SPH Analytics offers a suite of solutions that can help you maximize Medicare reimbursements and avoid the negative penalties from the new Merit-Based Incentive Payment System (MIPS). Our solutions minimize workload and administrative burden, while helping you improve your MIPS Composite Performance Score. Depending on your readiness, SPH solutions can improve your scores in any one or all of the four MIPS categories: Quality, Improvement Activities, Advancing Care Information, and Cost.

Timeline for MIPS Value-based Incentives

MIPS timelineAct now to ensure you capture every MIPS point to boost your composite score. Each year, CMS will set a new performance threshold (PT) number of points to avoid a negative payment adjustment. Each additional point above the PT earns higher incentives, and each point the final score is below the PT incurs proportional penalties. Therefore, every point translates directly into higher or lower reimbursement.

SPH Analytics has extensive expertise in population health solutions with more than 25 years of experience in healthcare measures and quality improvement.

  • Boost all four MIPS category scores: Directly impact your Quality, Improvement Activities, Advancing Care Information, and Costs with the SPH solution set.
  • Ongoing monitoring for improved score: Continually track your progress with our guided analytics and intuitive dashboards so you can make targeted improvements before submissions.
  • MIPS submissions: SPH can submit group or individual level performance data for all three MIPS categories.
  • Expert guidance: SPH works closely with our clients on measure selection, performance optimization, and understanding necessary data elements for success.
  • Multi-payer quality improvement: Display measure performance across Medicare and non-Medicare patients to support all payer quality improvement initiatives. Custom measure build available.
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Population Care | Quality Measures Analytics for MIPS Monitoring & Submission

SPH Solutions for Each Performance Category

Your trusted partner for Patient Experience Surveys that can count towards either:

A high-priority patient experience measure in the MIPS Quality performance category, or
A high-weighted activity in the MIPS Improvement Activities performance category

Frequently Asked Questions – About QCDRs

?What is a QCDR?
A Qualified Clinical Data Registry (QCDR) has successfully completed a qualification process and is a CMS-approved entity that collects clinical data on behalf of clinicians for data submission. Initially established in 2014 as a new reporting mechanism for the Physician Quality Reporting System (PQRS), QCDRs can report data for individual clinicians or groups on all MIPS performance categories that require data submission. A QCDR is different from a qualified registry in that it can host "non-MIPS" measures approved by CMS for reporting.
?How can SPHA’s QCDR Plus help me?
SPHA’s QCDR solution (QCDR Plus) is more than just a reporting submission tool. It is a foundational platform to prepare your organization for value-based care and maximizing payments from all payers. For CMS MIPS reporting, QCDR Plus can help you monitor and improve quality measures throughout the year and help you to determine the most suitable for submission to maximize your MIPS score. QCDR Plus will calculate performance on the entire measure library, enable you to select favorite measures to monitor and automatically recommend the best measures for CMS submission. Our streamlined solution alleviates administrative burden on your practice and manages the CMS submission process for you. SPHA can submit data for the MIPS Quality and Improvement Activities categories and earn bonus points in the Advancing Care Information category. QCDR Plus measures performance across all payers for a single quality improvement platform. Additional measure libraries for payer contract management are available for custom build.
?How does a QCDR work?
For MIPS quality reporting, clients determine data submission type (either registry measures or eCQMs) based on available data collected in the EHR. Relevant data required to calculate quality measures will be extracted from the database that stores the EHR data on a regular basis. It is stored in our secure Population Care data warehouse. Quality measure performance calculations and benchmark comparisons are updated and viewed on a web-based dashboard. Numerator, denominator, exclusions and patient list drill down capabilities can help target quality improvement and close care gaps. Each authorized user is given secure access to the dashboard with login credentials. For those providers and/or groups that require CMS submission, additional data validation steps, TIN/NPI attestations and results sign-off is conducted prior to data submission.
?How is a QCDR different from a population health management application or EHR?
SPHA offers a population health management tool (MDinsight) that aggregates and displays clinical data from disparate EHR systems, risk stratifies the population for high-risk targeting and provides practice-level workflow tools to close care gaps. MDinsight is not used for CMS MIPS quality reporting and submission, which is a function of the QCDR. A QCDR also differs from an EHR, which serves as the digital copy of the patient’s medical chart, that includes notes, lab results, scheduling and billing modules. Many EHRs do not support a vast library of standard clinical quality measures. Certified EHR vendors support Meaningful Use measures for the Medicare EHR Incentive Program, which is now MIPS Advancing Care Information. EHRs typically cannot normalize clinical data from multiple EHR vendors and may not be able to support extensive group reporting.
?Will my practice workflow be affected?
SPHA’s QCDR Plus is designed to minimize administrative burden and overhead, so you can monitor quality measure performance without manual data entry or additional staffing needs. Once the initial data mapping is complete, automated data extraction refreshes your quality measure performance without staff participation.
?What MIPS measures can I choose from?
For the 2017 performance year, providers can choose from 53 eCQMs (electronic clinical quality measures calculated from EHR data) or 48 registry-based quality measures that are all MIPS eligible measures. In the future, QCDR Plus will add CMS-approved non-MIPS measures that are aligned to provider types or specialties
?What is involved in implementation?
EHR connection, mapping, QA testing, initial data load, and system configuration typically require 8-10 weeks. Assistance will be required to set up connectivity, local users, and required FTP software. The installation of 7zip and opening of Outbound ports may also be required. Following installation, no additional work is required, unless the practice's EHR software is updated or changed. The typical timeframe may be extended if source/EHR data is incomplete or inaccurate or if the client desires to push a data file to SPHA vs EHR extraction.
?What kind of access do you need to the data?
Only read-only access to the EHR database is required, as there are no changes made to the database itself.
?How often is data collected?
After the load, SPHA will collect data on a weekly or biweekly basis. Continuous data refresh will allow SPHA to provide ongoing updates, trend analysis, and identify measures that indicate opportunities for quality improvement.
?Are you able to work with cloud-based EHRs?
SPHA has worked successfully with a number of cloud-based EHR vendors. We can also work with any new vendors as needed for a successful implementation.
?What file formats do you need?
The data is extracted into a text file format.
?Are these data connections bi-directional interfaces?
These are not bi-directional interfaces. Rather, our connections just enable data pull and transfer to the SPHA FTP server.
?When is data submitted to CMS for MIPS?
The suggested initial data load for QA purposes is 12 months. We suggest a full-year of MIPS performance data be collected for the calendar year January 1st through December 31st. During the MIPS 2017 transition year, data can be submitted for any period of time, but full participation requires a continuous 90-day period and 50% reporting rate for all patients eligible for the measure (Medicare and non-Medicare). For the 2017 performance year, file submission to CMS is due March 31, 2018. SPHA will conduct most customer file submissions between mid-February and early-March to allow sufficient time for review and sign-off.
?What can I expect when getting started?
If your organization has never calculated quality measure performance before, it’s not uncommon to have under-performing scores. This can be due to inconsistent EHR data capture or poor coding. This can also be due to patient to provider attribution (panels) or the inability to systematically target patients who have measure gaps. Over time the use of a QCDR and enhanced visibility into the EHR data can lead to improved data capture and documentation, thus leading to improved quality measure performance.

Helpful Resources on this Topic

Webinar Recording: 2018 MIPS Update
2017 Black Book Report for MACRA & MIPS Technology
Brochure - MIPS

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