit data accurately – the anesthesia episode of care identification number, or “ID.” Online, AQI provides a complete list of data elements and their definitions for practices (www.aqihq.org/files/AQI_NACOR_DATA_ELEMENT_DEFINITIONS_FINAL_v2_103116.pdf). This value is used to ultimately calculate reporting success, and incorrectly reporting this data point will invalidate all other data points. To complicate matters, clinical quality data usually is captured outside and separate from billing data. Aligning this data initially may be time-consuming but is necessary to ensure your scores and submissions are accurate and usable.
Layered on top of gathering billing and clinical quality data are the logistics of where anesthesiologists practice. It is not uncommon for an anesthesia practice to provide services in several separate facilities. Sometimes facilities may have access to electronic health records while others do not (e.g., large community hospital versus freestanding surgical center), whereas multiple larger facilities may use different EMRs, billing vendors or quality capture vendors.
The practice champion should spend some time conducting quality assurance on data submitted from billing and quality vendors. Common issues that practices encounter and AQI staff flag include inconsistent data identifiers submitted from disparate data sources and vendors as well as submitting data that does not meet AQI schema requirements.
Regardless of submitting data to fulfill payment programs, practices that submit data to NACOR should routinely review their reports. Data submitted to AQI is often available for analysis by practices within 24 hours. High-performing practices read their reports on a monthly basis and take effective steps to educate their practice members on how to improve quality or develop more comprehensive data capture techniques. In other cases, practice champions have compared data they submitted against their reports to ensure accuracy.
Many practices in NACOR not only submit data for payment programs but for local quality improvement purposes as well. Practices have leveraged their quality data and information to demonstrate their quality of care to hospitals and other facilities as well as to their surgical peers. The recent redevelopment of the Quality Capture Application also allows practices to collect and submit data on patient monitoring and safety elements as well as anesthesia-related events. Practices and individuals with access to NACOR’s rich data set for quality improvement activities have already taken advantage and published results using AQI data in peer-reviewed journals.
In our conversations with AQI participants, AQI recognizes practice desires for AQI to develop products and services that will improve the data submission process and enhance member experience. The Quality ConciergeTM product (www.asahq.org/quality-and-practice-management/quality-reporting-nacor/vendors) can be used to help practices operationalize and streamline the collection of data from disparate sources and assists in ensuring accurate and complete data submissions.
The initial steps in capturing and reporting data to AQI may seem quite burdensome and challenging. However, practices that have identified a practice champion have witnessed success in reporting and a better understanding in how to best use their AQI reports to improve workflows and quality in their practice. Physician anesthesiologists and their practices should be on the lookout for additional resources, products and services from AQI and ASA this year that could help you fulfill your payment program and local improvement activity needs.