HRSA Quality Improvement Awards (QIA)
Every fall, HRSA announces a new set of Quality Improvement Awards. They are a great benefit to the Health Centers and reward efforts to improve outcomes. However, it’s not always clear where they come from or how they are calculated. What’s more, it’s hard to think about what Health Center leadership might do to maximize this revenue source
In this series, we are going to cover some of this ground to help you understand how the program works, and what you can do to make sure you’re getting the most for your quality data. Specifically we will:
Explain the HRSA Quality Improvement Awards (QIA) - what they are and how they are paid out
Use a deidentified health center to understand how their awards were calculated
Review another example of what a health center should focus on to increase their chances of a payout
Take a look at the quality measures complexity versus pay offs
This post will focus on the explanation of each of the awards.
The 8 HRSA Quality Improvement Awards (QIA): Definition and Calculation
What are they?
HRSA’s Quality Improvement Awards are designed to promote health center’s performance on quality, efficiency, and value for their patients. These awards are based on the data submitted through the UDS. In 2020, these awards totaled more than $117 million and the average total award for health centers averaged at about $90,000 with the maximum take cashing in at over $705,000.
With alignment to the Triple Aim, there are 8 different categories that cover access, quality, and value:
These awards change from year to year, and are explained in an annual webinar by HRSA. The explanations below reflect the 2020 awards based on 2019 UDS data and are compared with the awards data. For each one, we provide a summary, how it’s calculated, any interesting remarks, and what it’s worth financially. Let’s dive in!
Clinical Quality Improver
Summary
The Clinical Quality Improver award is given to Health Centers who improve any individual Clinical Quality Measure (Table 6B and Table 7) by 15% or more from the previous year.
AWARD AMOUNT
Award = $3,162.50 × (Number of Improved Measures) + $1.00 × (Number of Patients Served)
Minimum Award in 2020 = $3,991.00
Maximum Award in 2020 = $217,621.00
Calculation
Improved Measure = If (Current Year Performance - Previous Year Performance) >= 15% × (Improvement Direction)
OBSERVATIONS
This award is paid out based on number of patients served. Not just the patients that qualify for the measure.
Sample size does not matter. If a health center has 2 patients in a measure, and increases from 50% to 100%, they qualify for this award.
Increases are independent of other measures increasing or decreasing. They are also independent of previous years’ performance.
It also appears that if health centers did not previously report on a measure, they are awarded if they started reporting this year, and the percent was at least 15% compliance.
What SHOULD WE DO WITH THIS?
Look for measures were there is room to improve by at least 15% (generally, the lower the score the better).
Discuss measures that are most likely a reporting issue that may be an easier adjustment in one year.
Ensure that reports are accurately removing all legitimate exclusions to maximize your performance.
Consider a consultation to review the reports to determine if there likely opportunities.
Health Center Quality Leader
SUMMARY
The Health Center Quality Leader awards are given to the Health Centers in the top 30% for the adjusted quartiles across all Clinical Quality Measures. There is a Gold Award (top 10%), Silver Award (top 20%), and a Bronze Award (top 30%). HRSA explains that the adjusted quartiles are modified for uninsured, minority, and special populations. It appears that the individual measures are adjusted for these factors as well as the aggregation of the measures.
AWARD AMOUNT
Award = Tier Base Award + $1.00 × (Number of Patients Served)
Bronze = $17,250 | Silver = $23,000 | Goal = $28,750
Minimum Award in 2020 = $19,080
Maximum Award in 2020 = $240,863
Calculation
Percentile for the Average of the Adjusted Quartiles
OBSERVATIONS
Adjusted Quartiles are only calculated with measures with at least 30 patients. So the number of measures being competed on may be different.
The Percentile Ranking correlates with the outcome, but does not align perfectly. HRSA has declined to comment on the discrepancy as of 1/11/2021.
What SHOULD WE DO WITH THIS?
Ensure that all uninsured, minority, and special population data is accurately reported as this may help your performance.
In your QI meetings, review the overall performance, and select measures that need to be brought up with others without compromising gains on other measures.
If you think you are close, but didn’t receive an award, request a comparison of your data to others to see if there is a case to be made with HRSA about your performance.
National Quality Leader
SUMMARY
Awarded to the Health Centers in the top 1-2% for a combination of measures that meet or exceed national benchmarks. The three categories are Behavioral Health, Diabetes Health, and Heart Health. Fair warning, the calculations are a bit complicated.
AWARD AMOUNT
Award = $28,750 + $1.00 × (Number of Patients Served)
Minimum Award in 2020 = $31,319
Maximum Award in 2020 = $182,778
CALCULATION
Meet the following items for each of the measures.
Behavioral Health
Depression screening and follow-up - Table 6B (>= 75.9%)
SBIRT - Table 6A (>= 5%)
MAT patients increase from previous year - Appendix E (>=10% )
Number of MAT patients (>= 70)
Diabetes Health
Uncontrolled diabetes (HbA1c > 9%) - Table 7 (<= 16.2%)
BMI screening and follow-up plan - Table 6B (>= 72.43%)
Weight assessment and counseling for nutrition - Table 6B (>= 71.21%)
Heart Health
Tobacco screening and cessation - Table 6B (>= 80%)
Hypertension control - Table 7 (>= 80%)
IVD: Use of Aspirin - Table 6B (>= 80%)
OBSERVATIONS
This award is intentionally elusive, and for the top performers. It reflects an understanding that there is interplay between the different measures.
WHAT SHOULD WE DO WITH THIS?
If you are strong in one of these areas, begin to build out tracking of the combinations to track in your QI meetings.
Even if you are not in the running, watching these groupings of measures can provide meaningful organization to your QI/QA plan for a several year period.
Access Enhancer
SUMMARY
Health Centers that increased the total number of patients served by 5% from the previous year and increased patients by 5% in an area other than medical (Mental Health, Substance Use Disorder, Vision, Dental, Enabling Services). Also, Health Centers must qualify for at least 1 of the previous quality awards to qualify for the Access Enhancer Award.
AWARD AMOUNT
Award = $5,750 for 1 area improved
Award = $11,500 × (Number of Areas Improved - 1) for 2 or more areas improved
Minimum Award in 2020 = $5,750
Maximum Award in 2020 = $46,000
CALCULATION
Total Patient Increase = 100 (Number of Patients This Year) / (Number of Patients Last Year) - 100
Same process as #1 for each additional area
OBSERVATIONS
This award is meant to be the carrot side of the patient targets set in the SAC.
This award favors organizations that are providing multiple services to patients
WHAT SHOULD WE DO WITH THIS?
Review how your enabling services are being reported. This is often overlooked because it is not revenue generating through claims.
Keep the unique patient counts as a steady measure to track with executive, clinical, and operational leadership.
Consider expanding areas like enabling services that may be easier to staff than medical or dental providers.
Value Enhancer
SUMMARY
Value Enhancer awards are for Health Centers who received both an Access Enhancer and Quality Award, and kept expenses better than the national average. This award focuses on the Medical Cost per Medical Visit (MCMV) as compared to 2015-2016 data supplied through the Medical Expenditure Panel Survey.
AWARD AMOUNT
Award = $28,750 + $11,500 × (Additional Value Tier)
Minimum Award in 2020 = $28,750
Maximum Award in 2020 = $51,750
CALCULATION
Health Center’s MCMV = Total Medical Costs / Total Medical Visits
Change = (Baseline MCMV) - (Health Center’s MCMV)
Change is scored out for how many standard deviations from the mean. 1 Standard Deviation - High Value, 2 Standard Deviations - Higher Value, 3 Standard Deviations - Highest Value.
OBSERVATIONS
This data is not publicly comparable because medical specific cost data is not released on data.hrsa.gov
All recipients of this award have to receive an Access and Quality measure to qualify.
All recipients did have a decrease in overall expenses from 2018 to 2019 or relatively small increase.
WHAT SHOULD WE DO WITH THIS?
Remember that costs matter. The UDS report separates out medical expenses from other categories. Categorize these jobs consistent with UDS paying attention to move things out when possible.
Health Disparities Reducer
SUMMARY
Health Centers that demonstrate improvement for clinical outcomes across racial and ethnic groups receive a Health Disparities Reducer award. Health Centers must be eligible for an Access Enhancer and are assessed on Low Birth Weight, Hypertension Control, and Diabetes Control which all come from Table 7 on the UDS report. There are two tiers. First, for every racial / ethnic group that meets or exceed the Healthy People 2020 goal. Second, each racial / ethnic group that improves by 10% toward the Healthy People 2020 goal.
AWARD AMOUNT
Tier 1 Award = $8,625 × (Number of Racial / Ethnic groups at goal)
Tier 2 Award = $2,300 + $9,200 × (Additional Racial / Ethnic groups improving by at least 10%)
Minimum Award in 2020 = $2,300
Maximum Award in 2020 = $77,625
CALCULATION
(Current Year Performance - Previous Year Performance) Grouped by Race / Ethnicity
Compared to the Healthy People 2020 goals.
oBSERVATIONS
The award allows for improvement as well as goal attainment
Compared to a benchmark in Healthy People 2020
Dependent on Access Enhancer which is dependent on a quality measure
WHAT SHOULD WE DO WITH THIS?
Pay attention to race / ethnicity assignments for Table 7
Use the Healthy People 2020 as benchmarks for these 3 measures in your QI plan
Advancing HIT for Quality
SUMMARY
Given to promote the use of Health Information Technology, the Advancing HIT for Quality Award was given to 90% of Health Centers. To receive this award, Health Centers must provide a combination of HIT services such as: e-Presciptions (eRx), Clinical Decision Support (CDS), Health Information Exchange (HIE), Health IT - Patient Engagement (Portal), Telehealth Services, or Social Risk Screening.
AWARD AMOUNT
Award = $4,600 + $1,150 [if meeting 4 measures] + $2,500 [if Telehealth] + $2,500 [if Social Risk Screening]
Minimum Award in 2020 = $4,600
Maximum Award in 2020 = $16,500
CALCULATION
Matching the lists of items. Threshold one is meeting 3 items. Threshold two is meeting 4. Telehealth and Social Risk Screening are additional items.
oBSERVATIONS
Many health centers will meet this measure with COVID-19 requiring the addition of telehealth services
This measure is likely to change over time as the improvements become more wide-spread
WHAT SHOULD WE DO WITH THIS?
Ensure these items are reported correctly in the Appendices.
If you are piloting a program with Social Risk Screening, consider piloting in November or December and report out on the UDS report.
Patient-Centered Medical Home (PCMH)
SUMMARY
To support the transformation to value-based care systems, organizations that received accredited PCMH recognition are awarded by HRSA. In 2020, 78% of Health Centers received this award, which is up from 38% in 2013.
AWARD AMOUNT
Based on analysis of the awards, it appears the following formula is used
Award = $30,000 + $5,000 × (Additional PCMH Site)
CALCULATION
The number of sites that have received PCMH accreditation and were submitted in the EHB through the Notice of Intent process
OBSERVATIONS
This program is being promoted through several avenues, and has some financial benefit from HRSA.
WHAT SHOULD WE DO WITH THIS?
Review your award to ensure that all of your PCMH sites were identified and awarded
Submit your Notice of Intent in EHB to participate for all sites.
Conclusion
Given the number of awards that can come from the UDS reporting and the quality initiatives, it is financially wise to invest in quality reporting and tracking this information in the way that HRSA will reward. In many cases, it may be worth assessing the tradeoff of complexity of measures and the value to patients and the financial pay off. Check out one of our other posts to review specific examples, or contact us to schedule a time to review your data and develop a plan to performance.