The Risk of EHR Reliance for QPP Performance

November 2nd, 2017 by

Relying on the EHR to manage performance in MIPS and Alternative Payment Models (APMs) in the QPP is like relying on an emergency medical technician (EMT) to conduct major surgery. While both the EHR and EMT deliver essential life-saving functions in their own regard, neither are specifically equipped to perform with such precision. The QPP, although meant to be uncomplicated, is anything but, leaving healthcare providers, and quality managers scrambling to understand, and comply with the rule.

According to a State of the Quality Payment Program (QPP) study conducted by Porter Research and SA Ignite, there is significant misalignment between customer expectations and EHR delivery for MIPS. In the study, 83% of medical, quality, and operations executives, and directors from 109 large health systems, and integrated delivery networks said that they rely on their EHR as the primary tool to manage performance in MIPS, yet 72% are unaware if their EHR currently offers, or plans to offer, a MIPS solution. This misalignment sheds light on why healthcare organizations may continue to struggle.

While the EHR is a primary source of data it should not be the primary tool for managing your QPP participation for three key reasons: The need for continued visibility into performance, application of detailed and evolving program rules, and ability to focus on what’s most important for organizational objectives

The need for continued visibility into performance

Successful QPP management is built on a solid data foundation that informs effective and focused performance management. Oftentimes there are gaps or inconsistencies in the EHR data that easily go unnoticed without a secondary, external view. For example, a single measure that applies to multiple value-based programs may be on your priority list, but activity is being captured in two different places in the EHR. Moreover, some Quality measures apply to more than one program, but are scored differently. Understanding these differences is essential when trying to make decisions or manage programs that have financial and reputational impact to your organization.

Application of detailed and evolving program rules

QPP rules are very detailed and complex, and require finely tuned analytical algorithms to accommodate for the regulatory nuances within each performance category to ensure compliance, and to help providers make the most informed choices for final submission. Plus, CMS is modifying the 2018 rule very soon, which means vendors will need to invest additional development resources to incorporate new rules into the EHR. The question is, when and how much will they invest given larger, corporate initiatives?

Ability to focus on what’s most important for organizational objectives

MIPS and/or an APM is one of many value-based care programs that healthcare organizations are addressing, so it’s critical to be able to identify what is important, and engage clinicians and leadership with clear and focused direction. For example, there will be cases where some providers are excelling on a measure, but others aren’t doing so well. It’s much more effective to engage each group with targeted conversations about what’s going right, and where adjustments can be made to improve. In addition, healthcare providers are competitive by nature, and they want to understand the reasoning behind decisions. Being able to dig into the data to foster competitiveness or provide the why behind the decision is important for driving organizational objectives. This type of analytical detail is not readily available in the EHR, so external tools are essential.

Learn how organizations are using purpose-built tools in conjunction with the EHR to proactively manage MIPS with much success. Watch the webinar replay of Going Beyond the EHR to Optimize QPP Performance, where value-based program leaders from United Health Services, Christie Clinic, and Jefferson City Medical Group share their strategies. These, and other proactive organizations will be poised and ready for 2017 submission, and be able focus on 2018 performance early


Penny Schlyer
Senior Product Marketing Manager

Download the Healthcare Playbook for MIPS!

Insights from the Final 2018 QPP Performance Feedback Reports

Read blog >

Top 6 Questions to Drive Clinician Engagement

Read blog >
Back to all blog posts