1. Resident Meeting: Awards Robb Malone Scott Daniels 11/2/2009

2. Quick updates

3. Website continues to evolve http://www.med.unc.edu/im/staff

4. QI Reporting https://www.med.unc.edu/im/staff/QI

5. CSW 2.0 is coming

6. Incentives for Quality

7. Physician Federal Incentives Medicare’s Physician Quality Reporting Initiative (PQRI) Medicare’s Physician Quality Reporting Initiative (PQRI) Health Information Technology (HITECH) Health Information Technology (HITECH) Certified EMR Certified EMR “Meaningful Use” “Meaningful Use” Medicare e-Rx incentives/penalties Medicare e-Rx incentives/penalties

8. National Committee for Quality Assurance NCQA's Physician Recognition Programs recognize high-performing physicians & practices NCQA's Physician Recognition Programs recognize high-performing physicians & practices GIM applying for Diabetes, Heart/Stroke, and Patient-Centered Medical Home programs GIM applying for Diabetes, Heart/Stroke, and Patient-Centered Medical Home programs Tied to BCBS Contract incentives that increase reimbursement for ALL P&A and CBP physicians Tied to BCBS Contract incentives that increase reimbursement for ALL P&A and CBP physicians

9. NCQA’s Key Principles

10. Heart/Stroke

11. Blood Pressure: Measure 1 Blood PressureScoringStandard < 140/90 mm Hg100%Average score of 75% < 145/90 or <140/95 mm Hg75% < 145/95 mm Hg50%

12. Complete Lipid Panel: Measure 2 Complete Lipid PanelScoringStandard TChol, HDL, LDL, TG100%Average score of 80% ordered within 1 year of visit

13. LDL: Measure 3 LDL measured and …ScoringStandard < 100 mg/dl100%Average score of 50% 100 – 109 mg/dl75% 110 – 119 mg/dl50% 120 – 129 mg/dl50% In those that we measure, we far exceed the standard

14. Smoking Advice: Measure 4 SmokingScoringStandard Smoking Status Assessed and Advice Given 100%Average score of 80%

15. Anti-thrombotic Use: Measure 5 Anti-thrombotic UseScoringStandard ASA, Warfarin, Plavix, Heparin, or LMWH on WebCIS MedList 100%Average score of 80%

16. Patient-Centered Medical Home

17. Transitioning to PCMH TODAY’S CARE MEDICAL HOME CARE Patients’ chief complaints or reason for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts It’s up to the patients to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients

18. PCMH: One Example Physician Response Time

19. 1 st Annual House Staff Awards Presentation

20. Diabetes Metrics

21. Residents: BP, majority exceed expectations

22. Residents: TC, majority exceed expectations

23. Residents: Significant Variation

24. Residents: Widespread use

25. Residents: Majority Exceed Goal

26. Residents: Eye exams remain a struggle

27. Residents: A1c, variable results, majority above goal

28. The results are in & the winners are…..

29. MVP: Second and Third Year Catherine Hathaway Michael Cammarata