By definition, Qualified Clinical Data Registries (QCDRs) are a “Centers for Medicare & Medicaid Services-approved entity that collects clinical data on behalf of clinicians for data submission.” But QCDRs should optimally be viewed as a bridge to success with new payment models.
“When we talk about moving to alternative payment models and value-based care, it’s this big, scary thing—we have to jump a chasm into a fog and we don’t know what’s on the other side,” said Lance Mueller, AMA manager of health care quality.
“I see QCDRs as really being this bridge across that chasm and removing that uncertainty,” Mueller said. “Instead of this leap into the unknown across the chasm, it’s just stepping off the other side of the bridge.”
Mueller made these remarks during an AMA webinar, “Finding a QCDR,” which is part of the AMA’s Share, Listen, Speak, Learn Series. The webinar described the purpose and uses for QCDRs, including how to complete reporting for Medicare’s new Merit-based Incentive Payment System (MIPS) using a QCDR partner. (Also worth reading: The AMA’s “MIPS Action Plan: 10 Key Steps for 2018.”)
The advantages of using a QCDR for MIPS reporting is that many of them can report across all MIPS performance categories—quality, improvement activities, and advancing care information—and they can collect and aggregate local data from a variety of sources—such as claims data, electronic health records, and other quality-reporting systems—and submit it to CMS.
Beyond the collection of data and submitting of that information to CMS, Mueller said the key purpose of using a QCDR is to foster improvement in the quality of care.
“It’s not just about MIPS,” he said, explaining that QCDRs can organize data for other government reporting program requirements, whether it be for health-system credentialing, maintenance of certification, or quality-reporting programs operated by commercial payers.
“CMS really wants practices to move towards alternative payment models and value-based care,” Mueller said. “MIPS is but a way-stop on that journey. CMS tells us that fairly often.”
Hitting for the cycle
So while using QCDRs enables success with MIPS, it also facilitates continuous improvement powered by feedback reports that are reliable, timely and actionable.
The feedback reports identify opportunities for improvement. Practices can then act on these to create and get credit for a MIPS improvement activity that can then drive better performance on quality measures.
Mueller described several different QCDRs, briefly touching on the characteristics of those for family medicine, internal medicine, psychiatry and radiology. One QCDR singled out in the webinar was the Genesis Registry operated by the American College of Physicians. What makes this QCDR particularly useful is that it provides daily feedback reports.
“The more often you look at your data and use it for local improvement, the better your [MIPS] score is going to be,” Mueller explained. “The feedback and improvement—that’s the power of the QCDR.”
The number of QCDRs available for physicians to partner with has tripled to 150 in three years, with 31 QCDRs being sponsored by a medical society.
One advantage of going with a state- or a specialty-society QCDR is that they may offer their use at no or very low cost beyond a setup fee for members. Reporting through a specialty-society QCDR may also lower reporting requirements. MIPS requires reporting six quality measures or a specialty-specific set of measures. So, even if the specialty’s set only has four measures, it will fulfill the requirement.
Specialty societies also have experience supporting the physicians in their particular field and know what is uniquely relevant to them.
Multispecialty groups may be required to do more research in choosing a QCDR. If a QCDR reports across quality, improvement activities and advancing care information categories, they should have sufficient measures in their library to satisfy most groups’ needs. Some of these may be commercial entities, however, and groups may be charged a per-clinician fee.
The CMS Quality Payment Program offers a listing of all 150 QCDRs, noting which performance categories they measure.