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©PPRNet 2014 PRE-CONFERENCE WORKSHOP PPRNet 101. ©PPRNet 2014 INTRODUCTIONS Who you are Why you are here What you hope to learn.

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Presentation on theme: "©PPRNet 2014 PRE-CONFERENCE WORKSHOP PPRNet 101. ©PPRNet 2014 INTRODUCTIONS Who you are Why you are here What you hope to learn."— Presentation transcript:

1 ©PPRNet 2014 PRE-CONFERENCE WORKSHOP PPRNet 101

2 ©PPRNet 2014 INTRODUCTIONS Who you are Why you are here What you hope to learn

3 ©PPRNet 2014 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

4 ©PPRNet 2014 AGENDA 1:00pm-1:15pmIntroductions Vanessa Congdon Andrea Wessell 1:15pm-1:30pmWhat is PPRNet?Andrea Wessell 1:30pm-2:00pmPPRNet Performance Reports and FAQsVanessa Congdon 2:00pm-2:30pm Using PPRNet Tools for Recognition and Incentive Programs Andrea Wessell 2:30pm-2:45pmBreak 2:45pm-3:00pm Recognition/Incentive Programs, continued Andrea Wessell 3:00pm-3:15pm PPRNet Top 10 List for Quality Improvement Andrea Wessell 3:15pm-4:00pm Open Session Demonstrations, Follow-up Discussions All Participants

5 ©PPRNet 2014 REVISE AGENDA? 1:00pm-1:15pmIntroductions Vanessa Congdon Andrea Wessell 1:15pm-1:30pmWhat is PPRNet?Andrea Wessell 1:30pm-2:00pmPPRNet Performance Reports and FAQsVanessa Congdon 2:00pm-2:30pm Using PPRNet Tools for Recognition and Incentive Programs Andrea Wessell 2:30pm-2:45pmBreak 2:45pm-3:00pm Recognition/Incentive Programs, continued Andrea Wessell 3:00pm-3:15pm PPRNet Top 10 List for Quality Improvement Andrea Wessell 3:15pm-4:00pm Open Session Demonstrations, Follow-up Discussions All Participants

6 ©PPRNet 2014 WHAT IS PPRNET?

7 ©PPRNet 2014 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

8 ©PPRNet 2014 “Blur the distinction between quality improvement and research ” PPRNET AIMS TO…

9 ©PPRNet 2014 PPRNET: PRIMARY CARE PRACTICE-BASED RESEARCH AND LEARNING NETWORK

10 ©PPRNet 2014 PPRNET Agency for Healthcare Research and Quality Center for Primary Care Practice-Based Research and Learning –Answer questions relevant to practice –Disseminate findings

11 ©PPRNet 2014 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, CKD- TRIP…

12 ©PPRNet 2014 PRACTICE SPOTLIGHT: NEW LONDON FAMILY MEDICINE

13 ©PPRNet 2014 DISSEMINATING “LESSONS LEARNED” Ongoing PPRNet Activities –Annual meetings –Monthly webinars –Listserv –Social media Publications Presentations

14 ©PPRNet 2014 PPRNET PERFORMANCE REPORTS Practice-Level Performance Report Patient & Provider- Level Report

15 ©PPRNet 2014 CLINICAL PRACTICE QUALITY MEASURES MEASURE CONDITION # Diabetes Mellitus12 Cardiovascular Disease17 Women’s Health Care2 Cancer Screening3 Immunizations8 Mental Health & Substance Abuse6 Respiratory Disease4 Medication Safety15 TOTAL: 67

16 ©PPRNet 2014 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)

17 ©PPRNet 2014 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

18 ©PPRNet 2014 PPRNET SWITCHBOARD

19 ©PPRNet 2014 PRACTICE PERFORMANCE ON INDIVIDUAL MEASURES

20 ©PPRNet 2014 PROVIDER PERFORMANCE ON INDIVIDUAL MEASURES

21 ©PPRNet 2014 PATIENT REGISTRY

22 ©PPRNet 2014 CMS MU CQM

23 ©PPRNet 2014 CMS ACO CQM

24 ©PPRNet 2014 USPSTF RECOMMENDATIONS (GRADE A AND B)

25 ©PPRNet 2014 CDC ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES RECOMMENDATIONS

26 ©PPRNet 2014 NIAAA ALCOHOL SCREENING AND INTERVENTION RECOMMENDATIONS

27 ©PPRNet 2014 CDC GET SMART TREATMENT GUIDELINES FOR URI’S

28 ©PPRNet 2014 CMS PQRS CQM GROUPINGS

29 ©PPRNet 2014 PQRS DM TAB All Pts with DM

30 ©PPRNet 2014 PQRS DM LIST

31 ©PPRNet 2014 ACC/AHA CHOLESTEROL GUIDELINES FOR ASCVD RISK REDUCTION

32 ©PPRNet 2014 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 yr Estimated 10-yr ASCVD Risk >=7.5% age yrs

33 ©PPRNet 2014 ACC/AHA CHOLESTEROL GUIDELINES FOR ASCVD RISK REDUCTION ESTIMATED 10-YR ASCVD RISK EQUATIONS  Age  Sex  Race  Total Cholesterol  HDL-CSystolic BP  Hypertension Dx  Diabetes Mellitus  Dx Smoking Status  Systolic BP  Hypertension Dx  Diabetes Mellitus Dx  Smoking Status

34 ©PPRNet 2014 Q: WHAT DATA ARE USED FOR CALCULATING PERFORMANCE?

35 ©PPRNet 2014 A (PART 1): REPORT GUIDE DETAILS DATA SOURCE FOR EACH MEASURE

36 ©PPRNet 2014 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

37 ©PPRNet 2014 HOW DO I UPLOAD MY DATA EXRACT AND ACCESS MY REPORTS? https://pprnetportal.musc.edu/

38 ©PPRNet 2014 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!

39 ©PPRNet 2014 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

40 ©PPRNet 2014 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

41 ©PPRNet 2014 USING REPORTS FOR RECOGNITION AND INCENTIVE PROGRAMS

42 ©PPRNet 2014 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

43 ©PPRNet 2014 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?

44 ©PPRNet 2014 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

45 ©PPRNet 2014 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 : Team-Based Care A.Continuity B.Medical Home Responsibilities C.Culturally and Linguistically Appropriate Services (CLAS) D.*The Practice Team Pts : Population Health Management A.Patient Information B.Clinical Data C.Comprehensive Health Assessment D.*Use Data for Population Management E.Implement Evidence-Based Decision- Support Pts : 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 Pts : Track and Coordinate Care A.Test Tracking and Follow-Up B.*Referral Tracking and Follow-Up C.Coordinate Care Transitions Pts : 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 Pts *Must Pass Elements Scoring Levels Level 1: points. Level 2: points. Level 3: points.

46 ©PPRNet 2014 Element 2D: The Practice Team The practice uses a team to provide a range of patient care services by: 1.Defining roles for clinical and nonclinical team members 2.Identifying practice organizational structure and staff leading and sustaining team based care 3.Having regular patient care team meetings or a structured communication process focused on individual patient care* 4.Using standing orders for services 5.Training and assigning members of the care team to coordinate care for individual patients (continued) PCMH 2: TEAM-BASED CARE

47 ©PPRNet 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 PCMH 2: TEAM-BASED CARE

48 ©PPRNet 2014 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 team- based care PPRNET TOOLS

49 ©PPRNet 2014 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 PCMH 3: PLAN AND MANAGE CARE

50 ©PPRNet 2014 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 PCMH 3: PLAN AND MANAGE CARE

51 ©PPRNet 2014 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 TOOLS

52 ©PPRNet 2014 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* PCMH 4: CARE MANAGEMENT AND SUPPORT

53 ©PPRNet 2014 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) PCMH 4: CARE MANAGEMENT AND SUPPORT

54 ©PPRNet 2014 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

55 ©PPRNet 2014 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)

56 ©PPRNet 2014 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

57 ©PPRNet 2014 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

58 ©PPRNet 2014 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

59 ©PPRNet 2014 Use PPRNet reports to show how your practice measures clinical quality performance, implements QI, demonstrates QI and reports performance across: –Clinical processes –Clinical outcomes PCMH 6: MEASURE AND IMPROVE PERFORMANCE

60 ©PPRNet 2014 MORE ON PPRNET RESEARCH AND PCMH SATURDAY… Engaging patients in upcoming and planned projects as part of the “Practice Team” element

61 ©PPRNet 2014 OTHER PCMH EXAMPLES What other ways have you applied PPRNet tools to PCMH work? How has your practice benefited from PCMH recognition?

62 ©PPRNet 2014 BREAK

63 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

64 ©PPRNet 2014 PQRS Is this “old news”? Have you used PPRNet reports for this program in the past?

65 ©PPRNet 2014 PQRS INCENTIVES/ADJUSTMENTS 2014: +0.5% of total estimated allowed charges for Medicare Part B Physician Fee Schedule during reporting period 2015: -1.5% based on 2013 participation 2016-: -2% based on 2014 participation Additional +0.5% incentive with Maintenance of Certification Program participation

66 ©PPRNet 2014 PQRS REPORTING MECHANISMS Claims Registry Qualified Clinical Data Registry (QCDR) Certified EHR Technology Group Practice Reporting Options Stay tuned – PPRNet will apply for 2015!

67 ©PPRNet 2014 TAB IN PPRNET PLR All Pts with DM

68 ©PPRNet 2014

69 PQRS is pay for reporting See note regarding > 0% requirement for full sample

70 ©PPRNet 2014

71

72 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!

73 ©PPRNet 2014 PHYSICIAN COMPARE

74 ©PPRNet 2014 PPRNET’S “TOP 10” LIST FOR QUALITY IMPROVEMENT

75 ©PPRNet Identify a Clinician Leader

76 ©PPRNet Use PPRNet reports to identify opportunities for improvement and monitor progress.

77 ©PPRNet Select a limited number of priorities for improvement and build on incremental successes

78 ©PPRNet Adopt standing orders and have all staff function at the top of their licenses

79 ©PPRNet Educate staff members as needed for their expanded roles

80 ©PPRNet Hold regular practice “PPRNet meetings”

81 ©PPRNet Use HM broadly and establish a practice goal to “get the red out”

82 ©PPRNet Use PPRNet patient-level reports (PLRs) for patient case management and/or outreach.

83 ©PPRNet Provide staff incentives for achieving improvement goals.

84 ©PPRNet Participate in PPRNet projects and attend PPRNet meetings.

85 ©PPRNet 2014 OPEN SESSION “MAKING THE MOST” OF PPRNET

86 ©PPRNet 2014 RECAP First time attendees, how many new acronyms have you learned today? “Refresher” attendees, what new thing(s) did you learn?

87 ©PPRNet 2014 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

88 ©PPRNet 2014 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

89 ©PPRNet 2014 AGENDA 5:30 pm Happy Hour Rooftop at Vendue Inn, 19 Vendue Range 7:00 pm Presenters Dinner (Invitation only) Blossom, 171 East Bay Street Friday, August 22, :15 amBreakfast & Registration 8:00 amWelcome 8:15 am Plenary: Improving the Quality of Primary Care Through "Meaningful" EHR Use

90 ©PPRNet 2014 FOLLOW-UP NEEDS ASSESSMENT Webinar topic suggestions


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