PQRS Enhancement

Introduction

From the inception of the PQRS DV project, Arch Systems, LLC has continuously reviewed, assessed and implemented processes and systems to save costs and bring value to CMS. As a result, in the base year and OY1, Arch’s excellent project management saved CMS approximately $262,000 and $30,000 respectively.

1 Executive Summary

This Executive Summary provides high-level results of enhancements and process changes implemented in the program for the first quarter of OY2.

Arch Systems strongly believes in continuous improvement and strives to innovate processes and tools which will provide value to both CMS and the PQRS stakeholder community. In order to achieve these goals, we reviewed our existing Primary Source Validation (PSV) process and Case Management Tracking System (CMTS) application. As a result of our review and analysis, we implemented new PSV processes and based on internal user feedback, added additional functionality to CMTS.

We believe that these changes resulted in improved data quality, reduced issues and risks associated with data integrity, while achieving overall cost savings.

The primary changes done were to the Case Management Tracking System (CMTS) and Primary Source Verification (PSV) processes were:

  • CMTS application changes include process automation to upload sampling spares, generate documents, ability to select failure comments on a chart and finally the ability to generate 9 standard reports.
  • PSV process changes include performing initial outreach via email, initiate PSV process earlier, use of a contract resource to obtain HICN for GPRO’s, provide HICN to EP’s and adding documented reasons for failures in the Final Letter.

Application Enhancements and Process changes have resulted in resource cost reduction associated with manual processes, reduced errors associated with manual data input and report generation, reduced data integrity errors.

Primary Source Verification (PSV) process changes have resulted in increased participation via early outreach. Additionally, we have achieved cost reduction by automating processes, reduced errors associated with manual data handling.

2 System Enhancements

2.1 Case Management Tracking System (CMTS)

Case Management Tracking System is a web based application developed to assist nurse reviewers during the Primary Source Validation (PSV) process. CMTS is used during PSV to track status of medical review, analyze results and create reports.

Table below provides a list of changes made to CMTS Application between Base Year, OY1 and OY2.

Table 1. Case Management Tracking System (CMTS) Application Changes

Base Year, OY1 OY2 Benefits
Spares were manually uploaded into
CMTS throughout the year. This
process slowed PSV process as the
team had to wait for Dev Resources to
update the system
Spares are pre-loaded in the
application. If a provider is inactivated,
the application will provide a new
provider
Cost reduction associated with
development resources manually
uploading data. Reduction in errors
associated with manual data entry
Manual data entry of failure comments
by nurse reviewers.
CMTS application is pre-populated with
failure comments. Nurse reviewers can
select the appropriate failure reason.
Reduction in errors associated with
manually uploading data.
Nurse reviewers manually edited
introductory and final documents prior
to sending them to EP’s
Process automated to generate
introductory and final documents
package.
Reduction in error associated with
manual processes.
Nurse reviewers and development team
manually developed final reports
Application enhanced to generate the
following reports:
  • Participation Report
  • Reporting Error Summary
  • Measure error type summary
  • Reporting Option Error Report
  • EP error report
  • Casual Error report
  • Weekly Status Report
  • Total Report
Reduction in costs associated with
manual processes.

3 Process Improvements

3.1 Primary Source Validation (PSV) Process Improvements

During OY2, Arch Systems made the following process improvements to the PSV process.

Table 2. Primary Source Verification (PSV) Process Changes

Base Year, OY1 OY2 Benefits
GPRO contact information. Information
was retrieved from IDR, This was a
manual process and resulted in
erroneous data being generated
For OY2, Arch is utilizing a
contractor to generate this data.
Switching to a contracted resource has
resulted in cost savings, reduced
erroneous data getting generated.
Initial Outreach was done using USPS.
This process resulted in delays as team
had to wait for EP’s to receive
information and respond back
For OY2, initial contact is being done
via telephone.
Initial outreach via telephone has allowed
team to reach out to larger pool of EP’s.
Initial Outreach for OY1 started in
February resulting in a shorter window
to complete PSV
For OY2, initial outreach started in
January and decision was made to
breakdown PSV into 2 cycles.
Early start of PSV cycle has already
yielded improved results. Within the first
week, Arch team was able to complete 30
introductory calls and had scheduled 28
additional calls (32% of total sample).
EP’s had to locate HICN prior to
submitting data
Arch provides HICN to EP’s Reduced burden on EP’s and increased
participation rate.
Final letter did not include additional
teaching on error reasons
Final letter included additional
teaching information documenting
reasons for errors.
Provides EP’s with documented reasons
for errors.
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