HDVI's CEO, Michael Klotz, and COO, Mike Curran, talk about how HEDIS® audits can be made easier with the MRRV Wizard.
With the books closing on our 2013 HEDIS® data collection projects and with a fresh copy of the 2014 HEDIS® Technical Specs in hand (actually in both hands, this thing is getting War and Peace big!), I thought it would be a good time to reflect on the year and what we learned.
- Failing a Medical Record Review Validation should now be virtually impossible. Apprehension and fear abounded as the launch of HEDIS® 2013 drew near with the new deadlines and rules for the MRRV. In reality, the new rules actually improve a health plan's chances of passing the audit. True, execution and adherence to data collection and abstraction timelines are more important than ever, but even plans that start data collection as late as March should have 8-10 weeks to collect and abstract for their samples. This should be more than enough time to do a very good job on hybrid data acquisition. Knowing which measures are going to be reviewed on May 1st, plans and/or their vendors can begin the process of audit prep in parallel to the final weeks of collection. Plans with greater resources typically don’t wait for the measure list to come out as they over-read 100% of any measures they suspect might be pulled. By May 15th, plans, informed by their auditor’s input from the convenience samples, should be making decisions on which numerator hits they may want to back out of compliance due to missing or incomplete documentation before sending the lists to auditors. Once the lists are sent to auditors, there should be very little uncertainty about whether documentation exists to support numerator hits.
- Avoid the temptation to be too conservative. I have no doubt that thousands of perfectly viable numerator hits were backed out of rates this year due to fear of failing the audit. This was a tough year for both Compliance Auditors and Health Plans; the stakes have been raised. CMS is paying out (or not paying out) hundreds of millions of dollars in STAR Rating bonuses based largely on HEDIS® performance. The is more pressure on auditors to make sure that their audit work papers reflect a scrutiny that satisfies the NCQA and CMS that rates are valid and free of shenanigans. The convenience sample is not the only time auditors should give health plans feedback. Plans pay auditors for their services and can switch if auditors are not adding value. Have auditors review troublesome measures throughout the project. This way, plans can submit numerator lists with more confidence and less back tracking on hits due to nerves.
- Year-round partnerships with chart collection and abstraction vendors are more critical than ever. Points 1 and 2 above amount to very little if a plan and its vendor cannot get out of the gates fast. Both parties need to work together in the off-season to identify a network engagement strategy that will assure timely access to groups and physician offices. For example, identify special-handling groups that should be done first, EMR groups to which plans may be able to get access, or groups that may be open to block scheduling prior to the release of the samples. These are all worthwhile “off-season” activities that plans and vendors can collaborate on to ensure a fast launch in 2014.
What have you learned from the HEDIS® 2013 season?
OK, we’ve actually done it in under 15 minutes. Generate the complete MRRV Response package for the auditors, that is. We used the second MRRV Wizard in MRCS (we discussed the first one last week) to accomplish this.
How It Works…
It takes a few seconds to select the numerators and exclusion categories previously used in the MRRV Prep Wizard (as determined by the auditor), which is done in the first step in the MRRV Package Wizard. In step 2, using the filter and search function, find and select the appropriate members the auditor requested to audit. Someone good at copying and pasting member names can complete this step in 1 – 2 minutes for each numerator and the exclusion category. So now, let’s say we are about 9 minutes in.
Next, is a review screen that shows all the selections made, checking this list takes a couple minutes. Once confirmed, clicking one button takes care of the rest. It triggers the system to generate one zip file with everything in it:
- One zip file for each numerator and exclusions (6 zip files)
- One PDF for each member within these zip files (typically 16 PDFs for each numerator/exclusion)
Those PDFs have everything in them. A cover sheet with all the member and measure information, date and time generated, user who generated the PDF and all relevant numerator (or exclusion) information on it. For each numerator value, a page reference to the appropriate chart and page number on that chart as a clickable hyperlink.
The package automatically includes all the relevant charts (sometimes there are more than one) and each page has the chart (or Chase) ID as well as the page number on them, just to be sure.
It takes a few minutes to generate that package. One ZIP file, albeit a big one, ready to ship to the auditor, securely downloadable directly from the system. Done in 15 minutes.
So, if you take your time, double and triple check the selections and also consider the time to deliver the file to the auditor, you can be easily done in 60 minutes. Knowing that it’s complete, neat and clean.
The HEDIS® 2013 project season is coming to an end and Medical Records Review Validation is more stringent than ever, with tighter timelines leading up to it. Uncertainty remains until the auditors give an 'all clear' in the next couple weeks. Not fun.
So, what have we at HDVI done this year to assist clients with their HEDIS® Hybrid projects? Well, quite a few things, including even more stringent quality controls on abstraction, over-read and data. The latest features we rolled out just ahead of the MRRV weeks may deserve special attention because they aim to make MRRV as pain-free and anxiety-free as possible.
What we came up with are two wizards. This blog post discusses the first one. The second one will be discussed in our next blog post.
The MRRV Preparation Wizard
It is common, logical and prudent to review all the MRs and abstractions for the numerators chosen by the auditor (typically 5 numerators and all exclusions). In addition to all the QA features and over-read capabilities (for project team and/or client), the wizard allows the selection of the relevant numerators. It provides a simple yet powerful way for a targeted review of all the hybrid-positive numerators and the associated medical records, and tracks 'cleared' members and those with issues/questions/concerns.
Results: HDVI's project teams reviewed the relevant numerators in a 'beta-pass' in just a couple hours, then clients performed their own review using the wizard. Within a couple days, any members with questions were isolated and resolved (no abstraction errors were found due to prior QA working as designed). Last-minute abstractions that came in were easily identified and reviewed as well. Member lists for the relevant numerators and exclusions were created with the click of a button. Now we wait…
Return for part 2, where we discuss how the second wizard makes completing the MRRV Sample process easy.
Here is a short video that shows a typical provider visit by one of HDVI's field technicians. While not overly exciting, it clearly illustrates some of the key features of HDVI's patent-pending MRR approach:
- Scanning speed
- Comprehensive protection of PHI (notice how no paper leaves the provider)
- Least intrusive to provider (little space needed)
Learn more about our completey secure approach to PHI.
At a recent LAVA Healthcare meeting, the discussion inevitably turned to technology and technology-related topics. An eerily familiar discussion to me, one where I find myself feeling about as guilty as productive. Productive, because technology and processes is what I use to make things work; better, faster, etc. Guilty, because I often catch myself thinking technology is the solution to all our problems...
A certain quote always comes to mind during those moments:
'We've become the tools of our tools'
Despite its undeniable effect, the quote is not shocking at a time when we have gadgets for everything and stare at one screen or another, pretty much from the time we check the weather in the morning to streaming Netflix before we fall asleep. What IS shocking is that the quote is from Henry David Thoreau (1817 - 1862). I try to imagine what he would say if he could see what we are doing to ourselves today with our fancy technology. Many words come to my mind. Throeau, no doubt, would have been more eloquent in stating them.
When we talk about EHR adoption, HIE, ACO, RAPS, medical devices that connect to the Internet, Healthcare apps for our mobile phones and many other things, we have to keep things in perspective. If we do, and the more we do it, the better we will be at tackling our challenges with those fancy technology tools of ours. Let's remember that a physician needs to be attentive to a patient and maintain eye contact. This basic patient contact should not be sacrificed as the physician enters reams of information into the new EHR. Let's aim high and capture that valuable data AND enhance patient encounters.
It's almost gratifying that Thoreau's quote still has a very strong, humbling and yet cleansing effect on me. It's almost like a reset after which I see things a little more clearly. We need clarity, especially if we are to have a meaningful impact. We'll, of course, often arrive at the conclusion that 'less is more', or as Thoreau put it:
'A man is rich in proportion to the number of things he can afford to let alone.'
Many changes in technology, health policy, and healthcare finance are changing the way PCPs interact with their patients. Within the last two to three years some doctors and patients began to communicate over email. Then communications went mobile, with text messages including reminders sent to patients, while patients were sending biometric data to providers via mobile devices. With the explosion of social media tools this new means of connecting doctors and patients continues to evolve offering new, and innovative ways for providers to interact with their patients, specifically those with chronic illnesses. These different communication methods will enhance and support providers efforts to better manage their patients. At the same time, federal and state government agencies, and health plans have developed healthcare performance measures to measure the effectiveness of providers including: Meaningful Use measures, HEDIS®, PCMH accreditation measures, and Pioneer ACO quality measures. These measures have led to increased demand to capture details of patient encounters which may not always appear in claim submissions and are often hard to find in medical records, whether electronic or paper.
Some of these interactions may actually involve details relating to certain measurable hybrid performance metrics. Those might include weight counseling, anticipatory guidance, etc. It will be critical for providers and health plans to devise processes to ensure that these critical interactions are captured and reported on. The consistent and accurate reporting of these events have a financial impact on both the provider, and in many cases the payer.
Federal and state Agencies, accreditation entities, such as CMS, AHRQ, NCQA, URAC, and the National Quality Forum, to name a few, should explore new ways to allow measure specifications to include these data. Specifications should be less restrictive, where evidence of video chats, text and email messages and secure communications via patient/provider portals count towards the numerator of the measure.
From the desk of Michael Klotz, President and CEO of Health Data Vision, Inc.
Almost everyone in the healthcare industry I talk to, well actually, each and every one I talk to tells me the same thing: MRR is a pain, it’s laborious, painful, expensive, annoying – pick an adjective, I’ve probably heard it. And, listening to the stories and explanations behind those feelings, I think I get it: MRR is a drag.
So, then, why in the world would anyone possibly think of collecting and analyzing medical records as an opportunity? Call me crazy if you like. I’m not going to try to convince anyone to completely change their mind. However, everyone can agree that MRR is here to stay and it addresses some needs or at least mandates and regulations. In other words, it won’t go away.
Having come to that conclusion, it seems pragmatic to ‘make the best of it.’ When probing deeper, and our team has done that for a number of years, we find that there is a list of very common pain-points underlying the current state of MRR. Easy enough, right? Apparently not. Many before us have identified those pains, some have attempted to address them, others have promised to fix them. Largely, customers have been left with disappointment, surprises and lost faith in anyone’s ability to address the issues for real. Sarcasm and vendor fatigue follow.
At this point, everyone clearly expects me tell them that our company has figured out a perfect solution to all MRR pains and issues and that we’ll all live happily ever after (which, of course, our biz dev team does extremely well !). Seriously, we haven’t figured it all out, at least not yet. What we have done is taken a new approach to MRR. And what I want to share with you is not so much what we have done, but what factors we considered, what good or best practices we are aiming to implement, what principles we find of value.
Here are some of them:
- Process Centric Approach: Most data lives in databases, transactional systems and data warehouses. Dealing with that type of data is fundamentally different from MRR. It is the end result. Once the data is obtained, the MRR task is complete. However, looking at it from another perspective, MRR is a sequence of successive steps in a process. Each subsequent step can be performed easily, successfully and efficiently as long as the previous steps accomplished their objectives.
- Provider Data: One of the first things in the process is to verify, fix, enrich, update, group, and re-verify provider information. Sometimes provider data is already very accurate from the get-go. In most cases it is not. The important thing is, it can be fixed.
- MR Collection – Efficiency & PHI: we have concluded that the best way to handle medical records is to obtain them first, then centrally review and overread them. Many out there agree with this approach, others don’t. We all agree that for most organizations, this approach is a significant change, which in many cases needs time. Now, assuming we are collecting medical records, there are many ways to make it inefficient, cause pain downstream, including potential PHI violations. MR collection can be done very efficiently, however. It requires technology, process and discipline, but it can be done and even the possibility of a PHI violation can virtually be eliminated.
- Audit Readiness: Another common pain point is getting medical records and review results ready for audits. Depending on the approach used, this is typically somewhere between inconvenient and almost impossible. By using an approach that permanently ties electronic copies of the MR together with the review results, however, this can easily be addressed.
- Vendor Accountability: I know, everyone is doing that, or trying, at least. So why state the obvious? While most contracts attempt to define the what and when and even how, the most important things are usually overlooked or assumed not feasible: clear metrics, even down to weekly benchmark numbers and the ability for a vendor and their systems to provide objective, timely reporting. And, maybe most importantly, incentives for the vendor that unambiguously align their financial success with their customers’ goals.
If you agree that these items can be accomplished, and others can be tackled, we may find ourselves entertaining the possibility of a process that works, even works well. And if we take that step, it’s not a big leap to consider that the mechanics of MRR can be taken care of, so we can focus on what these efforts were about in the first place: measure quality, effectiveness, understanding your populations, providers and areas that need improving; finding additional sources for reimbursements, and many more. And that, you may agree, are opportunities. Opportunities to turn Medical records into the value they were meant to provide in the first place.
Download the slide deck with additional ideas on best practices (including maximizing MR yield through pursuits, abstraction and coding best practices, IRR tracking and reporting).