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Medicare Pay for Performance Quality Indicators: A Tool to Measure Performance Quality in Ophthalmology Residents Meagan Celmer, Maria Lim, Nancy Awender,

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Presentation on theme: "Medicare Pay for Performance Quality Indicators: A Tool to Measure Performance Quality in Ophthalmology Residents Meagan Celmer, Maria Lim, Nancy Awender,"— Presentation transcript:

1 Medicare Pay for Performance Quality Indicators: A Tool to Measure Performance Quality in Ophthalmology Residents Meagan Celmer, Maria Lim, Nancy Awender, Deepak Edward The authors of this presentation have no financial interests to disclose

2 Introduction Committee for Medicare and Medicaid services (CMS) adopted a Pay- for-Performance (P4P) program P4P creates a financial incentive for involved health care providers to practice Evidence Based Medicine 1-3 Improved patient outcomes Increased quality of care Reduced cost 2% bonus to physicians who voluntarily report Measure could potentially provide a tool to measure the quality of care provided by residents and provide systems based practice education Such data for resident based clinics does not exist Aim of the project: to determine if the ophthalmology resident clinic at Summa Health Systems meets quality indicators set forth by CMS for Pay-for-Performance and educate the residents of these guidelines

3 Materials and methods This study was approved by the Summa Health Systems IRB Inclusion Criteria All patients meeting diagnostic criteria for Primary open angle glaucoma (POAG) Diabetic Retinopathy (DR) Age related Macular degeneration (ARMD) ICD -9 bill coding charges submitted in 2009 were used to determine which records met diagnostic criteria (via Decision Support reports) Exclusion criteria POAG: if the patient had no appointment in 2009, received treatment prior to transfer of care to resident clinic (unable to determine pre- treatment IOP), eye disease managed by outside physician, no diagnosis of POAG on chart (ie. Glaucoma suspect), not on Treatment/ IOP wnl, secondary glaucoma DR/ARMD: if the patient had no appointment in 2009

4 Materials and Methods Medical records were reviewed for the indicators derived from the American Academy of Ophthalmology, National Committee for Quality Assurance, Physician Consortium of Performance Involvement for POAG, DR, and ARMD (see Table 1) A goal compliance of at least 80% in accordance with standards set by CMS 4

5 Table 1POAGDRARMD % of patients who were counseled within 12 months about: 1) the importance of glaucoma on visual function and quality of life 2) importance of treatment adherence % of patients who had a dilated macular or fundus exam performed in the last 12 months including: 1) documentation of the severity of retinopathy and 2) presence/absence of macular edema % of patients who were counseled within 12 months on the benefits/risks of AREDS formation % of patients whose glaucoma treatment has not failed (decrease IOP by 15% of pre-intervention level) OR A plan of care documented within 12 months % of patients who had a dilated exam with documented communication to the physician who manages on-going care of the patient with diabetes % of patients who had a dilated exam performed within 12 months including: 1) documentation of presence/absence of macular thinking or hemorrhage AND 2) level of macular degeneration severity

6 Results: Percentage of Compliance with P4P IndicatorsPOAGDRARMD Counseled on treatment compliance 33.2% Dilated exam with documentation 98.3% Counseled patient on AREDS 16.3% Decreased level of IOP/ plan of care 100% Documentation of communication with patient 37.1% Dilated exam with documenta tion 95.9%

7 Results No Yes Non specific education Provided Non specific education Not Provided Provided Not Provided POAG: patient education DR: Communication with PCP ARMD: Patient Education

8 Discussion Residents met quality indicators for POAG: decreased IOP from pre-intervention levels or indicating plan of care DR/ ARMD: performing a dilated eye exam with documentation The data reveals that residents did not meet an 80% compliance for POAG: counseling patients on the benefits/risks of treatment compliance DR: document communication with the patient's PCP ARMD: counseling patients on the benefits/risks of AREDS use An overwhelming number of patients were provided with non- specific education

9 Discussion Recommended practices may have been performed but not documented Possibly the result of current chart template in the resident clinic Ways to improve documentation in order to meet quality indicators Create a new chart template that is more conducive to documentation Lecture residents on the P4P quality indicators and documentation Future use of electronic medical record to increase quality and efficiency of documentation 5,6

10 Discussion A recent study found that 34% of recently graduated ophthalmologists felt unprepared with their knowledge of insurance, billing, coding, and reimbursement Rated the most surprising aspect of practice ????? After residency Integration of P4P guidelines into the curriculum of residency This data can be used as a baseline in the future to assess The quality of care residents provide Meet RRC requirements Help guide residents as they embark into practice

11 References 1. Parke DW. Impact of pay-for-performance intervention: financial analysis of a pilot program implementation and implications for ophthalmology (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2007; 105: Chung S, Palaniappan LP, Trujillo LM, Rubin HR, Luft HS. Effect of physician-specific pay-for-performance incentives in a large group practice. Am J Manag Care. 2010; 16(2):e Sagoo MS and Raina J. Evidence-based medicine audit as a tool for improving emergency ophthalmology. Eye. 2009; 23: Centers for Medicare and Medicaid Measures Codes for Physician Quality Reporting Initiative Available at: https://www.cms.gov/PQRI/15 MeasuresCodes.asp. Accessed July 13, 2010 https://www.cms.gov/PQRI/15 MeasuresCodes.asp. Accessed July Niemiec ES, Anderson KL, Scott IU, Greenberg PB. Evidence-based management of resident-performed cataract surgery: An investigation of compliance with a preferred practice pattern. Ophthalmology. 2009; 116 (4): Suleman H, Vernon SA, Ainsworth G, et al. Eyetrack vs the conventional paper record (CPR): A study comparing the accuracy and speed of data retrieval from glaucoma patient records. Eye. 2006; 20: McDonnell PJ, Kirwan TJ, Krinton GS, et al. Perceptions of recent ophthalmology residency graduates regarding preparation for practice. Ophthalmology. 2007; 114(2):387-91


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