MACRA program attestations are a data-heavy, intensive fact of life for behavioral health and human services providers around the United States. This annual task is important for agencies in many ways, however, and for Qualifacts team members, it’s a very important annual element of customer support.
Here’s a quick primer, courtesy of Mary Givens, Qualifacts’ Product Manager of Federal Compliance:
If a behavioral health or human services agency has programs that are eligible for federal funding via Medicare (through the Centers for Medicare and Medicaid Services), then it must attest to how it performed on specific measures. This is done once a year, and must be completed or the agency can face financial penalties. (On the plus side, a successful attestation and the surpassing of certain goals can mean bonus payments.)
What this means for Qualifacts customers is a deep dive early every year into a lot of CareLogic data (the filing deadline is March 31). Specifically, CareLogic’s clinical quality measures (CQM) functionality allows for data around service-provision clinical outcomes provided to be compared to national healthcare initiatives and benchmarks.
“An example is, asking a client ‘Do you smoke?’ Then that information can be used to provide cessation counseling, medication or other rehabilitative intervention,” Mary explains. “Then those outcomes are recorded.”
Other data points collected include assessment around alcohol abuse, diet and exercise, medication adherence and others. As a group, they are designed to foster better client outcomes, and lower healthcare costs, for an agency’s clients. Often the data reveals “gaps in care” allowing the agency to have a valuable opportunity to retool programs and deliver more focused clinical interventions.
“We hear customers say that they perform suicide risk assessments routinely, and then their data shows that it’s only 21 percent of the time,” Mary says. “That’s because the measure is very specific: the assessment must be done every time the client comes in to see their doctor. The assessment must be done then, not the next day or three days later. Don’t do it then? It doesn’t count. So when they see the data, they are able to put into place the training and support to get a better outcome.”
Acting as facilitators for huge volumes of data
So how does Qualifacts help? CareLogic supports 17 different measures with 17 different sets of data, all of which must be monitored by teams within our company as well as at the agencies themselves. It is time-consuming and complicated because so much data is being collected and calculated for reports.
“None of this process would be successful without the technical SMES at Qualifacts,” Mary says. “Our tech people have to watch and make sure the reports are running efficiently as possible. The technical team has a broad and deep understanding of each measure and has to answer many, many technical questions from our customers, the support team and me. The technical team worked tirelessly around the clock to support the attestation process. Their commitment to our customers is unyielding.”
Additionally, she adds, Qualifacts’ customer-support team is the front line of the attestation process and they facilitate the customer experience every step of the way.
“The support team is answering tons of questions about specific measures as well as questions about the process for running reports,” she says. “If data is not collected properly using the correct workflows and if the reports don’t aggregate correctly, providers will be disappointed in their results. It’s a lot of close monitoring, but it is the results of these very specific measures that help these agencies see what they are doing well, and what they could be doing better.”
The penalties can be up to 9 percent of their Medicare Part B payments, a huge amount for agencies whose budgets are already stretched thin. The bonus payments can be anywhere from 4 percent of 5 percent, so attestation is very much worth the time and trouble. And Qualifacts customers are very, very happy with the service and support they get!
“There were many questions, struggles and frustrations on my end, and Mary dealt with them with such patients and tolerance. Jonathon (Hau) also worked very closely with us,” says Maria E. Rios Moscoso, Director of Business Services and CareLogic System Administrator at Catholic Charities — Archdiocese of Hartford (Conn,). “The end result was extremely successful, with our data uploaded two weeks prior to the deadline.”
Catholic Charities has been with Qualifacts since 2014, and began its attestation process three years ago, Moscoco says, adding that it has gotten simpler each time around.
“Every year the process deviates a little bit, and it can be so tedious and frustrating,” she says. “Having the support of people who understand what I am going through and are here for me to get over every little barrier has been so helpful. Mary and Jonathon have kept me on target and doing everything I needed to do on my end to get this very big job accomplished.’
Another three-year veteran of attestation is Josh Marlin, MBA, Director of Receivables and Information Systems at Highland Rivers Health in Dalton, Ga. He too applauds the dedication of Qualifacts’ attestation professionals.
“The process is confusing and I have trouble remembering what to do from year to year,” Marlin says, “The fact that the [clinical measures] are pulled from the system and that Qualifacts helps me navigate through the process makes it much more seamless. I appreciate the ability to get these done on time, as there enough other things to keep my agency busy — the less time we spend on this is the more time we can spend on something else.”
It all comes down to the data, and making sure that it’s properly collected and usable is essential, notes Jonathon Hau, Team Lead, Programs & 3rd Party. “We make sure the information they are expecting to see is accurate. Our teams act as an extra set of eyes, looking at what’s collected and making sure it lines up with what they are expecting to attest to.It’s not an easy process by any means, but when we can help them be successful it’s really something we are very proud of.”
And going forward, new processes and systems Qualifacts are putting into place, such as dashboards that provide strong visual cues, will allow for even more clarity, she adds.
“We are always working on better ways to calculate CQM, and it really takes the burden off customers,” Mary says. “The beauty of a dashboard is that they don’t have to wait until they are doing the attestation to see how they did — they can pull up data every day to see measures around smoking cessation, blood pressure monitoring, depression assessment or whatever they want to dig into. That means they can catch gaps in care early, which means they can implement a process of continuous improvement in the quality of care for their clients and, hopefully , will make attestation easier and more valuable for them.”
2020 Attestation By The Numbers:
- Between Feb. 19 and March 31, 10 staff in Lima, Nashville, and Colorado worked around the clock, seven days a week, to process more than 200,000 CAT I files of CQM data so that 111 providers could attest to MACRA for the 2019 reporting period.
- Although CMS extended the MACRA deadline to April 30, 2020 (due to COVID -19) Qualifacts was able to meet the original deadline of March 31.
- This was the first year Qualifacts worked with Clinigence to aggregate the CAT III files for the Group attestations and it went off without a hitch.