Pay for Performance Reporting & Quality Improvement An Implementation Strategy Tom Ricciardi, PhD Stroke Patients on Aspirin A d h e r e n c e R a t e 85% 75% 65% 55% 45% MQIC Pooled Data Norumbega 12/24/2003 3/22/2004 7/9/2004
The State of Quality in Medicine Americans receive only 55% of recommended care. Source: McGlynn et al. NEJM 2003; 348:2635-45 2
National Response: Pay for Performance 3
National Drivers of Pay for Performance Physician Group Practice Demonstration Care Mgmt Performance Demonstration Care Coordination Administration Outcomes Technology Outcomes 4
P4P Mixed Reviews Who Benefits? Budget neutral? Punitive? Reporting Burden? 5
Problem Physicians are lacking the information tools & processes required to: Improve quality & process of care Measure clinical performance Increase reimbursement??? Medical Quality Improvement Consortium (MQIC) 6
MQIC: 4 Million Patients & Growing Data Warehouse Centricity EMR Users Use data to improve patient care Strengthen clinical reporting Disease management Quality of care Practice profiles Clinical research 7
MQIC: 5,100+ Providers by Specialty Family Practice 818 Internal Medicine 1088 Pediatrics 432 Obstetrics & Gynecology 152 Geriatrics 43 Total Primary Care MD 2,533 Focus Focus on on Primary Primary Care Care 63% 63% Cardiology 227 Surgery 153 Infectious 58 Pulmonology 96 Hematology/Oncology 85 Neurology 77 Orthopedics 56 Other Specialties 712 Total Specialty MD 1,464 Growing Growing Specialties Specialties Over Over Time Time Last updated 5 June 2005 Resident MD 415 Allied Health Professionals 694 8
MQIC Components 3 Adherence Rate 85% 80% 75% 70% 65% Adherence Rate Post-MI Patients on Beta Blocker Post-MI Patients on Beta Blocker 85% 80% 75% 70% 65% MQIC Benchmark Clinic MQIC Benchmark Clinic MQIC Web Portal Reports & Outcomes Centricity Physician Office EMR Data Warehouse Services Database Data Extract System Data Data Import Import 2 Staging Area 1 1 1 1 1 2 2 2 3 3 3 3 Report Report Data Data 1 9
Data Security HIPAA-compliant Remove patient-identifying information Only EMR customers can re-identify individuals Name, SSN, Phone, Address Zip code to 3 digits only DOB --> Age PID --> transformed to EPID 10
Clinical concepts are essential to successful reporting Need to derive value from data stored your way. Many entry forms for one concept myocardial infarction MI S/P MI 1987 hx of heart attacks Need decision support and reporting to occur at a more general level, e.g., patients with heart disease 11
Data Cleanup Most common errors cleaned Entered Value Cleaned Value 120 120 110 RT 110 130 L LGE CUFF 130 refused -1 3-2 5 10-1 350-3 12
MQIC Web Portal 13
Quality Reports 14
Example Norumbega Medical Medium-sized primary care care practice in in Maine Maine Implemented EMR EMR over over 6 years years ago ago 9 9 Physicians, 30 30 allied allied health health providers Serving over over 21,000 21,000 patients Medical Quality Improvement Consortium Stroke Patients on Aspirin Adherence Rate 85% 75% 65% 55% 45% MQIC Pooled Data Norumbega 12/24/2003 3/22/2004 7/9/2004 Quality Quality metrics metrics showing showing quarterly quarterly trends trends for for MQIC MQIC Pooled Pooled Data, Data, 13k 13k patients patients versus versus Norumbega Norumbega Medical, Medical, a multi-site multi-site primary primary practice. practice. The The graph graph shows shows compliance compliance with with a commonly-accepted commonly-accepted clinical clinical guideline guideline for for the the management management of of patients patients after after a stroke. stroke... 15
Diabetes 16
Example Community Clinic Community health health center center near near Boston Boston 32 32 providers (12.6 (12.6 FTE) FTE) Serving over over 7,500 7,500 patients Federal Bureau Bureau of of Primary Health Health Care Care Health Health Disparities Collaborative MQIC MQIC 8.4 8.4 8.2 8.2 8 8 7.8 7.8 7.6 7.6 HgbA1c 7.4 7.4 7.2 "We 7.2 "We have have been been recognized recognized at at the the local local and and 7 national 7 national level level in in the the past past year. year. Our Our efforts efforts to 6.8 to provide provide the the best best patient patient care care to to our our 6.8 diabetic 6.6 diabetic patients patients have have been been greatly greatly 6.6 enhanced enhanced because because of of the the tools tools available available to to us. us. The The EMR EMR has has become become one one of of the the critical critical components components of of our our patient patient care care delivery delivery system." system." July 2003 Jan 2004 July 2004 17
Heart & Stroke 18
DOQ-IT Measures in MQIC TODAY Q4 2005 Q1 2006 CMS Physician Focus Quality Initiative, March 04 Source: Lumetra 19
Thank You! Thomas N. Ricciardi, PhD Global Manager, Quality & Outcomes Centricity Physician Office tom.ricciardi@med.ge.com www.gehealthcare.com 20