How to track quality measures

Healthcare’s ongoing transition to rewarding quality and outcomes rather than volume means that practices of all sizes need to pay attention to quality metrics. And while doing so requires time and attention, it’s not beyond the reach of even small independent practices, says Doral Jacobsen, MBA, FACMPE, senior manger with the accounting and consulting firm Dixon Hughes Goodman LLP. 

The first step, Jacobsen says, is to ask your practice’s three or four largest payers exactly what you’re being measured on, and what your scores are. Whenever possible, the information should be presented and discussed in a face-to-face meeting with an insurance company representative. 

“Some of the information can be difficult to understand, and it’s not always intuitive, especially if you’re not accustomed to looking at these kinds of reports,” she says. “I’ve seen folks make incorrect assumptions, and you’re not going to know you’re doing that unless you’re talking directly with the payer about why your score is the way it is.”

The next step is to construct a matrix that lists payers on one axis and the measures they are applying on the other. It will soon become apparent which metrics are the most common, and those are the ones your practice should focus on, Jacobsen says. Also important: knowing how those measures are tied to your practice’s reimbursements from each payer. “It’s often buried in the contract’s language somewhere and you may not know about it. So be sure to have the company explain it to you.”

Jacobsen says that knowing your practice’s performance on various metrics sometimes can yield surprises. “Every one of my clients will say, ‘we’re doing fine,’ then they look at the numbers and realize there’s an issue, so this is where the rubber really meets the road.”

Sometimes, she adds, failure to meet a metric isn’t due to the physician’s performance, but instead is a workflow or process issue, or could even be a problem with capturing and entering quality data correctly. 

Jacobsen recommends that practices meet with payer representatives at least annually, because payers constantly update, add, and drop metrics as the medical guidelines on which they are based continue to evolve.