Enhancing patient care quality

Challenge

The Centers for Medicare & Medicaid Services (CMS) created the Quality Payment Program (QPP) in response to legislation incentivizing clinicians to provide quality patient care while reducing their reporting burden.

To help Medicare providers submit their data, CMS switched to a simplified standard that accepts JSON and XML using equivalent data models and validation rules. Since many reporting systems and providers still used the previous data format (QRDA-III), CMS wanted to build a tool to convert data into a new simplified form to support their partners who had invested in previous data submission formats and might have been nervous about transitioning to a new standard.

Approach

Flexion was awarded a competitive task order to build a tool that converted data from existing formats to the new simplified standard. We assembled a scrum team of five developers, a data scientist, a scrum master, and an agile coach.

Since CMS was quite new to agile development methodologies, having a part-time agile coach on the team was instrumental in the project’s success and CMS’s continued growth in agile practices. We provided an open-source tool allowing Medicare providers to convert files using the official web interface, REST endpoint, or the local command line application.

The design featured a modular converter that let the team build plugins for each conversion measure, which could be independently developed and tested using JUnit. The core Java-based converter was made accessible using a modern Java web service tech stack running in AWS.

We also built a new validation path for CPC+ QRDA-III files. We collaborated with other vendors to incrementally develop an API that indicated the location and details of QRDA-III errors. This enabled them to direct users to the specific file location, measure, and type of error to correct.

Outcomes

We delivered the tool into production within nine months—just in time for providers to meet their annual submission deadline. Thanks to the real-time nature of the new QPP system, providers submitting their QRDA files could now find out within seconds if their submissions would process correctly, rather than waiting a month or more as they did with the legacy system.