Do you wish you had accessible information on patient outcomes based on the actions you take in the emergency department? Have you ever stopped to think about how your reimbursement will be determined once you are past residency and working in the community? These may seem like unrelated questions, but a new ACEP emergency data registry is going to change the way emergency medicine data are collected and utilized. The goals of the registry include improving quality and effective care of patients and ensuring that EM physicians are reimbursed appropriately for the important work we do.
The goals of the registry include improving quality and effective care of patients and ensuring that EM physicians are reimbursed appropriately for the important work we do.
Some background is helpful in understanding the need for such a registry. With the 2015 repeal of the sustainable growth rate (SGR) method for determining Medicare payments for physicians, a new process for deriving reimbursement is being enacted. On April 16, 2015, President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This permanently dispensed of the SGR payment system and utilizes a merit-based incentive payment system (MIPS), which is designed to shift Medicare and other reimbursements from a fee-for-service model to a pay-for-performance model and will be phased in over 5 years beginning in 2019. Between now and then, MACRA creates a period of stability with short-term physician payment updates of 0.5% per year. Starting in 2019, physicians will have the potential to earn bonuses or take substantial cuts in their pay of +/- 4% the first year of the program, +/- 5% in 2020, +/- 7% in 2021, and +/- 9% in 2022 and beyond based on four general criteria:
- The quality of their care
- Meaningful use of electronic health records (EHR)
- Use of health care resources (e.g., not ordering excessive or unnecessary tests)
- Activities undertaken to improve clinical practice.
MIPS also allocates additional bonuses to be paid to those physicians who are top performers based on information collected and reported.
Payment adjustments will be made at the level of individual providers, but Congress has allowed groups to be considered an accountable unit for reporting data and assessing performance. ACEP, in collaboration with FigMD, has developed the Clinical Emergency Data Registry (CEDR), designed for emergency medicine physicians specifically. CEDR extracts data from EHRs and group practice management systems of participating organizations/providers and will allow for the aggregation and analysis of the data for reporting to CMS and other entities. It has been approved by CMS as a qualified clinical data registry (QCDR) and provides a unified method for ACEP members to collect and submit data for the Physician Quality Reporting System (PQRS), maintenance of certification, ongoing professional practice evaluation, and other local and national quality initiatives. The overall aim: to provide CMS and any other regulatory bodies with critical information about the way we work, the care we provide, and the effect this care ultimately has on the patients we serve.
Stacie Jones, MPH, is the Quality and Health IT Director for ACEP. She works in ACEP's Washington, D.C., office and is one of the drivers behind the development and implementation of CEDR. In this Q-and-A, Jones addresses some of the key questions surrounding CEDR and how it will affect emergency physicians.
What is CEDR?
Jones: CEDR is the first EM specialty-wide registry at a national level, designed to measure health care quality, outcomes, practice patterns, and trends in emergency care. ACEP has developed the CEDR registry as part of its ongoing commitment to provide the highest quality of emergency care. CEDR is a QCDR designated by CMS for the 2015 performance year.
Why Does it Matter?
Jones: In the past, physicians across all specialties were paid small incentives for voluntarily reporting data on their actions and performance through a system called the Physician Quality Reporting System (PQRS). That incentivized system is going away, and physicians can now be penalized for not reporting data. Participation in CEDR allows emergency physicians the opportunity to get CMS credit for reporting more meaningful measures than the PQRS system of the past. Instead of being mired in an “alphabet soup” of reporting requirements, CEDR provides a single system that all EM providers who enroll can use to fulfill the requirements of multiple programs, making quality measure reporting easier and more efficient. The CEDR registry will ensure that emergency physicians, rather than other parties, are identifying which practices work best and for whom. Not only will CEDR provide a unified method for ACEP members to collect and submit PQRS data, but CEDR data will also facilitate emergency care research that will help demonstrate the value of emergency care to policymakers in Washington, D.C.
How will these data be used, and how will the availability of these data change the way emergency physicians are reimbursed?
Jones: The health care environment is transitioning from volume-based to value-based payment for care. Not only will CEDR allow emergency physicians to maximize their reimbursements under current programs such as the PQRS and the value-based modifier, but qualified clinical data registries will also play an important role under MACRA, which was the SGR repeal and replacement law passed in April 2015. Under MACRA, CMS will be rolling out a new merit-based incentive payment system over the next few years. Qualified clinical data registries will play an important role under the MIPS.
Furthermore, the use of de-identified aggregated data generated by CEDR will support national comparative benchmarks and evidence-based physician practices. It will provide participating emergency clinicians with feedback regarding their individual- and/or ED-level performance on a range of process and outcome quality measures, benchmarked against their peers at national and regional levels. For government policy makers, CEDR will provide further understanding of and information surrounding clinical effectiveness, patient safety, care coordination, patient experience, efficiency, and system effectiveness.
How Does this Affect Residents?
Jones: Although residents' current reimbursements are not directly tied to these programs, how their patients fare will impact the overall group performance on many of the quality measures in CEDR, and this will certainly affect residents as they get out into practice in the next few years. The sooner residents understand how they will be reimbursed and how the actions they take affect patient outcomes, the better.
Stacie, this is all very confusing and complicated! How can we learn more?