Webinar recap: “Why data integrity matters for MACRA success”

By nThrive | Posted: 04/18/2018

Are you worried about how well your data will hold up under the scrutiny of MACRA MIPS regulations? In a recent MACRA educational webinar, nThrive experts Moshe Starkman, senior director, value-based reimbursements and Denise French, MS, RHIA, FAHIMA, senior manager of Solutions Marketing, discussed how data integrity can ultimately affect your Medicare reimbursement.

The presenters noted that organizations must be strategic in their choice of metrics to report, focusing on why health information governance and clinical documentation integrity are foundational to any MACRA reporting effort.

Click here to access the on-demand recording.

Choosing wisely on specific measures to report is important, Starkman said, because, with MACRA, you are competing against others not just yourself. “CMS has changed the ground rules, with scoring now based on how you compare against other organizations,” he explained. “What you might have considered a good score before could actually hurt you if your competition is performing at a higher level.”

To judge performance fairly and accurately, French noted that MACRA places a much higher premium on the integrity of clinical data generated during patient care. “MACRA offers providers the opportunity to focus on quality health care rather than simply more care,” she explained, “however, it is also dependent on secure information sharing and patient access through an emphasis on technology and practice improvement.”

This is where the role of health information management (HIM) comes in, helping to protect and ensure ethical use of data, regardless of whether organizations choose the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM) path.

The significance of accurate and complete data has never been greater given the implications of MACRA. Where in the past this information was used primarily to gain insight into general quality levels and practice performance expectations, today these measures are expected to be particularly accurate and will be used to compare a given practice and or provider against another.“The implications of this change put tens of millions of dollars at risk for many care networks!” said Starkman, adding “trust in health information is acutely dependent upon information governance to create a single and reliable source of truth.”

In order to establish and maintain reliable and actionable health care records, the following three areas are fundamental to HIM success:

  1. Accuracy – Does the documentation represent the severity of illness and intensity of resources provided?
  2. Completeness – Does the codified information represent the clinical concept to its fullest capacity?
  3. Currency – Is the clinical information in the patient’s record of care current?

Ultimately, French and Starkman agreed that collaboration throughout the organization is key to improving patient care, revenue and compliance. Gaps anywhere in the clinical documentation will contribute to poor data quality, potentially having a negative impact on QPP performance scores and significantly increasing the risk of malpractice liability.

Dependencies for both MIPS and APMs include:

  • Medical necessity – Can you defend the patient’s care setting?
  • Severity of Illness (SOI) and Risk of Mortality (ROM) – How able are you to ensure appropriate risk-adjusted outcome profiles and payments for hospitals and physicians?
  • Preventing hospital readmissions – Do you have a comprehensive discharge plan that includes the ability to communicate with community care provides to identify risks?
  • Improving quality of care – Are potential patient complications identified and preventive measures put in place to offset risk?
  • Present on Admission (POA) – Have presenting conditions been identified versus hospital-acquired issues to prevent payment penalties?
  • Withstanding audit activity – How accurate and consistent is clinical documentation across the board?

To meet the demands of these rigorous dependencies, successful implementation of MACRA’s QPP increases the need for better clinical documentation improvement (CDI) in both acute and non-acute patient settings.  Because little attention has been paid to CDI in the physician practice setting, this is an area that is expected to increase in importance.

Click here to view the on-demand recording of “Why data integrity matters for MACRA success.”

Interested in being notified about our future MACRA educational webinars? Let us know here.

Denise French, MS, RHIA, FAHIMA

Denise French is senior manager of Solutions Marketing at nThrive. She has more than 30 years of experience in operational, technical, marketing, sales support and leadership roles, with a strong background and proven success in health information management (HIM) business issues and processes, electronic health records (EHR) and workflow.