The Healthmonix team joined Accountable Care Organization (ACO) leaders throughout the country at the National Association of ACOs (NAACOS) Spring Conference at the beginning of May in Baltimore. There were many great discussions and presentations during the conference, but the hot button topic was eCQM / MIPS CQM reporting. The overwhelming sentiment from the conference is that eCQM reporting is a challenge that all ACOs are struggling with.

The Centers for Medicare & Medicaid Services (CMS) provided strong language to ACOs saying that the timeline for mandatory eCQM / MIPS CQM reporting is not going to change.  CMS encouraged ACOs to use the program years of 2023 and 2024 for strategic preparation and building their infrastructure in advance of the mandatory transition in 2025. 

Challenges await ACOs  

As an ACO, your first task is to understand what the challenges for eCQM reporting are going to be. During one of the breakout sessions on the last day titled, “eCQMs and CMS’s vision for Digital Measurement” CMS stated clearly that the feedback they have received for biggest challenges that await ACOs with eCQM reporting are:

• Data Aggregation,
• Patient Matching
• De-duplication
  
  Healthmonix took special note of data aggregation being a specific pain point for ACOs during this process. We have seen that taking All-Payer data from numerous EHR’s to be very challenging for organizations, especially as you implement different workflows. Our current ACO partners have utilized everything from EHR integrations to spreadsheet upload to help meet the requirements for reporting.  Healthmonix is an organization that can ease your anxiety and address your data aggregation needs.  We have connections with most EHRs as well as the ability to work with numerous data resources to optimize your performance. 

Patient matching and deduplication: a complex undertaking 

As mentioned above, patient matching or de-duplication is another issue that is an undertaking for ACOs. ACOs that have patients that see multiple providers in an ACO that work at different practices will be the most heavily impacted.  During the session, CMS gave guidance stating that, “patient matching, parsing, and data cleansing may rely on a combination of available variables. While variable selection and matching criteria may vary across organizations, ACOs should identify an appropriate combination of variables to achieve consistent and replicable patient matching that provides the most complete and accurate data to meet the measure specification and valid and reliable measure performance.”  If your ACO only utilizes one EHR, then patient matching most likely will not be an issue.  But what if you have 100 EHRs?  You will need to find a solution that can not only ingest your data but can also provide the most accurate patient matching to maximize your gaps in care. 

Data completeness: a key aspect of success 

Data completeness (at least 70% of ALL-PAYER data, for EVERY eligible encounter, by EVERY participating practitioner) for eCQM reporting is a key aspect in being successful for this type of reporting. During the conference, CMS gave guidance as to what ACOs should strive to report on the data completeness threshold in 2023 performance year and beyond, “ACO submissions must include 100% of eligible and matched patients across all ACO participants’ (i.e., TINs) patients. The ACO must also meet a data completeness threshold of 70% for 2022 and 2023 performance years for CQMs, increasing to 75% for 2024 and beyond.  ACOs should not leave practitioners or practices out of the equation when calculating their performance. 

This means that performance data (i.e., “Met” or “Not Met,” or denominator exceptions) should be present for at least 70% or 75%, as applicable, of the eligible and matched patients that meet the measure's denominator criteria.” Furthermore, CMS also gave guidance on the data completeness expectation on eCQMs, “In the case of eCQMs, since they are specified to be calculated using all-patient data and submitted electronically without any manual manipulation certain cases, ACOs that submit eCQMs via CEHRT would generally achieve 100% data completeness by virtue of the eCQM end-to-end electronic reporting.” 

Healthmonix: guiding ACOs to success 

The overwhelming sentiment through this specific session is that CMS is giving ACOs guidance on how to be successful with eCQM reporting. It is clear, by giving this guidance, CMS is stating that ACOs will need to use the next two years to “ramp up” to be successful in this transition. In a previous blog, we laid out the Healthmonix approach to success.  The plan is to get started now and be prepared for 2025 when this gets real. eCQM reporting is challenging beyond just reporting. Having accurate and complete data, mapping a game plan on where the data is coming from, and the infrastructure and buy-in from your providers is vital to your success in this transition. 

Partnering with Healthmonix for seamless transition 

Furthermore, having a partner in Healthmonix will be the key to getting your process and plan in place. The ability to implement a solution that fits your organizational needs is imperative to the overall success of your ACO. Healthmonix is a partner that will guide you through this transition successfully.  We will work with you to identify and meet your needs to be successful in eCQM reporting. 

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