Transcript PPRNet 2014 Annual Meeting

PRE-CONFERENCE
WORKSHOP
PPRNet 101
©PPRNet
INTRODUCTIONS
• Who you are
• Why you are here
• What you hope to learn
©PPRNet
WORKSHOP GOALS
• To (begin to) answer the question: “How can
I maximize the benefit of PPRNet in my
practice?”
– Introduce (or reintroduce) PPRNet and its mission
– Provide an overview of PPRNet reports
– Share examples of how practices use PPRNet
reports to achieve recognition and/or incentives
– Allow time for participants to use reports and network
with one another
©PPRNet
AGENDA
Vanessa Congdon
1:00pm-1:15pm
Introductions
1:15pm-1:30pm
What is PPRNet?
Andrea Wessell
1:30pm-2:00pm
PPRNet Performance Reports and FAQs
Vanessa Congdon
2:00pm-2:30pm
Using PPRNet Tools for Recognition and
Incentive Programs
Andrea Wessell
2:30pm-2:45pm
Break
2:45pm-3:00pm
3:00pm-3:15pm
3:15pm-4:00pm
Recognition/Incentive Programs,
continued
PPRNet Top 10 List for Quality
Improvement
Open Session
Demonstrations, Follow-up Discussions
Andrea Wessell
Andrea Wessell
Andrea Wessell
All Participants
©PPRNet
REVISE AGENDA?
Vanessa Congdon
1:00pm-1:15pm
Introductions
1:15pm-1:30pm
What is PPRNet?
Andrea Wessell
1:30pm-2:00pm
PPRNet Performance Reports and FAQs
Vanessa Congdon
2:00pm-2:30pm
Using PPRNet Tools for Recognition and
Incentive Programs
Andrea Wessell
2:30pm-2:45pm
Break
2:45pm-3:00pm
3:00pm-3:15pm
3:15pm-4:00pm
Recognition/Incentive Programs,
continued
PPRNet Top 10 List for Quality
Improvement
Open Session
Demonstrations, Follow-up Discussions
Andrea Wessell
Andrea Wessell
Andrea Wessell
All Participants
©PPRNet
WHAT IS PPRNET?
©PPRNet
WHAT IS PPRNET?
• Primary (care) Practices Research Network
• A virtual network of primary care practice
teams and researchers that aims to:
– Turn EHR data into actionable information for
clinicians and practice staff
– Empirically test theoretically sound primary care
quality improvement interventions
– Disseminate interventions that improve primary
health care
©PPRNet
PPRNET AIMS TO…
“Blur the distinction between
quality improvement and research”
©PPRNet
PPRNET: PRIMARY CARE
PRACTICE-BASED RESEARCH AND
LEARNING NETWORK
©PPRNet
PPRNET
Agency for Healthcare Research and Quality
Center for Primary Care Practice-Based
Research and Learning
– Answer questions relevant to practice
– Disseminate findings
©PPRNet
PPRNET RESEARCH
• Primary Care-Relevant Questions
– “Preventive Services Delivery in Patients With Chronic
Ilnesses: Parallel Opportunities Rather Than Competing
Obligations”
– “Learning from Primary Care Meaningful Use Exemplars”
• Translating Research into Practice (TRIP)
Interventions
– Impact studied across a variety of clinical areas
• Prevention, chronic disease management, acute care and
medication safety
– A-TRIP, C-TRIP, SO-TRIP, MS-TRIP, AM-TRIP, CKDTRIP…
©PPRNet
PRACTICE SPOTLIGHT: NEW LONDON
FAMILY MEDICINE
©PPRNet
DISSEMINATING “LESSONS LEARNED”
• Ongoing PPRNet Activities
– Annual meetings
– Monthly webinars
– Listserv
– Social media
• Publications
• Presentations
©PPRNet
PPRNET PERFORMANCE REPORTS
Practice-Level Performance Report
Patient & Provider- Level Report
©PPRNet
CLINICAL PRACTICE QUALITY
MEASURES
MEASURE CONDITION
Diabetes Mellitus
Cardiovascular Disease
Women’s Health Care
Cancer Screening
Immunizations
Mental Health & Substance Abuse
Respiratory Disease
Medication Safety
#
12
17
2
3
8
6
4
15
TOTAL: 67
©PPRNet
PRACTICE PERFORMANCE REPORT
 67 Quality Indicators
 3 Summary Measures
 SPC Methodology
 Time trends – Monthly over 2 years
 Comparison with PPRNet benchmark (ABC)
 Comparison with national benchmarks (when
available)
©PPRNet
PATIENT-LEVEL REPORT
(PLR)
 Excel Spreadsheet with 78 tabs:
• PPRNet Switchboard
• Practice Performance on Individual Measures
• Provider Performance on Individual Measures
• Patient Registry
• PPRNet Measure Groupings (8 tabs)
• Patient Lists of those not meeting criteria for
each of 67 Individual Measures
 Same indicator criteria as practice report
 All “active” patients ≥ 3 months age
©PPRNet
PPRNET SWITCHBOARD
©PPRNet
PRACTICE PERFORMANCE
ON INDIVIDUAL MEASURES
©PPRNet
PROVIDER PERFORMANCE
ON INDIVIDUAL MEASURES
©PPRNet
PATIENT REGISTRY
©PPRNet
CMS MU CQM
©PPRNet
CMS ACO CQM
©PPRNet
USPSTF
RECOMMENDATIONS
(GRADE A AND B)
©PPRNet
CDC ADVISORY COMMITTEE ON
IMMUNIZATION PRACTICES
RECOMMENDATIONS
©PPRNet
NIAAA ALCOHOL SCREENING
AND INTERVENTION
RECOMMENDATIONS
©PPRNet
CDC GET SMART
TREATMENT GUIDELINES
FOR URI’S
©PPRNet
CMS PQRS CQM
GROUPINGS
©PPRNet
All Pts 18-75
with DM
PQRS DM TAB
©PPRNet
PQRS DM LIST
©PPRNet
ACC/AHA CHOLESTEROL
GUIDELINES FOR ASCVD RISK
REDUCTION
©PPRNet
ACC/AHA CHOLESTEROL GUIDELINES FOR
ASCVD RISK REDUCTION
HIERARCHICAL STATIN BENEFIT GROUPS
ADULTS >=21 years old
• Diagnosis of ASCVD (CHD or Atherosclerosis)
• Highest LDL-C >=190 mg/dL
• Diagnosis of Diabetes Mellitus; age 40-75 yr
• Estimated 10-yr ASCVD Risk >=7.5% age 40-75
yrs
©PPRNet
ACC/AHA CHOLESTEROL GUIDELINES FOR
ASCVD RISK REDUCTION
ESTIMATED 10-YR ASCVD RISK EQUATIONS
 Age
 Dx Smoking Status
 Sex
 Systolic BP
 Race
 Hypertension Dx
 Total Cholesterol
 Diabetes Mellitus Dx
 HDL-CSystolic BP
 Smoking Status
 Hypertension Dx
 Diabetes Mellitus
©PPRNet
Q: WHAT DATA ARE USED
FOR CALCULATING
PERFORMANCE?
©PPRNet
A (PART 1): REPORT GUIDE DETAILS
DATA SOURCE FOR EACH MEASURE
©PPRNet
A (PART 2): PPRNET MEASURES ARE NOW
ALIGNED WITH MEANINGFUL USE CLINICAL
QUALITY MEASURES
• Applies to some new measures (ie, eye
exam in patients with diabetes) and new
categories (ie, ACO CQMs)
• Identifiers (ie, CMS id, NQF # or PQRS id)
cited in reports
©PPRNet
HOW DO I UPLOAD MY DATA EXRACT
AND ACCESS MY REPORTS?
https://pprnetportal.musc.edu/
©PPRNet
NEW DATA EXTRACT
• PP users will be migrating to a new extract
process for October reports
• McKesson support for prxtract ends in October
• The MUSC OCIO has worked with us to develop
a “vendor neutral” extraction process
• New reports will include patient identifiers!
©PPRNet
SUMMARY:
PPRNET REPORTS IN PRACTICE
•
•
•
•
Evaluate performance over time
Identify patients overdue for care
Engage, motivate, and incentivize practice team
Demonstrate quality of care for quality recognition
and incentive programs
©PPRNet
QUESTIONS
• To (begin to) answer the question: “How can
I maximize the benefit of PPRNet in my
practice?”
– Introduce (or reintroduce) PPRNet and its mission
– Provide an overview of PPRNet reports
– Share examples of how practices use PPRNet
reports to achieve recognition and/or incentives
– Allow time for participants to use reports and network
with one another
©PPRNet
USING REPORTS FOR
RECOGNITION AND INCENTIVE
PROGRAMS
©PPRNet
RECOGNITION AND
INCENTIVE PROGRAMS
• PPRNet practices use reports for a variety
of local and national quality recognition
and pay for performance programs
• During this session, we will highlight:
– NCQA Patient-Centered Medical Home
– CMS Physician Quality Reporting System
©PPRNet
PPRNET 101: GLOSSARY
•
•
•
•
•
•
•
NCQA
PCMH
CMS
PQRS
ABFM
PLR
SQUID
What is your experience with these
recognition programs?
How has your practice benefited
from recognition?
©PPRNet
NCQA PCMH 2014 STANDARDS
• Published in March 2014 (must be used by March 2015)
• Revisions to align with MU Stage 2, reflect PCMH evidence
base and from stakeholder input
• Major edits in the areas of:
• Care management of high-need populations
• Team-based care
• Focus on triple aim domains (patient experience, cost, clinical
quality)
• Sustaining transformation
• Integration of behavioral health
©PPRNet
NCQA PCMH 2014 Content and Scoring
(6 standards/27 elements)
1: Enhance Access and Continuity
A. *Patient-Centered Appointment Access
B. 24/7 Access to Clinical Advice
C. Electronic Access
Pts
4.5
3.5
2
10
2: Team-Based Care
A. Continuity
B. Medical Home Responsibilities
C. Culturally and Linguistically Appropriate
Services (CLAS)
D. *The Practice Team
Pts
3
2.5
2.5
4
4: Plan and Manage Care
A. Identify Patients for Care Management
B. *Care Planning and Self-Care Support
C. Medication Management
D. Use Electronic Prescribing
E. Support Self-Care and Shared Decision-Making
20
Pts
6
6
6
5: Track and Coordinate Care
A. Test Tracking and Follow-Up
B. *Referral Tracking and Follow-Up
C. Coordinate Care Transitions
18
12
3: Population Health Management
A. Patient Information
B. Clinical Data
C. Comprehensive Health Assessment
D. *Use Data for Population Management
E. Implement Evidence-Based DecisionSupport
Pts
3
4
4
5
4
6: Measure and Improve Performance
A. Measure Clinical Quality Performance
B. Measure Resource Use and Care Coordination
C. Measure Patient/Family Experience
D. *Implement Continuous Quality Improvement
E. Demonstrate Continuous Quality Improvement
F. Report Performance
G. Use Certified EHR Technology
20
Pts
3
3
4
4
3
3
0
20
Scoring Levels
Level 1: 35-59 points.
Level 2: 60-84 points.
Level 3: 85-100 points.
Pts
4
4
4
3
5
*Must Pass Elements
©PPRNet
PCMH 2: TEAM-BASED CARE
• Element 2D: The Practice Team
• The practice uses a team to provide a range of patient
care services by:
1.
2.
3.
4.
5.
Defining roles for clinical and nonclinical team members
Identifying practice organizational structure and
staff leading and sustaining team based care
Having regular patient care team meetings or a
structured communication process focused on
individual patient care*
Using standing orders for services
Training and assigning members of the care team to
coordinate care for individual patients
(continued)
©PPRNet
PCMH 2: TEAM-BASED CARE
6.
Training and assigning members of the care
team to support patients/families/caregivers in
self-management, self-efficacy and behavior
change
7. Training and assigning members of the care
team to manage the patient population
8. Holding regular team meetings addressing
practice functioning
9. Involving care team staff in the practice’s
performance evaluation and quality
improvement activities
10. Involving patients/families/caregivers in quality
improvement activities or on the practice’s
advisory council
©PPRNet
PPRNET TOOLS
• PPRNet Improvement Model as background
• Build team meeting agendas based on PPRNet
reports, webinars or network meeting topics
• Use plans for Element 3D (Population
Management) or 4A (Care Management and
Support) to document responsibilities for teambased care
©PPRNet
PCMH 3: PLAN AND MANAGE CARE
• Element 3D: Use Data for Population
Management (MUST PASS)
• At least two different preventive care services
• At least two different immunizations
• At least three different chronic or acute care
services
• Patients not recently seen by the practice
• Medication monitoring or alert
©PPRNet
PCMH 3: PLAN AND MANAGE CARE
PPRNet Patient-level Report (PLR) includes
lists of patients:
• With specific diagnoses
• Needing preventive services,
including immunizations
• Requiring clinician review
or action
• Taking specific medications
©PPRNet
PPRNET TOOLS
• Add narrative describing who
does what
• Save examples of letters or
chart flags
• Pick 2-3 areas to work on every
quarter to “complete” all in 12
months
©PPRNet
PCMH 4: CARE MANAGEMENT AND
SUPPORT
• Element 4A: Identify Patients for Care Management
• Systematic process and criteria for identifying
patients who may benefit from care management
The process includes consideration of the following:
1. Behavioral health conditions
2. High cost/high utilization
3. Poorly controlled or complex conditions
4. Social determinants of health
5. Referrals by outside organizations (e.g., insurers, health
system, ACO), practice staff or patient/family/caregiver
6. The practice monitors the percentage of the total patient
population identified through its process and criteria*
©PPRNet
PCMH 4: CARE MANAGEMENT AND
SUPPORT
• Performance Reports
• Use Summary Quality Index (SQUID)
as marker of “poorly controlled or
complex conditions”
– Define your practice’s target SQUID
• Patients that fall below this = patients that
may benefit from care management
– Use a screen shot of PLR to document the
number of patients that fall into this
category
– Track this number (and % of total patients)
– Design and implement care management
plan for Element 4B (MUST PASS)
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
“The
practice uses performance data to
identify opportunities for improvement and
acts to improve clinical quality, efficiency and
patient experience.”
A. Measure Clinical Quality Performance
B. Measure Resource Use and Care Coordination
C. Measure Patient/Family Experience
D. *Implement Continuous Quality Improvement
E. Demonstrate Continuous Quality Improvement
F. Report Performance
G.Use Certified EHR Technology
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
• Element 6A: Measure Clinical Quality
Performance
• At least annually, the practice measures
or receives data on:
– At least 2 immunization measures
– At least 2 other preventive care
measures
– At least 3 chronic or acute care
clinical measures
– Performance data stratified for
vulnerable populations (to assess
disparities in care)
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
• Element 6D: Implement Continuous Quality Improvement
(MUST PASS)
• Ongoing QI process that includes regular review of
performance data and evaluation of performance against
goals or benchmarks to:
–
–
–
–
–
–
–
Set goals and analyze at least 3 CQM from A
Act to improve at least 3 CQM from A
Set goals and analyze at least 1 measure from B
Act to improve at least one measure from B
Set goals/analyze at least 1 patient experience measure from C
Act to improve at least one patient experience measure from C
Set goals and address at least one identified disparity in
care/service for identified vulnerable populations
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
• Element 6E: Demonstrate Continuous Quality
Improvement
• Ongoing effort of assessing, improving and
reassessing
• Emphasis on ongoing QI to demonstrate that
practice has gone beyond setting goals
– Measuring effectiveness of actions it takes to improve
measures selected in D
– Achieving improved performance on at least 2 CQM
– Achieving improved performance on one utilization or care
coordination measure
– Achieving improved performance on at least one patient
experience measure
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
• Element 6F: Report Performance
• Results reflect care provided to all patients in the
practice, not only patients covered by a specific
payer and shares:
– Individual clinician performance results with the practice
– Practice-level performance results with the practice
– Individual clinician or practice-level performance results
publicly
– Individual clinician or practice-level performance results
with patients
©PPRNet
PCMH 6: MEASURE AND IMPROVE PERFORMANCE
• Use PPRNet reports to
show how your practice
measures clinical
quality performance,
implements QI,
demonstrates QI and
reports performance
across:
– Clinical processes
– Clinical outcomes
©PPRNet
MORE ON PPRNET RESEARCH AND
PCMH SATURDAY…
• Engaging patients in upcoming and
planned projects as part of the “Practice
Team” element
©PPRNet
OTHER PCMH EXAMPLES
• What other ways have you applied
PPRNet tools to PCMH work?
• How has your practice benefited from
PCMH recognition?
©PPRNet
BREAK
©PPRNet
CMS PHYSICIAN QUALITY REPORTING
SYSTEM (PQRS)
“A reporting program that uses a combination
of incentive payments and payment
adjustments to promote reporting of quality
information by eligible professionals (EPs).”
• Evolved from the Physician Quality Reporting
Initiative (PQRI)
• Aims to reach 50% of EPs by 2015
©PPRNet
PQRS
• Is this “old news”?
• Have you used
PPRNet reports for
this program in the
past?
©PPRNet
PQRS INCENTIVES/ADJUSTMENTS
• 2014:
• 2015:
• 2016-:
+0.5% of total estimated allowed
charges for Medicare Part B
Physician Fee Schedule during
reporting period
-1.5% based on 2013 participation
-2% based on 2014 participation
• Additional +0.5% incentive with Maintenance of
Certification Program participation
©PPRNet
PQRS REPORTING
MECHANISMS
• Claims
• Registry
• Qualified Clinical Data Registry
(QCDR)
Stay tuned
– PPRNet
will apply
for 2015!
• Certified EHR Technology
• Group Practice Reporting Options
©PPRNet
All Pts 18-75
with DM
TAB IN PPRNET PLR
©PPRNet
©PPRNet
• PQRS is pay for reporting
• See note regarding > 0% requirement for
full sample
©PPRNet
©PPRNet
©PPRNet
USING PPRNET REPORTS FOR PQRS
• For 2014, use October 2014 PLR to fill out
ABFM registry/report to CMS
– ABIM diplomates, check PQRS page for other
registry options ($)
• For 2015, look for news of PPRNet
becoming a Qualified Clinical Data
Registry
– More tomorrow!
©PPRNet
PHYSICIAN COMPARE
http://www.medicare.gov/physiciancompare/
©PPRNet
PPRNET’S “TOP 10” LIST FOR
QUALITY IMPROVEMENT
©PPRNet
1. Identify a Clinician Leader
©PPRNet
2.Use PPRNet reports to identify
opportunities for improvement and monitor
progress.
©PPRNet
3. Select a limited number of priorities for
improvement and build on incremental
successes
©PPRNet
4. Adopt standing orders and have all
staff function at the top of their licenses
©PPRNet
5. Educate staff members as needed for
their expanded roles
©PPRNet
6. Hold regular practice “PPRNet
meetings”
©PPRNet
7. Use HM broadly and establish a
practice goal to “get the red out”
©PPRNet
8. Use PPRNet patient-level reports
(PLRs) for patient case management
and/or outreach.
©PPRNet
9. Provide staff incentives for achieving
improvement goals.
©PPRNet
10. Participate in PPRNet projects and
attend PPRNet meetings.
©PPRNet
OPEN SESSION
“MAKING THE MOST” OF PPRNET
©PPRNet
RECAP
• First time attendees, how many new
acronyms have you learned today?
• “Refresher” attendees, what new thing(s)
did you learn?
©PPRNet
RECAP
• To (begin to) answer the question: “How can
I maximize the benefit of PPRNet in my
practice?”
– Introduce (or reintroduce) PPRNet and its mission
– Provide an overview of PPRNet reports
– Share examples of how practices use PPRNet
reports to achieve recognition and/or incentives
– Allow time for participants to use reports and network
with one another
©PPRNet
OPEN SESSION
• Use your reports! Talk to each other!
– Identify patients for NCQA PCMH population
management or care management standards
– Identify 1 or 2 areas for improvement from
your practice report
©PPRNet
AGENDA
5:30 pm
Happy Hour
Rooftop at Vendue Inn, 19 Vendue Range
Presenters Dinner (Invitation only)
7:00 pm
Blossom, 171 East Bay Street
Friday, August 22, 2014
7:15 am
Breakfast & Registration
8:00 am
Welcome
8:15 am
Plenary: Improving the Quality of Primary Care
Through "Meaningful" EHR Use
©PPRNet
FOLLOW-UP NEEDS
ASSESSMENT
• Webinar topic suggestions
©PPRNet