Erin Crum, MPH
The paradigm shift in reimbursement to value-based care and mandatory quality data reporting presents new challenges for community oncology practices. Specifically, many clinicians now participate in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM), other alternative payment models (APMs), and the Merit-based Incentive Payment System (MIPS). These all tie payments directly to efficient use of healthcare dollars and improvements in patient care.
Many commercial payers have gravitated toward payment models that reflect this new emphasis on value-based care and require data demonstrating high-quality patient care and cost reduction. To ease the administrative burden, CMS has facilitated the collection and processing of information by allowing the formulation of Qualified Clinical Data Registries (QCDRs), which collect data on quality measures from individual providers and group practitioners and transfer this information to CMS. This helps practices to satisfy MIPS requirements for quality and value improvement.
Various organizations have been designated as QCDRs in response to this need for information that shows how well providers are meeting quality and value standards, which CMS uses to determine financial rewards and penalties.
For the MIPS program, CMS allows providers to submit data through a variety of mechanisms in addition to QCDRs. These avenues include claims-based submission, direct electronic health record (EHR) submission, and CMS Web interface data submission. However, QCDRs have a significant advantage over these alternative methods.
The Evolution of a Qualified Clinical Data Registry
In 2017, McKesson Specialty Health launched a full, end-to-end solution for quality measure reporting and MIPS data submission directly to CMS, achieving designation as a QCDR. McKesson’s is one of the few oncology-specific QCDRs. This gives McKesson, in collaboration with providers in The US Oncology Network, the ability to develop custom quality measures that are clinically relevant, improve patient care, and reduce unnecessary healthcare expenditures.
The technological foundation for McKesson’s QCDR is Practice Insights, a reporting platform fully integrated with McKesson’s oncology-specific iKnowMedSM EHR technology. The Practice Insights QCDR enables practices to capture and report on MIPS measures by leveraging the clinical data contained within iKnowMed.
MIPS quality measures and additional reporting metrics for the OCM and other valuebased care initiatives are supported through the reporting platform, and MIPS data are submitted directly to CMS, without the need for a separate registry vendor. This streamlines data submission and minimizes the need for additional administrative resources, both of which are important for oncology practices seeking to participate successfully in the MIPS program. Several QCDRs, including McKesson’s, support data capture and submission for all 3 MIPS practice-reported categories for 2018: Quality, Advancing Care Information, and Improvement Activities.
A Tailored Solution for Community Oncology Practices
Generally, quality measures included in MIPS are broad based and do not address specialtyspecific concerns. QCDRs differ from qualified registries because they do not limit practices to MIPS measures. Often QCDR-developed measures are more specific and relevant to areas of medicine. The support and expertise of physicians, specialty societies, and other healthcare organizations are used to help identify opportunities for quality or cost-of-care improvements and to define specifications for monitoring performance trends. If approved by CMS, these custom-targeted measures can be leveraged for use in the MIPS program.
Table. Looking for Quality and Value
For example, in 2018 the Practice Insights QCDR includes both MIPS and custom non-MIPS quality measures designed to drive improvements and reduce the cost of cancer care. Specific to the MIPS program, clinicians are required to submit data on only 6 quality measures; however, the Practice Insights QCDR supports an inventory of 20 MIPS and custom oncology-specific measures, providing clinicians with the opportunity to select their top 6 measures to submit for MIPS scoring from a variety of measures they may feel are clinically relevant to the way they practice medicine. Measures of quality and value submitted through QCDRs are closely examined for relevance (Table
The iKnowMed technology was recently ONC-ACB 2015 Edition certified, a designation that makes providers eligible for 10 MIPS bonus points if they use the 2015 edition exclusively. The points that practices earn for data submission enable them to improve the quality scores they receive from CMS.
In the future, McKesson intends to continue to identify areas in oncology that drive patient engagement and improve patient outcomes. Ultimately, the QCDR will house an inventory of oncology-specific measures that align with a variety of value-based care programs— beyond MIPS and the OCM—to aid practices in achieving their program- or payer-specific reporting needs.
Erin Crum, MPH is the director of Quality Reporting for McKesson Specialty Health.