Regional Feedback Reports Are Here!
May 24, 2017
Written by Kristen Schuster, Practice Facilitator
Thank you to all the Comprehensive Primary Care Plus (CPC+) practices that joined us in Helena or virtually for the first learning session. It was great to meet you and to see the collaboration between the different groups. Remember: You can keep sharing questions and best practices through CPC+ Connect.
The Centers for Medicare & Medicaid Services (CMS) has released the first practice regional feedback report for 2017. What does that mean? Do you remember the QRUR reports? Well, it is like that, but actually user friendly!
The feedback report is a baseline report on claims and utilization data for Medicare fee-for-service beneficiaries. This information is crucial to looking at patient utilization. This is 50 percent of the per beneficiary incentive payment (PBIP). If practices do not meet benchmarks, they will have to give back portions of or all the PBIP to CMS.
What is in the report?
- Practice makeup
- Double check provider roster
- Total Medicare expenditures
- High-cost specialists for your patients
- Acute inpatient expenditures
- Inpatient utilization by patient
- Inpatient discharges
- Emergency department visits
How should practices use it?
- Compare the hospital discharge list to your practices identified discharges.
- Is the practice workflow catching the majority of discharged patients?
- Is there an obstacle in communication with the hospital that needs to be addressed to improve discharge notification?
- Does your patient population utilize the hospital too frequently and what can you do?
- Expand office hours
- On-call provider 24/7
- On-call care team member 24/7
- Costly specialist utilization
- Is a proper referral process in place to reduce patient self-referrals?
- Are there other specialty providers that are more cost-effective?
- Are patients getting primary care services from a specialist?
- Are problems being treated by a specialist that could be treated by a PCP?
- E.g., A patient with diabetes sees his/her endocrinologist for all diabetes care but is not a complex/high-needs patient
- This red flag allows providers to educate patients on correctly utilizing the system.
The feedback reports will come to practices quarterly with utilization measures. The electronic quality measure (eCQM) data will be updated annually in the same report. Begin by designating a staff member to look at the cost and utilization measures to begin working on improving the overall cost for your practice’s Medicare beneficiaries. If you have questions about how to use this report, please review the CMS recorded webinar or look for resources on CPC+ Connect by looking up “feedback reports.”
If you have any questions, or run into issues with any of the CPC+ objectives and would like help please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.