CMS Exec recommends learning about reports via FHIR

In a Q&A at the recent Primary Care Transformation Summit, CMS Director Ms. Michael Schreiber touched on several forward-looking topics related to quality measurement, including alignment of scales, measures of equity in health, and digital clinical quality measurement reports using FHIR.

Schreiber is deputy director of the Center for Clinical Standards and Quality for the Centers for Medicare and Medicaid Services. In addition, she holds the position of Group Director of Quality Measurement and Value-Based Incentives. It is responsible for implementing CMS quality strategies including quality measurement and value-based incentive programs to encourage the transition to value-based care.

She is a GP in Internal Medicine with over 25 years of experience in the healthcare field. Prior to her work with CMS, she was Senior Vice President and Chief Quality Officer at Henry Ford Health System (HFHS) in Detroit. At Henry Ford, she was previously Senior Vice President of Clinical Transformation and IT Integration, where she was the clinical lead for the system-wide application of Epic. The Epic app and its use were awarded by the HFHS at Davies in 2018.

Focus on alignment
Schreiber began by noting that the National Quality Management System (CMS) strategy focuses on results, equity, safety, digital transformation, and workforce resilience. Another key principle, she added, is alignment, “because we recognize that there are a lot of different measures that are sometimes a little different, but different enough to make it difficult for organizations to report. We are working hard to align procedures across all of our programmes. In addition, we want Program alignment. There is the MIPS program, which now turns into MIPS Value Pathways, and then the MSSP or ACO programmes. She explained that the innovation models in each of these models were sometimes a little different, not just the processes, but the measures.” The MIPS MVP is a starting point for clinicians, but to make it feel successful in the same procedures that will be used in ACOs, the same measures that will be used in typical programs so that clinicians gain confidence and so that we also continue to build incentives for primary care clinicians to move to value-based programs.”

The future of eCQMs
Schreiber began talking about electronic clinical quality metrics (eCQMs) by saying that she has implemented many electronic health record systems, and recognized the burdens and pitfalls, “but I also recognize that healthcare has to go digital like any other industry. If COVID doesn’t teach us anything else, We need to have coordinated and interoperable data that will help drive real-time quality measurement and support clinical decision. There’s really no other way to do that than with digital data.”

She added that CMS is working closely with ONC and CDC in an effort to push digital quality standards. “At CMS, we are committed to moving towards our quality metrics that are all digital and ultimately reported in this way, possibly through FHIR APIs,” Schreiber added. “We recognize that support management offices have faced a number of challenges, particularly when it comes to data collection. We are providing additional time and additional flexibility to allow ACOs to make that transition, but that transition will come.”

Schreiber recommends that you become very familiar in your EHR with workflows and what drives data reporting, because this should be seamless data from EHRs that were part of the clinical workflow rather than the add-on. Secondly, I emphasized that, know very well about reporting through FHIR.

“Having the FHIR and FHIR APIs is now a mandate not just for healthcare systems, but for payers, and this is really a way for the future. She explained that there is no other good way to move forward in healthcare than through digital transformation.” I encourage everyone to really get involved. In that matter, because that’s definitely going to be the future of digital quality reporting, but it’s actually the future of healthcare as well.”

health justice
Schreiber was asked about the intersection of health equity and quality measurement efforts.

She noted that the Biden administration is truly committed to putting equity front and center, and working to eliminate care disparities. She noted that “we haven’t traditionally had a lot of quality standards that underpin fairness,” but there’s more to come. On the MIPS side, CMS has introduced several measures around screening patients for five social determinants of health: food insecurity, transportation insecurity, housing insecurity, difficulty paying utility bills, and personal safety.

The question is, do doctors examine their patients for this? What is the percentage of positivity rate? In the long term, she said, over the next few years, we are also likely to introduce measures to bridge this gap. In other words, if you find a problem, what do you do in terms of planning to fill that gap? There are other measures that we have seen being developed by other organizations on their way to work, and the National Education Quality Assurance Authority is also adapting some of its measures around equity as well as in a very similar context around social drivers of health.”

Another strategy, she said, involves stratifying existing measures of performance – eg, readmission or vaccinations. She noted, “You can stratify metrics in many different ways.” Via CMS, we’re having these conversations now. Is it race, ethnicity, culture, language, SOGI status, disability status, dual eligibility, region disadvantage index, or any other geographic coding? We look to all of these to decide across agency and across government, what are the best stratification models. We’re looking at some of our performance metrics that are stratified. The plan would be to provide confidential feedback information, to both clinicians and facilities, about their performance, so they can look at what their data actually shows. Over time, you can imagine that we will associate this with payment and public reporting. But I think this is going to take some time because we all need to get used to seeing this data first, to make sure the data we’re giving is correct.”

And she asked, other than screening, what programs would you put in place either in the ACO or in your personal practice to participate in quality improvement in terms of equity?

“One of the lessons from the coronavirus has been the severe disparities in care,” Schreiber said. “For me, that’s really very personal. I’ve been pretty much a primary care physician in Detroit for most of my career. This has affected my patients, it has affected my practice, it has affected my viewing of it. And we owe it to every patient to make sure they get the best out of it.” An attainable sponsorship, so we are very excited about moving forward in that direction.”

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