The underlying foundation of Value-Based Care (VBC) is not based on limiting care or quality. It’s about aligning optimal patient care with financial benefit – for the patient, for the doctor, and for the unsustainable cost of healthcare to our overall economy.

Health Information Exchange (HIE) Optimization is a vital and proactive solution for all payor classes (Medicare, Medicare Advantage, ACO and Advanced ACM members, Medicare Shared Savings Plans (MSSP), Medicaid, Commercial – Insured and Employer Self-Funded Plans, and other Risk Based Reimbursement Plans).

For TINs that utilize an Ambulatory Certified EHR, proactive steps must be taken NOW to meet compliance requirements. The CMS National Quality Strategy (NQS) and its requirements for sharing, receipt, and use of digital data could have a serious impact on your reimbursement.

Our HIE Optimization platform is the very best way to meet NQS requirement challenges and maximize reimbursement. And it is also vital for TINs, physicians, and clinicians who score well on MIPS CQM, but more must be done to qualify for the maximum payment adjustment under the QPP & MACRA.

To learn more about MACRA, see our MACRA Optimization webpage and watch our MACRA Payment Adjustment Explained video.

Compliance is Now Incentivized

Though most TINs and their IT departments did a good job with HIE in the past, due to complexity and the failure of HIE and EHR vendors to provide TINs and their providers with the proper expertise, tools, and/or training, most are NOT meeting NQS requirement benchmarks and targets.

Administrators even boast about their robust IT. Unfortunately, they are still apathetic about actions needed because up until now NQS requirements have not amounted to any significant increase in revenue. This has now changed.

So, now when ownership, boards, and/or stakeholders ask why your TIN’s reimbursement has been reduced or why you failed to maximize reimbursement, and no one can explain why or do anything about it, ignorance or apathy will not be an accepted excuse. Don’t let this to happen to you!

The NQS advances electronic health information exchange and streamlines cumbersome health care processes by establishing standardized requirements across the industry. These rules reflect the deep collaboration between CMS and ONC to ensure that providers and payers adopt common, open-industry standards to advance interoperability and industry innovation.

It develops and expands the requirements for sharing, receipt, and use of digital data, including digital quality measures, across CMS quality and value-based programs. And to transition to all digital quality measures and digital data collection by 2030 to reduce burdens and enable timely availability of quality data.

Highlighted Initial Actions of the NQS

• Annually increase the percentage of digital quality measures used in CMS quality programs.
• Build one or more CMS quality data receiving systems that can receive data using the *FHIR standard with **Application Programming Interface (API) delivery by 2030.
• Collaborate with ONC to promote interoperability and ensure standardized digital data elements for quality measures through USCDI and USCDI+.

* Fast Healthcare Interoperability Resources - defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. **The Beneficiary Claims Data API (BCDA) gives organizations the insights they need to provide high quality, coordinated care. BCDA uses the FHIR® standard as a simple, flexible, and effective way for Medicare Shared Savings Program, ACO REACH, and other Alternative Payment Model participants to receive Medicare Part A, B, and D claims.

In addition to meeting NQS requirements, your Promoting Interoperability (PI) Score is a major component of your Final MIPS Score and measured by CMS through the calculation of:

1. The Effective Use of Your EHR (Integration & Feedback with CMS)
2. Coordination of Care Among Multiple Providers (Referral Network)
3. Patient Care Coordination & Integration (Patient Outreach/Data collection)

Your PI score is an integral part of your CMS ranking calculated under the QPP & MACRA requirements. It is vital to optimize your score to qualify for maximum payment adjustment.

Effective Use of Your EHR (Integration & Feedback with CMS)

You might think your EHR currently handles your compliance requirements. Your EHR is only the start - not the finish.

Even the best EHRs only keep up with CMS requirements at the superficial level, and only Ambulatory certified EHRs can submit data directly to CMS. No Inpatient certified EHRs can submit.

NQS compliance and your PI Score are EHR driven because all reportable metrics come from your EHR system. And your EHR needs to define your relationship between eligible clinicians (EC) and TIN, and match and properly integrate with CMS.

All EHR systems are required to have CMS integration features built into their platform. However, vendors are not required to sell them to you with all features turned on.

Our platform will help you optimize your EHR by coordinating with your team (and your EHR vendor) to have all CMS integration add-ons activated (this comprises up to 30% of your PI score).

Coordination of Care Among Multiple Providers (Referral Network)

The most challenging part of meeting NQS compliance and achieving a high PI score lies in managing your Referral Network data. CMS prefers you use a bi-directional HIE, but this option is not available in all areas.

There is an alternative for those without a viable HIE. It is possible to share relevant clinical data by incorporating information about your referral network into your EHR – and incorporating information about you into theirs.

Our platform analyzes the options available in your area. And if available, coordinate between your EHR vendor and your HIE provider. If your area is not supported, they have a fallback process for managing Direct Messaging (in the event they need to take this step, there may be additional fees) or we can coach you through the process of doing this on your own.

It will help you achieve the most effective referral pathways to exchange clinical data, which will help you meet NQS requirements and dramatically improve your PI Score for you and for your entire Referral Network (this comprises up to 40% of your overall PI score).Top of Form

Patient Care Coordination & Integration (Patient Outreach/Data Collection)

To achieve or maintain NQS compliance and revenue performance, mandated and incentivized assessments based on each patient treatment care plan and their medical necessity is the tip of the spear.

Increasing Quality of Care by directly assessing and highlighting gaps in care at the individual patient level is required by the NQS. Our platform’s electronic and live engagement gathers risk-level data on your entire patient population across all payors utilizing assessments that have been designed to gather the maximum relevant health information (this comprises up to 30% of your PI score).

Our platform’s electronic and live engagement gathers risk-level data on your entire patient population across all payors utilizing assessments that have been designed to gather the maximum relevant health information (this comprises up to 30% of your PI score).

To learn more, see our Patient Outreach Optimization webpages and watch our Patient Outreach Optimization Explained videos.

You are required to share and have access to patient data and compile and collect data for use in treating patients. But what makes this difficult is the goal post is moved every year and the NQS will make it much more difficult for TINs to navigate compliance and be subject to the penalty of lower reimbursement.

To ensure you avoid the penalty and improve reimbursement, you must make the commitment to optimize your EHR and improve your Referral Network pathways. If you don’t - this oversight will now cost you a lot of money. And to avoid non-compliance, you must use the NQS requirements as part of your broader strategy around interoperability and patient engagement/outreach.

While the NQS requirements present significant challenges, they also provide an impetus to gather new levels of clinical data. And if you’re looking to do more than check the compliance box, it will allow you to turn your compliance into a competitive advantage by developing new services in line with Value-Based Care such as CCM, RPM, and more.

Must Know for MIPS Eligible

The PI Category Weight is worth 25% of your TIN or ACOs Final MIPS Score and requires a minimum of any continuous 90-day reporting period during the calendar year. Under certain circumstances, CMS will reweight the PI Category to 0% and the 25% would be added to other MIPS Category Weights.

The last day to start a minimum 90-day reporting period to attest to PI is October 1^st. So. you need to start optimization as early in the year as possible or you risk failing on PI, and therefore fail to maximize your payment adjustment under the QPP & MACRA in next the PAY.

Our Provider Partner is a MACRA & HIE expert and CMS Certified Clinical Qualified Registry that specializes in the processes of MIPS and MACRA & HIE Optimization for financial ROI.

They support thousands of independent and hospital-based physicians & clinicians, multi-TIN organizations, and ACOs and their Member TINs. As a Certified Clinical Qualified Registry their a CMS approved entity that collects clinical data from MIPS eligible TINs, physicians, and clinicians (both as individuals and groups) and submits it to CMS on their behalf for purposes of MIPS (reporting options are limited to measures within MIPS and the Quality Payment Program).

They possess a knowledgeable team of people that handle all necessary tasks and provide frequent reporting and useful analysis.

In a 30-minute Zoom call, we’ll talk about how our platform will enhance your EHR and help you achieve the most effective referral pathways to exchange clinical data, which will help you meet NQS requirements, and improve your PI score and your entire Referral Network.

Take a few moments to download our HIE Optimization flyer, the NQS, and our NCND. Complete and email it to: support@livewellaps.com. Then reserve a Zoom call with us.

1. Click Here to download the NQS 2024 (pdf).
2. Click Here to download our Mutual NCND (pdf).
3. Click Here to go to our Calendly page to reserve a Zoom call (complete the required fields and when asked “purpose of call,” click: HIE Optimization).