How are HRSA Quality Improvement Award Calculated?
The HRSA Quality Improvement Awards (QIA) are hard to understand. The calculation is complicated and involved. Often (truth be told), we don’t really know why we received the money. And we certainly don’t know how to play the game.
Building on my in-depth assessment of the awards, in this article, we’ll look at how the awards depend on one another, and an example calculation of what a health center might receive. This article is for:
Quality Directors looking to make a case to their CFOs on why they need staff to close quality measures
CMOs who are trying to pick from several different initiatives to prioritize
CFOs who are trying to budget for next year and get their mind around an estimate for next year’s QIA payout
All Quality Measures Are Not Created Equal
HRSA’s QIA system is a huge windfall to Community Health Centers. It recognizes and rewards efforts to improve the quality of care we provide to our patients. However, not all awards are as easy to get. In fact, like any good video game, certain awards can only be unlocked once you meet the first level.
The diagram below is an attempt to summarize the dependencies and criteria for each award.
First, of course, you must submit your UDS on time. Once you’ve done that, there are three possible quality awards - Clinical Quality Improvers, Health Center Quality Leaders, and National Quality Leaders. Then, if you increase access to patients by 5% overall and 5% in a non-medical service, you are eligible for the Access Enhancer Award. Then, you become eligible for the Value Enhancer and Health Disparities Reducer Awards, if you have both a Quality Award and the Access Enhancer Award.
The PCMH and Advancing Health Information Technology Awards are independent and can be received by meeting the specific requirements.
What Should I Do With This?
Register your PCMH sites with HRSA through the EHB. Now. Make sure you have every site listed. Every site counts, and you’ve already done the work. Make sure you get the credit.
Use HIT to its full potential. This measure is not dependent on anything else. Make sure you have a clinical decision rule that you are really using. Also, continue to push for HIE in your area.
Report from the EMR. If you are still sampling charts, your chances of getting big payouts is limited. Address workflows that are not giving you the data you need. Start insisting that the data the report produces IS the source of truth.
Focus on Quality is key. Pick a measure you think you can improve by 15%. Make sure your uninsured, minority, homeless, and agricultural workers are accurately reported. If you are within reach, get multiple measures in the 1st quartile to score on the Leader awards. Without Quality, you can’t unlock the others.
Provide Access to your community through your non-medical services. Can you expand enabling services? Can you increase access to behavioral health? Often, because of the smaller patient sizes, increasing 5% is within reach.
Watch your spending. The Value award is based on the medical expenditures. Make sure that only the necessary expenses are attributed to medical so that this number is as accurate as possible.
The Bottom Line
Now that you understand how to get the awards, how do we determine what they are worth? Better yet, what should we plan on receiving for our Health Center?
Let’s take a look at the example below.
This health center serves 20,000 patients per year. This is important when we get to the quality awards.
For their 3 PCMH sites, they earn $40,000
For using ePrescribing (eRx), a Portal, and Clinical Decision Support, they earn $4,600
For using Telehealth due to COVID-19, they earn another $2,500
For increasing their Dental Sealant measure by 20% due to an improved report, they earn $23,162.50
Unfortunately, they have a few measures still in the 4th ranked quartile, and are not eligible yet for the Health Center Quality Leader or the National Quality Leader Awards
This year, they increased their Substance Use Disorder by 15%, and their overall patients by 6%. This earned them $5,650.
Their costs have stayed flat when compared to the national average, so they did not earn a Value Enhancer Award.
Finally, their diabetes numbers for Pacific Islanders improved by 12% and earned them $2,300.
All in all, this Health Center was able to earn $78,212.50 for their work to improve access and quality.
So, for CFOs and Quality Leaders, take a look at your priorities and see how you can align the often under-paid work of quality improvement by planning for what HRSA will pay for your achievements.
If you would like a copy of the Excel file above to estimate your payouts, contact me. I can send you the file, or we can set up a time to talk through your strategy to maximize your financial payout for the quality work you are already doing.