The Physician Quality Reporting Initiative: Using Information Technology to Advance Quality of Care

Transcription

1 The Physician Quality Reporting Initiative: Using Information Technology to Advance Quality of Care Joseph Cooke, MD; Chief Quality and Patient Safety Officer Mary Koval, RN; Clinical Quality Program Manager NYP-Weill Cornell Medical Center New York, NY There are no disclosures in regards to this presentation 1

2 Weill Cornell Physician Organization Federation of 21 Clinical Departments >750 Full-Time Clinical Faculty Members Affiliated with: New York-Presbyterian Hospital Memorial Sloan-Kettering Cancer Center Hospital for Special Surgery Rockefeller University One Day at NYP/WCMC Operating Room Procedures 180 Emergency Room Visits 250 Obstetrical Deliveries 25 Outpatient Visits 4,000 Beds Occupied 800 2

3 Physician Quality Reporting Initiative History Created in 2006 by the Tax Relief and Healthcare Act under the Bush Administration Voluntary Participation Pay for Reporting (3 measures/80% applicable cases) July December measures; selection based on practice Claims based reporting 1.5% of allowable Medicare charges potential bonus Included e-prescribing Evolution of PQRI Measures Claims or Registry Reporting Individual or Group Measures Two reporting periods 1.5% Incentive Measures 2% Incentive E-Rx Program Third Party Payer Participation Measures Added Group Practice Reporting & EHR Reporting Measures 1% Incentive 3

4 Our Approach Changes That Result in Improvement Hunches, Theories, Ideas 2007 PQRI Reporting Leadership Commitment PO Administration Manual Reporting Physician Responsibility 40% Providers on Electronic Medical Record (EMR) Quality Codes added to the EMR dictionary Coordinated by Office of Billing Compliance 4

5 2007 PQRI Reporting Results 8 physicians received incentive bonus Challenges Lack of Global Awareness/Voluntary Participation Physician Dependent Manual Reporting Manual Entry Quality Codes in Billing System No Formal Feedback Mechanism Insignificant Incentive/No Benefits 2008 PQRI Reporting Leadership Commitment PO Administration Departmental Chairman Selection of Measures Pertinent to Practice Manual Reporting 52% Providers on EMR Coordinated by Office of Billing Compliance 5

6 2008 PQRI Reporting Results 11% physicians received incentive bonus Challenges Lack of Global Awareness/Voluntary Participation Physician Dependent Manual Reporting Manual Entry Quality Codes in Billing System No Formal Feedback Mechanism Insignificant Incentive/No Benefits 2009 PQRI Reporting Leadership Commitment Expanded Coordinated by the PO s Division of Quality and Patient Safety 57% Providers on EMR Measure Selection by Chairman, Departmental QPS Chairman, and Physicians Involvement of IT, Business Office, Dept. Administrative Staff Automated and Semi- Automated Measures Manual Reporting on some measures Three common measures tracked: Use of EMR Medication Review Tobacco Inquiry Monthly Reports/Feedback to Physicians 6

7 PQRI Report PQRI $ Non- Compliant Sum of Medicare 2% Bonus Potential PQRI $ Percent Compliant PQRI Eligible Providers Compliant / Total Percent Providers Compliant PQRI $ Department Compliant CARDIOTHORACIC SURGERY 100% 15 / % DEPARTMENT OF PATHOLOGY 100% 10 / % DEPARTMENT OF NEUROLOGICAL SURGERY 99% 10 / 11 91% WEILL CORNELL MEDICAL ASSOCIATES 100% 14 / 18 78% WEILL CORNELL PULMONARY ASSOCIATES 79% 9 / 12 75% WEILL CORNELL INTERNAL MEDICINE ASSOCIATES 76% 35 / 51 69% DEPARTMENT OF OPHTHALMOLOGY 85% 19 / 28 68% WEILL CORNELL ANESTHESIOLOGY ASSOCIATES 70% 55 / 94 59% DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 68% 11 / 21 52% DEPARTMENT OF SURGERY 50% 19 / 41 46% WEILL CORNELL ED PHYSICIANS 34% 19 / 41 46% DEPARTMENT OF OTORHINOLARYNGOLOGY 41% 12 / 28 43% WEILL CORNELL PEDIATRIC CARDIOLOGY 100% 1 / 3 33% DERMATOLOGY 11% 3 / 10 30% HEMATOLOGY-ONCOLOGY 14% 11 / 38 29% DEPARTMENT OF PEDIATRICS 0% 4 / 14 29% DEPARTMENT OF MEDICINE 36% 11 / 45 24% DEPARTMENT OF UROLOGY 0% 3 / 14 21% DEPARTMENT OF REHABILITATION MEDICINE 0% 1 / 5 20% NYH-CUMC RADIOLOGY GROUP 9% 7 / 43 16% DIGESTIVE DISEASES 15% 4 / 26 15% DEPARTMENT OF NEUROLOGY 7% 6 / 40 15% DIVISION OF CARDIOLOGY 2% 4 / 38 11% WEILL CORNELL IMAGING AT NYP 7% 1 / 27 4% DEPARTMENT OF PSYCHIATRY 0% 0 / 40 0% ENDOCRINOLOGY & METABOLISM 0% 0 / 11 0% WEILL CORNELL RADIATION ONCOLOGY ASSOCS. 0% 0 / 10 0% Grand Total 33% 284 / % PQRI Reporting Success RUN_YEAR Department Provider PQRI Overall Compliance 2010 DEPARTMENT OF MEDICINE Dr. A Compliant 2010 DEPARTMENT OF MEDICINE Dr. B Compliant 2010 DEPARTMENT OF MEDICINE Dr. C Compliant 2010 DEPARTMENT OF MEDICINE Non-Compliant 2010 DEPARTMENT OF MEDICINE Non-Compliant 2010 DEPARTMENT OF MEDICINE Non-Compliant 2010 DEPARTMENT OF MEDICINE Non-Compliant 2010 DEPARTMENT OF MEDICINE Non-Compliant 7

8 Measure Trend Report PQRI Measures Jan 2009 PQRI Reported Jan - Feb 2009 PQRI Reported Jan - Mar 2009 PQRI Reported Jan - Apr 2009 PQRI Reported Jan - May 2009 PQRI Reported Jan - Jun 2009 PQRI Reported Jan - Jul 2009 PQRI Reported 114 Inquiry tobacco use 1.67% 14.69% 26.51% 35.63% 41.11% 44.20% 42.69% 124 Use of EMR 40.63% 42.14% 46.15% 49.58% 51.81% 52.65% 48.43% 130 Medication Reconciliation 1.38% 12.38% 26.69% 38.36% 46.64% 50.47% 53.22% 2009 PQRI Reporting Results Challenges 39%of physicians were projected to receive incentive bonus via claims 62% of physicians received bonus via Registry Reporting Claims/Billing Issues System Issues Human Error Physician, House Staff Education Documentation Issues Text Blobs vs Data Entry 8

9 Automated Measure Examples Measure #6: CAD Anti-platelet Therapy System checks medication list and/or orders Measure #39: Osteoporosis Screening System checks orders or test results Measure #114: Tobacco Inquiry System checks Social History Measure #130: Medication Review System checks medication list Tobacco Inquiry Documentation 9

10 Semi-Automated Measure Examples Measure #5: CHF Measure #51: COPD Spirometry Evaluation Measure #52: COPD Bronchodilator Therapy Measure #71: Breast CA Hormonal Treatment Measure #72: Colon CA Chemotherapy Stg III Measure #84: Hepatitis C: Genotype Testing Alert and SmartSet for Measure # 5 (CHF) Alert SmartSet 10

11 2010 PQRI Reporting Leadership Commitment: Included Physicians and Administrative Staff 64% Providers on EMR Automated and Semi-Automated Measures Manual Reporting on some measures Emphasis on performanceof measure; included in monthly reports Physician Culture Change 2010 PQRI Sample Report Department PQRI Eligible Providers Compliant / Total % Providers Successfully Reporting PQRI Measure Performance CARDIOTHORACIC SURGERY 16 / % 83% DEPARTMENT OF NEUROLOGICAL SURGERY 14 / % 88% DEPARTMENT OF PATHOLOGY 10 / % 100% DEPARTMENT OF REHABILITATION MEDICINE 4 / 4 100% 80% DERMATOLOGY 11 / % 80% WEILL CORNELL ED PHYSICIANS 40 / % 99% WEILL CORNELL IMAGING AND VASCULAR 3 / 3 100% 93% WEILL CORNELL MEDICAL ASSOCIATES 16 / % 67% WEILL CORNELL PULMONARY ASSOCIATES 10 / % 68% WEILL CORNELL INTERNAL MEDICINE ASSOCIATES 38 / 40 95% 76% NYH-CUMC RADIOLOGY GROUP 37 / 39 95% 99% DIVISION OF CARDIOLOGY 33 / 35 94% 87% WEILL CORNELL RADIATION ONCOLOGY ASSOCS. 10 / 11 91% 82% WEILL CORNELL IMAGING AT NYP 26 / 29 90% 100% DEPARTMENT OF OPHTHALMOLOGY 24 / 28 86% 90% HEMATOLOGY-ONCOLOGY 32 / 38 84% 64% DEPARTMENT OF OBSTETRICS AND GYNECOLOGY 16 / 20 80% 44% DIGESTIVE DISEASES 20 / 25 80% 52% WEILL CORNELL ANESTHESIOLOGY ASSOCIATES 83 / % 93% DEPARTMENT OF OTORHINOLARYNGOLOGY 23 / 29 79% 18% DEPARTMENT OF SURGERY 31 / 43 72% 66% ENDOCRINOLOGY & METABOLISM 7 / 10 70% 69% DEPARTMENT OF UROLOGY 12 / 18 67% 63% WEILL CORNELL PEDIATRIC CARDIOLOGY 2 / 3 67% 50% DEPARTMENT OF PEDIATRICS 11 / 17 65% 53% DEPARTMENT OF NEUROLOGY 24 / 43 56% 73% DEPARTMENT OF MEDICINE 22 / 50 44% 57% DEPARTMENT OF PSYCHIATRY 9 / 46 20% 100% DIVISION OF HOSPITAL MEDICINE 0 / 22 0% 65% PRENATAL GENETICS 0 / 1 0% 100% Weill Cornell Medical College 584 / % 71% Medicare 2% Bonus Potential 11

12 2010 PQRI Sample Report Measure Performance Department PQRI Measures Jan 2010 Jan - Feb 2010 Jan - Mar 2010 Jan - Apr 2010 Jan - May 2010 DIVISION OF CARDIOLOGY 6 - CAD: Oral anti platelet therapy Rx 92.20% 92.65% 91.73% 91.57% 91.04% DIVISION OF CARDIOLOGY Inquiry tobacco use 92.14% 90.93% 90.88% 91.32% 91.52% DIVISION OF CARDIOLOGY Use of EMR % % % % % DIVISION OF CARDIOLOGY Medication Reconciliation 81.46% 80.95% 80.13% 80.14% 79.62% 2010 PQRI Reporting Results 76% of physicians are projected to receive incentive bonus via claims Challenges Documentation Issues EMR Work-Arounds Claims/Billing Issues System Issues Human Error Physician, House Staff Education 12

13 WCMC PO PQRI Reporting Success Rate 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Claims Registry 2010 Measure Performance 13

14 Measure Performance January December 2010 Challenges to Implementing Quality Initiatives Staff buy-in Documentation Quality improvement is time consuming and labor intensive Distribution and redistribution of work Communication of quality initiatives to others Implement change Data ownership and development for academic pursuits 14

15 E-Prescribe Submission of E-Rx Quality Code (G8553) 25 Rx electronically/year = 2% CMS incentive System qualified in May 2010 E-Rx Default for office visits in (mid-july 2010) NYS Medicaid E-Rx Incentive (May 2010) 0.80 cents per electronic prescription Inactivation after 189 days of non-use Monthly Reports excluded controlled substances, DME Challenge: Entering pharmacy information PO e-rx Utilization 2010 (% monthly Rx E-Prescribed) 15

16 Summary of Activities PO Administration Leadership Meetings 2008 Chairman and Division Chief Meetings 2009 Faculty Meetings Task Force (IT, POBO, Safety) Weekly Meetings Work Group (PO Leadership, Safety, MCO, Compliance) Monthly Meetings Dept. Administration/Staff Meetings 2010 Faculty Meetings Individual Physician Instruction Task Force (IT, POBO, Safety) Weekly Work Group (PO Leadership, Safety, MCO Compliance Monthly Dept. Administration /Staff Meetings Practice Operations Committee Discussion Town Hall Meetings Monthly PO QPS Committee Discussion Dept. QPS Committee Discussion Included in Dept. Annual Quality Evaluations Presentations to PO Operating & Policy Board PO Board of Overseers NYP Board of Trustees Inclusion in Ongoing Physician Performance Evaluation (OPPE) Alignment / NYP Safety Initiatives 16