Publication MO-12-08-PREV March 2012This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents

presented do not necessarily reflect CMS policy

Six Things You Must Know About Quality to Keep Your Practice Alive

Sandy Pogones, Primaris

MGMA Joplin Chapter Meeting

March 20, 2012

Who is Primaris

Founded in 1983 by the Missouri State Medical Association, Missouri Hospital Association and Missouri Association of Osteopathic Physicians and Surgeons

Primaris serves as the federally-designated Quality Improvement Organization (QIO) for the state of Missouri.

– Mission of QIOs: To improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries.

Subcontractor with the Missouri Health Information Technology Assistance Center (MO-HIT) to assist providers in reaching Meaningful Use

What do the following have in Common?

Medicare Value-based Modifier

Physician Quality Reporting System

E-Prescribe Incentive Program

Meaningful Use/EHR Incentive Program

Patient Centered Medical Home

Comprehensive Primary Care Initiative

Accountable Care Organizations

Medicare Wellness and Preventive Benefits

Answer

QUALITY = $$$

Countdown

#1: Value-Based Purchasing is a Reality

Medicare Value-Based Purchasing is Required by Law

“Value” will be determined by both Cost and Quality

– Cost: Total per capita and per capita costs for selected conditions

– Quality: Medicare focus

#2: Quality Will be Measured Using PQRS

Individual Quality Measures

– PQRS Cardiovascular Measures Group

– MU Core and Alternate Core

– Additional Measures for Chronic and Preventive Care

GPRO Measures

Future Measures:

– More measures for Clinical Processes/Effectiveness and Population/Public Health, specialty

– Functional Status, Care Coordination, Patient Safety, Efficient Use of health services

#3: 2013 is a Pivotal Year for Reporting

Base year for determining the VBM applied in 2015

MU Required to Avoid Penalty in 2015

– Years 2+ : MU for entire year 2013

– Year 1: Attest by 10/1/2014 for 90 day period

PQRS required to avoid penalty in 2015

Performance on measures reported in 2013 $$$

#4: e-Quality Measures are the Future of Reporting

Measure Development is focused on using EHRs

Data abstraction for manual reporting will become increasingly difficult

Structured data capture is crucial

Standard vocabularies are being required for use by all vendors to allow data exchange

Vendors must be “Qualified” to report PQRS or CQMs directly (“Qualified” is not the same as “Certified”)

Sample e-Quality Measure

Percent of patients age 18+ who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco User.

Data Elements

– Age (BD) - Visit Date (during reporting period)

– Encounter Code - Tobacco User / Non User (screen done)

– Counseling provided & Type – Date of Counseling

– Pharmacotherapy (drug, dose, order)

Logic—determines denominator & numerator, then combines for Performance Rate

#5: Use Population Management and Rapid Cycle Improvement to Close Performance Gaps

Run Population-based reports

– Generate Baseline data and patient lists

– Establish a team to address performance gaps

Apply Rapid Cycle Improvement Methodology

– Determine possible root cause(s) of performance gaps

– Assign responsibility for improvement

– Test small changes and re-measure for improvement

– Implement successful changes practice-wide

– Track your changes and results

#6: Take Advantage of Opportunities to Increase Revenue

Expanded Medicare Coverage for Prevention Services

Annual Wellness Visit

PQRS reporting bonuses through 2014; e-Rx 2013; Meaningful Use Medicare 2016/Medicaid 2021

Medicare Comprehensive Primary Care Initiative

Patient-Centered Medical Home bonus payments for Medicaid and Privately-Insured Patients

Resources

Primaris—Missouri’s Quality Improvement Organization

– Sandy Pogones: spogones@primaris.org; 573-673-4531– Primaris.org; PQRSMO.org

CMS INFORMATION RESOURCES: http://www.cms.gov

Medicare Prevention Services Info for Physicians: http://www.cms.gov/PrevntionGenInfo

Medicare Information for Patients: http://www.medicare.gov

Million Hearts: http://millionhearts.hhs.gov/index.html

Conclusion

“The healthcare organization that seeks merely to meet minimal standards may not ever reach any higher, and certainly will not achieve excellence.”

(Janet Brown, RN, CPHQ, The Healthcare Quality Handbook, 2010-2011)

QUESTIONS?