Building Physician Leadership in Performance Improvement

Transcription

1 Building Physician Leadership in Performance Improvement Dana Richardson, RN, MHA Director, PCPI Operations & Strategic Initiatives

2 Physician Quality Report* A 10-minute Internet survey was conducted in Respondents were recruited from the Physicians Advisory Council, Decision Analyst s online panel of over 27,000 physicians. The survey response rate was 45.4%. A total of 1,026 physicians were surveyed, including: 505 primary care physicians (PCPs), including internal medicine, general and family medicine, geriatrics, pediatrics, and obstetrics/gynecology physicians 521 specialists, excluding radiology and specialty surgeons Physicians were recruited to ensure that they: Are in active, full-time practice Have been in practice at least one year (post-residency or fellowship) Spend 20+ hours in direct patient care each week *AMA-convened PCPI Physician Quality Survey 2010

3

4

5

6 About two-thirds (62%) of physicians believe that performance improvement is an important aspect of quality care. However, only one-third of physicians (38%) are involved in quality improvement activities.

7 7

8

9

10 Federal Payment Incentives Sustainable Growth Rate Physician Fee Schedule (PFS) Update 1997 EHR Meaningful Use Program Physician Quality Reporting System (PQRS) erx Incentive Program Medicare Access and CHIP Reauthorization Act (MACRA) 2015

11 MACRA Repeals Medicare PFS Payment Merit-Based Incentive Payment System (MIPS) Incentives for participation in Alternate Payment Model (APM) Transition MIPS & APMs will drive payment starting January 1, 2019 PFS % % % % or more MIPS % + 4% extra bonus possible % + 5% extra bonus possible % + 7% extra bonus possible % + 9% extra bonus possible

12 MIPS Secretary to create methodology to assess Eligible Professionals (EP) performance and determine a composite performance score Adjustment can be positive, negative or zero Performance categories Quality measures (30% of Score) Resource use measures (30% of Score) Counts for not more than 10% in 2019 and 15% in 2020; additional weight of at least 20% and 15%, respectively, are added to the Quality score in those years Clinical improvement activities (15% of Score) Sub-Categories- Includes Better Off-Hours Access, Care Coordination Patient Safety, Beneficiary Engagement Others as Determined by Secretary Meaningful Use of EHRs (25% of Score)

13 APM If criteria are met, can receive 5% incentive payment for APMs must bear more than nominal risk, or be a qualifying medical home

14 14 14

15

16 Physician Activation Activation is more than dissemination It is behavior change, i.e., adoption of the change or improvement If we are to succeed in meeting the Triple Aim, we need to take activation to a whole new level within healthcare

17 A Review of 18 Initiatives* Bridges to Excellence (BTE) Get with the Guidelines Physician Group Incentive Program (PGIP) Return Preparer Program (RPP) Million Hearts Initiative (Million Hearts) Partnerships for Patients (PfP) 100,000 Lives Campaign TransforMED Community Transformation Grant Program Head Start Technical Assistance (HSTA) Door to Balloon (D2B) Alliance and Sustain the Gain Real Warriors Program (RW) Community Access to Child Health (CATCH) Not-on-Tobacco (N-O-T) Piggymojo Ask and Act OneBreath Americans in Motion *AMA commissioned study by Booze Allen Hamilton 2013

18 Communications Tools to carry out dissemination activities to inform key stakeholders on initiative purpose and to support stakeholder adoption of desired new behavior Incentives Developing programs to provide monetary and nonmonetary rewards and recognition to encourage desired behaviors Technical Support Provision of direct support to practices to help them successfully adopt new technologies, payment models, organizational structures, and comply with new regulations Partnerships Collaborations with external groups on dissemination or activation activities necessary for initiative success Collaborations can be tailored according to initiative and organizational type Guidance Evidence-based guidance to help with quality improvement, practice transformation, etc. Development of processes/tools to encourage improved clinical delivery, health outcomes, or practice transformation Advocacy Contributions to national policy discourse on the future of health care or specific change platform related issues Identifying and supporting specific regulations, frameworks, and initiatives designed to improve care quality C h a n g e L e v e r s

19 Key Finding for Each Change Lever Communications Peer networks are a highly effective communication channel and scaling tool Partnerships Teaming with the right partners at national and local level is a critical success factor Guidance Guidance is most effective when consistent but can be tailored to local needs Technical Support Broad use of partners with local reach with pacing based on audience needs Incentives Financial rewards not always successful; growing value to recognition programs Advocacy Generally not engaged in direct policy advocacy

20 Key Observations and Considerations Key Observations Multiple change levers needed to launch and sustain an initiative Developing local dissemination and activation strategies is necessary to drive broad change Gaps in business acumen and leadership can hinder practice transformation Are recipients ready and able to make change? Key Considerations Internal control versus ability to quickly scale via partners Identification of market segments at high level with partners to reach even more targeted segments locally Lag time to become fully operational (average 2 years) and to measure impact (4 to 5 years) Measurement of results (often use external parties for data aggregation and assessment)

21 PCPI 2020 Vision: The PCPI is a national catalyst to achieve optimal health outcomes Guiding Principles Align with the national goal of better care, better health and lower cost Focus on improvement within the health care system Leverage the unique attributes of the PCPI Engage a membership inclusive of all stakeholders Lead through partnerships Develop a hub within the health care learning system Increase scale as resources become available

22 Programs Measurement science Measure development education Consulting services National Quality Registry Network (NQRN ) Learning Network: best practices & tools Annual meeting, Webinars and Council calls QI Program Learning network: science of improvement and large scale initiatives Cross-cutting improvement topics such as Closing the Referral Loop

23 Why Change? Affordable Care Act Medicare Access & CHIP Reauthorization Act Systemization & integration of care across settings Care delivered by teams Use of EHR/HIT New diagnostic/therapeutic modalities Data driven improvement System Factors Improve & Measures Data comes from EHR/HIT systems, registries, large data systems & mobile devices Measures fit for purpose Process & culture change Stakeholder Needs Business Model Consumerism New care models; patient centered care Lower costs Payment based on value Lower administrative burden to report performance AMA & PCPI pursue new strategic priorities Diversifying revenue sources Leadership through innovation 23

24 Transforming the PCPI Expanding governance & membership - AMA & CMSS (designated seats) - Health systems, hospitals & clinics - Consumer & patient organizations - MD/DO accreditation & licensing organizations - Employers - MD/DO specialty societies - Health care professional organizations - MD/DO state societies - Health care accreditation & licensing organizations - Pharmacies - Health information technology - Quality improvement organizations - Health Plans Federal & state government agencies (non-voting) All can vote, be on BOD and will pay dues 501c3 Foundation

25 PCPI Value Proposition Data (interoperability) EHR & HIT* (claims, clinical, patient reported) Registry* Data warehouse Tools Measures*& analytics QI models, tools & projects* Decision support PCPI is a Catalyst for Improved Outcomes

26 Smart people are a dime a dozen. What matters is the ability to think different... to think out of the box. Walter Isaacson, CEO Aspen Institute & author