Pathway for Physician Quality Ratings
Hi All,
Hoping someone has knowledge of the specific pathway that the coding summary/abstract follows when we explain that billing is the first stop, the codes then "go on to other initiatives such as quality reporting, value based purchasing, research (all those circles) on our diagrams.
Our surgeons specifically want to know who reports their data-how do they get it-is it from CMS? Does CMS and other payers send it to a particular organization?
Leapfrog, healthgrades, others? who are they and specifically where do they all get their data from? Also, how current is it?
Thanks!!
Charrington "Charlie" Morell
Hoping someone has knowledge of the specific pathway that the coding summary/abstract follows when we explain that billing is the first stop, the codes then "go on to other initiatives such as quality reporting, value based purchasing, research (all those circles) on our diagrams.
Our surgeons specifically want to know who reports their data-how do they get it-is it from CMS? Does CMS and other payers send it to a particular organization?
Leapfrog, healthgrades, others? who are they and specifically where do they all get their data from? Also, how current is it?
Thanks!!
Charrington "Charlie" Morell
Comments
Here are some good links for you to start with:
https://cahps.ahrq.gov/consumer-reporting/talkingquality/create/hospitals/databases.html
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050345.hcsp?dDocName=bok1_050345
Each quality reporting entity uses their own proprietary methodology for risk adjustment, inclusion/exclusion. Most reporting agencies use MedPar data (see article link above). Many times the data reported is old data. For Healthgrades I believe it is a look back to 3 years. AHRQ for VBP purchasing for this year is using data from 2012 and 2013. Your quality department will be a great resource for you, and your physicians for information.
"We cannot become what we need to be by remaining what we are” – Max DePree