Big Data, MACRA, and Evidence: What’s the link?

big data_1200.jpgBy now, it’s probably safe to say that some, if not all, of you have experienced some level of “big data fatigue.” The phrase has become ubiquitous, no matter the industry, although it seems none more so than in healthcare. Indeed, almost every healthcare news source to which I subscribe these days seems to have weekly articles, essays, white papers and blogs about big data. But there’s a common thread often missing from these reports. While they all report on the inevitability of big data’s influence on the healthcare sphere, as well as the manner in which electronic health/medical records (EHR/EMR) will continue to impact the future of care delivery, there is little discussion of the role of evidence as it relates to big data.

“Electronic health records represent what you DID, while evidence is a record of what you SHOULD do. As such, evidence is a form of data.”


You cannot have a discussion about big data and evidence without talking about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The act repealed the Sustainable Growth Rate (SGR) formula that determined Medicare payments for physician services dating back to 1997. Additionally, it represented a significant move toward rewarding providers for value over volume through a quality payment program that includes a merit-based incentive payment system (MIPS).

EHR_1200.jpgThe MIPS system was significant in that many thought it was meant to replace meaningful use; in fact it is designed to enhance it by consolidating it, along with the Physician Quality Reporting System (PQRS), value-based modifier programs, and their penalties into one coherent scoring system. This system then compares them with other clinicians to determine their eventual positive or negative payments under the Medicare physician fee schedule.

 

The four categories on which physicians’ performance are scored:

  • Quality
  • Resources or costs
  • Improvement activities
  • Advancing Care Information

“The data from an EHR can identify trends that can be predictive in nature, but it’s an incomplete use of the information to base treatment on trends if the data is ‘dirty.’"

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The hospitals in which physicians work are considerably affected by the quality outcomes of clinical care, utilization of resources when making technology acquisition decisions, and the results of their innovation and improvement projects. With proper communication and engagement, physicians and hospitals can recognize significant financial benefit while improving healthcare delivery. But the physicians need a guide: evidence.

data and evidence_1200.jpgIn simplest terms, EHRs represent what you DID, while evidence is a record of what you SHOULD do. As such, evidence is a form of data. However, while evidence is data, not all of the data compiled by the EHR is evidence. This is an important distinction. In order for “big data” to be used as a guideline for treatment, it must be robust and accurate, with an inclusion of all of the different variables that can affect patient outcomes. The data from an EHR can identify trends that can be predictive in nature, but it’s an incomplete use of the information to base treatment on trends if the data is “dirty.” For example, EHR data does not account for patient and provider compliance with the prescribed treatments, or the lack thereof, resulting in “unclean” data. In addition, there is a lack of standardization surrounding procedures and documentation.

Evidence, provided by controlled clinical trials, takes into account the important and relevant variables and controls for their impact while answering the questions at hand. For newer technologies, big data cannot always provide that kind of analysis.

So which one should you use?

We’ve published a new eBook, Big Data, MACRA, and Evidence: Summiting Healthcare’s Everest to answer that question and more. We cover meaningful use, the implications of its evolution into MACRA, and the way evidence holds the key to the enigma that is big data and its use in improving healthcare delivery. And it’s FREE. Click the link below to start reading today.

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Topics: Hospitals, Hayes Blog, Healthcare Evidence, Medicare

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