CMS Performance Measurement & Reporting
Data analytics to track key metrics required by regulation
The Centers for Medicare & Medicaid Services (CMS) mandate compliance with various initiatives, impacting your revenue and reputation. Since the inception of the physician quality reporting system (PQRS) in 2007, PROTeam Management has teamed with our clients to provide expertise, knowledgeable professionals, and project management skills to meet deadlines with optimized submissions.
- The CMS Medicare Shared Savings Program (MSSP) quality reporting requires ACOs to use the Alternative Payment Model Performance Pathway (APP) or APP Plus to submit quality data, focusing on digital metrics like eCQMs and MIPS CQMs.
- CMS quality reporting ties provider payments to performance, impacting revenue.
- Health insurance plans use CAHPS surveys to obtain patient feedback, imposing financial penalties on organizations with low scores, impacting revenue.
- Publicly available CAHPS survey scores help consumers choose healthcare providers, impacting reputation
- HEDIS scores directly measure healthcare quality and performance of health insurance plans, significantly impacting insurance plan revenue, Medicare Star Ratings, and member acquisition.
- Hospital Compare scores directly measure hospital safety, impact hospital finances, reputation, and patient choices. High ratings (4-5 stars) drive higher patient volume and, in some cases, higher negotiated prices, while low scores can trigger CMS These scores influence reimbursement through Value-Based Purchasing (VBP) programs
These submissions are ever-changing, complex, and time sensitive deadlines.
High scores lead to increased CMS bonuses, while low scores cause financial penalties, reduced funding, and lower market competitiveness.