Reporting and P4P

HQM is not just another cute healthcare acronym. HQM, or health quality measures, is a highly useful automated reporting solution available to NextGen Healthcare clients at little or no additional cost (depending on which programs providers participate in/and if normalized data is shared.) Sounds good, but what does HQM actually do?  Simply defined, HQM is a clinical data repository that automatically reports providers’ clinical outcomes and quality measures data to various data registries required by pay for performance (P4P) programs. What had previously been a time-consuming data collection and reporting process is now an automated and time-saving solution within NextGen® HQM.

Quality programs include, but are not limited to:

Meaningful Use, Physician Quality Report System (PQRS), National Quality Forum (NQF), Million Hearts Program, ACO Medicare Shared Savings Program and Bridges to Excellence (BTE). Additional reporting registries are available on both a regional and a state basis in which providers may participate.

Why Quality Reporting Matters

Centers for Medicare & Medicaid Services (CMS) states that clinical quality measures (CQMs) are tools that measure and track the quality of healthcare services provided by eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) within our healthcare system. Continuously measuring and reporting CQMs helps ensure the delivery of safe, effective, efficient, patient-centered, and timely care.

CQMs encompass many aspects of patient care including: health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagement, population and public health, and clinical guidelines. Quality reporting as such is important for providers to qualify for various care delivery models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). In addition, more and more commercial insurance payers are offering providers an opportunity to participate in quality measures and programs.

Quality organizations must be able to view providers’ clinical outcomes and identify unmet measures in order to maintain payer-defined qualified measures.  A key differentiator that makes this data more valuable is that the physician’s performance reports are derived from actual clinical data based on each provider’s actual performance, not claims data, as do other systems.

NextGen HQM integrated in NextGen Ambulatory EHR and serves as a data warehouse that does the following:

  • Extracts and aggregates data organized by patient encounters. It also houses each quality program’s measures for specific chronic conditions such as diabetes, asthma, and heart disease
  • Produces summary and detail outcomes results using individual program rules
  • Performs automated calculation, tracking, and reporting
  • Extracts new clinical data
  • Provides useable reports to provide insight and performance metrics at the practice, provider, and patient level
  • Enables clients to receive incentive for performance

What do practices have to do?

Practices simply document patient encounters in NextGen® Ambulatory EHR and NextGen® Practice Management (NextGen PM) systems, and NextGen HQM extracts the patient/provider data from these systems to track and report on specific quality measures.

So, where’s the payoff?

This year, CMS released the 2012 Physician Quality Reporting System (PQRS) and Experience Report highlighting a significant increase in participation in both the PQRS and eRx programs. NextGen Healthcare ranked #1 with 8,276 NextGen Healthcare clients (eligible providers) submitted e-prescribing reporting through NextGen HQM with the highest number of registry submissions for eRx. The 2012 incentive payments for the eRx program totaled $335,331,216.

Go to the report for more information about participation by specialty type, reporting option, and quality measure. Download report

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