Post on 01-Nov-2014
description
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?