For the first time, Texas Tech is able to see the entire PQRS picture, both financial and clinically.
About Dana Garay, RN, BSN, CPHRM, CPHQ, JD
Dana Garay is a nurse attorney, Certified Professional Healthcare Risk Manager (CPHRM) and Certified Professional in Healthcare Quality (CPHQ). She previously served as associate general counsel for Texas Tech University Health Sciences Center (TTUHSC) School of Medicine before leaving to take a position focusing specifically on patient safety and risk management. In 2013, she returned to TTUHSC as director of performance improvement and currently works at the Lubbock campus.
Caray’s responsibilities include assisting with maximizing the incentives the organization can receive through the Meaningful Use (MU) and Physician Quality Reporting System (PQRS) value-based programs as well as working with providers to understand their current performance and implement processes to constantly improve. In order to successfully accomplish these tasks, she continually seeks more timely performance information so, together with the chief medical information officer (CMIO) and electronic health record (EHR) director, they can take a more proactive approach to their profession.
TTUHSC is a seven-university system that meets the healthcare needs of more than 2.5 million people who live throughout a vast 108-county area stretching from the Texas Panhandle south to the Permian Basin and west into Eastern New Mexico.
When Garay returned to TTUHSC in 2013 she recalls being asked to participate in the oversight of the MU and PQRS program. She quickly realized her law degree wasn’t going to be much help when it came to fully absorbing the impact of the myriad of rules and regulations related to these value-based programs. Not only was there a significant amount of financial benefits and risks on the line, but the continual rules changes as well as degree of regulatory oversight made the mission extremely difficult.
When it came time to report PQRS data in the first quarter of 2014, Garay along with the CMIO and the EHR director, set out to do the best they could in determining which PQRS measures to report for performance year 2013.
“This was a very difficult time,” Garay recalls. “We had a new team, an increasing degree of complexity of the PQRS program, and there was more money on the line for our institution than ever before. We had no idea whether or not these measures would yield positive results nor what benchmarks there might have been to compare them to. We just had to pick the measures we thought made sense at the time.” Garay chuckles. “They say ‘The first step is admitting you have a problem.’ We all knew we were providing high level quality of care but admitted we didn’t fully understand the intricacies of the PQRS program and how to ensure the quality of our provider performance was reflected in the final reporting. We were concerned we were missing out on some of the details and decided that we were not going to do it the same way the next year.”
A Comprehensive Solution
A colleague referred Garay to SA Ignite, and she became very interested in the company’s sole focus of helping organizations optimize their quality scores. The next step was to invite SA Ignite to come speak to Garay and team, including their providers, in order to get a sense for the company’s level of expertise and overall approach to our concerns.
We were pleasantly surprised with the depth of knowledge and expertise the SA Ignite team conveyed; even our providers were impressed. They truly knew the ins and outs of these CMS programs and we were convinced they were the right experts to partner with.
In Q1 2015 the SA Ignite team went to work analyzing PQRS data for 120-plus providers. The PQRS reporting deadline was fast approaching, and in about four weeks its experts were back on the Lubbock campus to present their findings.
“SA Ignite’s approach was very financially and mathematically driven,” Garay explains. “We’re clinicians. We provide good care, but what we didn’t understand was the impact of choosing one set of measures over another or how just a few providers could have such a big impact on the final outcome.”
“Suddenly, we had the numbers in front of us: if you report measures set A, this is what the financial results will be; if you submit measures set B, this is what the financial results will be; and so forth. We didn’t previously have that level of insight.”
For the first time, Garay and her colleagues were seeing the entire PQRS picture, both financially and clinically. She now had confidence in their measures selection and due to the predictive analytics provided by SA Ignite’s PQRS experts, TTUHSC wouldn’t have to wait nine months until it received the Quality Resource and Use Reports to understand where they’d likely end up.
“SA Ignite allowed me to focus on what I do best, developing process improvement initiatives that continue to drive provider quality performance upward. I would recommend them to another organization looking to ensure its value-based performance is also reflective of the quality of their care and fully optimized.”