Deborah Gash: Data reporting in the age of value-based reimbursement

Editor's note: This is part two of a two-part Q&A with Deborah Gash, vice president and CIO at Kansas City, Missouri-based St. Luke's Health System. In part one, Gash discussed the investments her organization has made in data security.

LAS VEGAS -- Sweeping changes to how Medicare will pay for physician services under the Medicare Access and CHIP Reauthorization Act (MACRA), which will implement new physician quality and value-based payment programs in 2019, has organizations reevaluating their quality data reporting tactics.

Kansas City, Missouri-based St. Luke's Health System is in growth mode--with an eye on population health management and preparing for value-based reimbursement. It's aligning with other healthcare organizations, has expanded its ambulatory services, including multi-specialty clinics, and plans to increase its post-acute care and retail business lines, as well.  

Like many other organizations, improving quality data reporting has been a challenge. "It's a moving target," said Deborah Gash (right), St. Luke's VP and CIO, in an interview with FierceHealthIT at this week's annual meeting of the Healthcare Information and Management Systems Society in Las Vegas. "We're still waiting for all the final regulations to come down."

Gash, who was one of FierceHealthIT's 2015 Influential Women in Health IT, explained how her organization is helping its physicians, both employed and affiliated, keep up with evolving quality reporting requirements.

FierceHealthIT: What are some of the biggest challenges of physician quality data reporting?

Deborah Gash: Historically, you needed to record data to avoid a penalty. It didn't matter what the data looked like--we just needed to send it. Then all of a sudden there was this value-based modifier. It took a lot of physicians by surprise. I started getting calls from private practices, saying "do you know what this is?'" They wanted to know what they could do about it. I told them "there's nothing you can do about it right now; just try to correct it in future years." Physicians knew they had to submit data, but weren't thinking about penalties for what the data looks like.

There were some people, even within my own organization, who thought "Well, it's just the doctors who have to report." They didn't understand the rule includes certified registered nurse anesthetists and nurse practitioners, for example--not just ambulatory providers. When you compare that to Meaningful Use, it's a much broader scope.

Trying to improve those metrics is really tough work. It's not as mature in the physician space because you don't have folks focusing on that.

For large organizations, you have that skill set and can apply it in the physician space. But a lot of people are struggling with meeting the regulations--and they're changing and merging into new legislation around MACRA and MIPS (the Merit-Based Incentive Payment System).

FHIT: What have you done to help physicians improve their quality data reporting?

DG: Within my own organization, it's educating people about the regulations. From an IT perspective, we can help by improving the build of the electronic health record to ensure that the right documentation is done. To say "This is a reflection of true practice." Because a lot of times clinicians follow all the best practices. They just don't document that they follow them all. And we had this happen in the hospital, too. So IT can be instrumental in helping to design workflows and putting in decision support tools to capture what you need for quality reporting.

It can be very challenging when you have a multi-specialty group. The easiest thing you can do is pick nine measures and submit that for the group. But it's usually primary care physicians who carry the burden for those measures. In independent multi-specialty practices, for example, some specialists don't feel accountable and they don't understand how they can contribute. And so they disengage.

You have to evaluate what it is you want to report on and which metrics you should pick that will allow you to engage those providers.

Sometimes the easiest path isn't always the right path.

FHIT: So how did St. Luke's get on the right path?

DG: You have to evaluate a lot of different things about your organization, such as challenges that prevent you from being too sophisticated. For us, that was the case in 2015 when we changed our electronic health records system in mid-year.

It was difficult to build out anesthesia and cardio, for example, and have it ready for a new EHR. Given that change, we had to determine what makes best sense for quality reporting. Using a decision tree, we picked 24 measures--rather than nine--that had some relevance to cardiology, some to primary care, some to pulmonary, etc. We did our best. The measures didn't necessarily cover the hospital-based doctors, but we felt we could be successful as a group.

Editor's note: This interview has been edited for length and clarity.