Robin Dore, MD

“I joined United Rheumatology as I have been in solo rheumatology practice for most of the last 36 years and want to stay independent.  I worked for Kaiser for the first two years of practice and did not enjoy having someone tell me how many patients to see per day and what days I could […]

Jeffrey Feinstein, MD

“We are purchasing a new ultrasound machine for our practice. The best price we were able to negotiate on our own was $33,400.00. The exact same system throughprovista was $22,822.00.”

What Are The Opportunities and Uses?

The aggregated data presents opportunities for commercialization. We currently have contracts with several commercial entities for data sales and are in discussion with others. While the fair market value of chart data has its limits*, the commercialization of data can provide a financial return that is substantially greater than the United Rheumatology Annual Practice Membership fee.

EMR data will however serve a far more important purpose. Policy makers and payers, commercial and government, have introduced their concepts of value and quality and linked these in a movement for pay for performance models. MACRA and MIPS call for new payment models to replace traditional fee for service. Data will be essential to validate a practice’s performance in any contract. The payers will have their sources of data, and we must have ours, and they must be robust and defensible. Thus the principal and most significant reason for participating in the data project is to contribute to the aggregated EMR database that may be analyzed and used to objectively define and then defend the highest level of standard of care for our patients.

The data is used to validate the United Rheumatology guidelines and inform modifications to these guidelines when indicated. The analysis of our aggregated data gives us the power to “intelligently” engage in alternative payment models with CMS and the payers, with a scope ranging from local to national.

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Even with MACRA and MIPS posing a January 1, 2017 start date, CMS has not yet published final descriptions of alternative payments models. Physicians will find themselves faced with a potentially daunting task in performing the due diligence needed to make participation decisions herenapotheek.nl. The door will be open to developing our own models as well. United Rheumatology has engaged consultants with national experience with both commercial and government payers, who will help and support us in developing Rheumatology specific models. In every conversation with every consultant, the value of the United Rheumatology MDI data project has been identified and praised, as the data has been described as providing our currency, our blood supply, or our nervous system.

The aggregated data will provide us with “our own” objective evidence to demonstrate that we have succeeded in performing in accordance with the payment model definitions and performance measures and are entitled to the incentives incorporated within those agreements.

*Payments for data may be considered a “transfer of value” under “Sunshine” statute, and limits may be placed by commercial entities based on their estimation of the fair market value of data.

Thus, while IMS and others continue to earn substantial amounts of money commercializing the data that we produce, and still others (CMS) are currently mandating the extraction of our EMR data to enable them to designate our quality and value as healthcare providers and adjust our payments accordingly, United Rheumatology is using our data to work for our practices and our patients in entirely positive ways.

 

How will data be collected?

We partner with MDI, a Medical Data Aggregation and Analytics company, our preferred Vender. MDI in turn has an exclusive agreement with revelationMD (revMD), for the use of their software tool, syncMD. Who does what?

First and foremost, every part of the process is performed in compliance with all applicable regulations. Your practice will sign a Business Associate Agreement as mandated by HIPAA. All HIPAA regulations that pertain are adhered to.

Second, there is a firm and written commitment- no entity will ever see your data except you. You will receive periodic benchmarking reports positioning your data against that from the entire network, and you will able to use this data as you choose. PHI (Protected Health Information) is never disclosed. You will decide if you wish to participate when commercialization opportunities are offered to you

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revMD powers the process technically. The syncMD tool enables them to map different EMR and PM systems, and identify the locations of the data to be extracted. The syncMD tool works in a read-only fashion – it cannot make any changes in your EMR or PM systems. It cannot change the software, or the data that has been entered. The syncMD tool will extract the data without impacting practice operations.

MDI performs practice operational and commercialization services. MDI finds commercial opportunities for data sales. MDI has built what is called the Standard Data Model, which is a list of all the parameters to be extracted. MDI has received input from the United Rheumatology Medical Policy Committee, which designates which clinical data are important for analysis of outcomes, and other clinical assessments. MDI researches which measurements are of interest to commercial entities, to ensure the commercial power of the Standard Data Model. MDI works with your office to help you build the structured fields in your EMR where data to be extracted will be recorded. Free text cannot be mined. The structured field process has been developed by practicing physicians and knowledgeable practice administrators with two goals: getting the data needed, and avoiding any impact on workflow and patient care. We do not add more than 15 seconds to any office visit. MDI offers data analytics capabilities as well.

Background

Data from medical claims has served as a source of data that has been analyzed for medical research purposes. Most of us are familiar with researchers (Dan Solomon for example) who have made major contributions to the rheumatologic literature through analysis of claims and other data. Companies such as IMS commercialize claims data, aggregating massive […]