2introductionsWho you areWhy you are hereWhat you hope to learn
3Workshop GoalsTo (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”Introduce (or reintroduce) PPRNet and its missionProvide an overview of PPRNet reportsShare examples of how practices use PPRNet reports to achieve recognition and/or incentivesAllow time for participants to use reports and network with one another
4agenda 1:00pm-1:15pm Introductions Vanessa Congdon Andrea Wessell What is PPRNet?1:30pm-2:00pmPPRNet Performance Reports and FAQs2:00pm-2:30pmUsing PPRNet Tools for Recognition and Incentive Programs2:30pm-2:45pmBreak2:45pm-3:00pmRecognition/Incentive Programs, continued3:00pm-3:15pmPPRNet Top 10 List for Quality Improvement3:15pm-4:00pmOpen SessionDemonstrations, Follow-up DiscussionsAll Participants
5Revise agenda? 1:00pm-1:15pm Introductions Vanessa Congdon Andrea Wessell1:15pm-1:30pmWhat is PPRNet?1:30pm-2:00pmPPRNet Performance Reports and FAQs2:00pm-2:30pmUsing PPRNet Tools for Recognition and Incentive Programs2:30pm-2:45pmBreak2:45pm-3:00pmRecognition/Incentive Programs, continued3:00pm-3:15pmPPRNet Top 10 List for Quality Improvement3:15pm-4:00pmOpen SessionDemonstrations, Follow-up DiscussionsAll Participants
6What is pprnet?“A practice-based learning and research organization designed to improve health care in its member practices and elsewhere in the United States.”
7What 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 staffEmpirically test theoretically sound primary care quality improvement interventionsDisseminate interventions that improve primary health care
8“Blur the distinction between quality improvement and research” PPRNet Aims to…“Blur the distinction between quality improvement and research”3 aims
9PPRNet: Primary Care Practice-Based Research and learning Network
10PPRNetAgency for Healthcare Research and Quality Center for Primary Care Practice-Based Research and LearningAnswer questions relevant to practiceDisseminate findings
11Pprnet 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) InterventionsImpact studied across a variety of clinical areasPrevention, chronic disease management, acute care and medication safetyA-TRIP, C-TRIP, SO-TRIP, MS-TRIP, AM-TRIP, CKD-TRIP…
15Clinical Practice Quality Measures MEASURE CONDITION#Diabetes Mellitus12Cardiovascular Disease17Women’s Health Care2Cancer Screening3Immunizations8Mental Health & Substance Abuse6Respiratory Disease4Medication Safety15TOTAL: 67
16Practice Performance Report 67 Quality Indicators3 Summary MeasuresSPC MethodologyTime trends – Monthly over 2 yearsComparison with PPRNet benchmark (ABC)Comparison with national benchmarks (when available)
17Patient-Level Report (PLR) Excel Spreadsheet with 78 tabs:PPRNet SwitchboardPractice Performance on Individual MeasuresProvider Performance on Individual MeasuresPatient RegistryPPRNet Measure Groupings (8 tabs)Patient Lists of those not meeting criteria for each of 67 Individual MeasuresSame indicator criteria as practice reportAll “active” patients ≥ 3 months age
31ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction
32ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction Hierarchical Statin Benefit Groups ADULTS >=21 years oldDiagnosis of ASCVD (CHD or Atherosclerosis)Highest LDL-C >=190 mg/dLDiagnosis of Diabetes Mellitus; age yrEstimated 10-yr ASCVD Risk >=7.5% age yrs
34Q: What data are used for calculating performance?
35A (part 1): Report guide details data source for each measure Highlight other things in appendix
36Identifiers (ie, CMS id, NQF # or PQRS id) cited in reports A (part 2): PPRNet measures are now aligned with Meaningful Use Clinical Quality MeasuresApplies 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
37How do I UPLOAD MY DATA EXRACT AND access my reports? https://pprnetportal.musc.edu/
38New DATA ExtractPP users will be migrating to a new extract process for October reportsMcKesson support for prxtract ends in OctoberThe MUSC OCIO has worked with us to develop a “vendor neutral” extraction processNew reports will include patient identifiers!
39Summary: PPRNet Reports in Practice Evaluate performance over timeIdentify patients overdue for careEngage, motivate, and incentivize practice teamDemonstrate quality of care for quality recognition and incentive programs
40questionsTo (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”Introduce (or reintroduce) PPRNet and its missionProvide an overview of PPRNet reportsShare examples of how practices use PPRNet reports to achieve recognition and/or incentivesAllow time for participants to use reports and network with one another
41USING REPORTS FOR RECOGNITION AND INCENTIVE PROGRAMS
42Recognition and incentive programs PPRNet practices use reports for a variety of local and national quality recognition and pay for performance programsDuring this session, we will highlight:NCQA Patient-Centered Medical HomeCMS Physician Quality Reporting System
43Pprnet 101: glossary NCQA PCMH CMS PQRS ABFM PLR SQUID What is your experience with these recognition programs?How has your practice benefited from recognition?
44NCQA PCMH 2014 StandardsPublished in March 2014 (must be used by March 2015)Revisions to align with MU Stage 2, reflect PCMH evidence base and from stakeholder inputMajor edits in the areas of:Care management of high-need populationsTeam-based careFocus on triple aim domains (patient experience, cost, clinical quality)Sustaining transformationIntegration of behavioral healthNCQA = national co for quality assurance
45NCQA PCMH 2014 Content and Scoring (6 standards/27 elements) 1: Enhance Access and Continuity*Patient-Centered Appointment Access24/7 Access to Clinical AdviceElectronic AccessPts4.53.52102: Team-Based CareContinuityMedical Home ResponsibilitiesCulturally and Linguistically Appropriate Services (CLAS)*The Practice Team32.54123: Population Health ManagementPatient InformationClinical DataComprehensive Health Assessment*Use Data for Population ManagementImplement Evidence-Based Decision- Support5204: Plan and Manage CareIdentify Patients for Care Management*Care Planning and Self-Care SupportMedication ManagementUse Electronic PrescribingSupport Self-Care and Shared Decision-MakingPts435205: Track and Coordinate CareTest Tracking and Follow-Up*Referral Tracking and Follow-UpCoordinate Care Transitions6186: Measure and Improve PerformanceMeasure Clinical Quality PerformanceMeasure Resource Use and Care CoordinationMeasure Patient/Family Experience*Implement Continuous Quality ImprovementDemonstrate Continuous Quality ImprovementReport PerformanceUse Certified EHR TechnologyPractice Team is newCare Management was must pass – now combined with “care planning and self-care support”All other must pass are the sameSame total pointsScoring LevelsLevel 1: points.Level 2: points.Level 3: points.*Must Pass Elements45
46PCMH 2: Team-based care Element 2D: The Practice Team The practice uses a team to provide a range of patient care services by:Defining roles for clinical and nonclinical team membersIdentifying practice organizational structure and staff leading and sustaining team based careHaving regular patient care team meetings or a structured communication process focused on individual patient care*Using standing orders for servicesTraining and assigning members of the care team to coordinate care for individual patients(continued)2 and 8 are new3 is critical factorOther factors were a part of 2011 Standard 1 “Enhance Access and Continuity”Documentation for Factor 3 – description of communication and at least 3 examplesFactor 2: The practice delineates responsibilities for sustaining team-based care, and specifies how care teams align to provide patient-centered care. Specific team units may focus on providing care coordination across and beyond the practice (factor 5). An organizational chart may be used to illustrate how a care team fits in the practice.8 (regular team mtngs) Factor 8: Description of staff communication processes and sample
47PCMH 2: Team-based careTraining and assigning members of the care team to support patients/families/caregivers in self-management, self-efficacy and behavior changeTraining and assigning members of the care team to manage the patient populationHolding regular team meetings addressing practice functioningInvolving care team staff in the practice’s performance evaluation and quality improvement activitiesInvolving patients/families/caregivers in quality improvement activities or on the practice’s advisory council2 and 8 are new3 is critical factorOther factors were a part of 2011 Standard 1 “Enhance Access and Continuity”Documentation for Factor 3 – description of communication and at least 3 examplesFactor 2: The practice delineates responsibilities for sustaining team-based care, and specifies how care teams align to provide patient-centered care. Specific team units may focus on providing care coordination across and beyond the practice (factor 5). An organizational chart may be used to illustrate how a care team fits in the practice.8 (regular team mtngs) Factor 8: Description of staff communication processes and sample
48PPRNet Tools PPRNet Improvement Model as background Build team meeting agendas based on PPRNet reports, webinars or network meeting topicsUse plans for Element 3D (Population Management) or 4A (Care Management and Support) to document responsibilities for team-based care
49PCMH 3: Plan and Manage Care Element 3D: Use Data for Population Management (MUST PASS)At least two different preventive care servicesAt least two different immunizationsAt least three different chronic or acute care servicesPatients not recently seen by the practiceMedication monitoring or alertDocumentation:Factors 1-5: Lists or summary reports of patients who need services within past 12 mo. (Health plan data okay if 75% of patient population) andFactors 1-5: Documented process demonstrating staff responsibilities and desired timing of reminders and materials showing how patients were notified for each service.The practice must perform these functions at least annually and make documentation of each reminder available to NCQA upon request.
50PCMH 3: PLAN AND MANAGE CARE PPRNet Patient-level Report (PLR) includes lists of patients:With specific diagnosesNeeding preventive services, including immunizationsRequiring clinician reviewor actionTaking specific medicationsFactor 1- Pts who need preventive screening or immunizations (at least 3 different immunizations or screenings)Factor 2-Pts who need acute or chronic care services (at least 3 different services)Factor 3-Pts who have not had recent appointment (practice may use own criteria)Factor 4-Pts on specific medications
51PPRNet Tools Add narrative describing who does what Save examples of letters or chart flagsPick 2-3 areas to work on every quarter to “complete” all in 12 months
52PCMH 4: Care Management and Support Element 4A: Identify Patients for Care ManagementSystematic process and criteria for identifying patients who may benefit from care management The process includes consideration of the following:1. Behavioral health conditions2. High cost/high utilization3. Poorly controlled or complex conditions4. Social determinants of health5. Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver6. The practice monitors the percentage of the total patient population identified through its process and criteria*Factors 1-6 are new, previously you could define it on your own.DocumentationFactors 1-5: Criteria and process for identifying patients.Factor 6: Report showing number and percentage of patients identified as likely to benefit from care management through one or any combination of the other five factors or other criteria determined by the practice.Must meet #6 to get any points
53PCMH 4: Care Management and Support Performance ReportsUse Summary Quality Index (SQUID) as marker of “poorly controlled or complex conditions”Define your practice’s target SQUIDPatients that fall below this = patients that may benefit from care managementUse a screen shot of PLR to document the number of patients that fall into this categoryTrack this number (and % of total patients)Design and implement care management plan for Element 4B (MUST PASS)
54PCMH 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.”Measure Clinical Quality PerformanceMeasure Resource Use and Care CoordinationMeasure Patient/Family Experience*Implement Continuous Quality ImprovementDemonstrate Continuous Quality ImprovementReport PerformanceUse Certified EHR Technology
55PCMH 6: measure and improve performance Element 6A: Measure Clinical Quality PerformanceAt least annually, the practice measures or receives data on:At least 2 immunization measuresAt least 2 other preventive care measuresAt least 3 chronic or acute care clinical measuresPerformance data stratified for vulnerable populations (to assess disparities in care)Vulnerable populations are “those who are made vulnerable by their financial circumstances or place of residence, health, age, personal characteristics, functional or developmental status, ability to communicate effectively, and presence of chronic illness or disability,” (AHRQ) and include people with multiple comorbid conditions or who are at high risk for frequent hospitalization or ER visits.
56PCMH 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 AAct to improve at least 3 CQM from ASet goals and analyze at least 1 measure from BAct to improve at least one measure from BSet goals/analyze at least 1 patient experience measure from CAct to improve at least one patient experience measure from CSet goals and address at least one identified disparity in care/service for identified vulnerable populationsVulnerable populations are “those who are made vulnerable by their financial circumstances or place of residence, health, age, personal characteristics, functional or developmental status, ability to communicate effectively, and presence of chronic illness or disability,” (AHRQ) and include people with multiple comorbid conditions or who are at high risk for frequent hospitalization or ER visits.
57PCMH 6: measure and improve performance Element 6E: Demonstrate Continuous Quality ImprovementOngoing effort of assessing, improving and reassessingEmphasis on ongoing QI to demonstrate that practice has gone beyond setting goalsMeasuring effectiveness of actions it takes to improve measures selected in DAchieving improved performance on at least 2 CQMAchieving improved performance on one utilization or care coordination measureAchieving improved performance on at least one patient experience measure
58PCMH 6: measure and improve performance Element 6F: Report PerformanceResults 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 practicePractice-level performance results with the practiceIndividual clinician or practice-level performance results publiclyIndividual clinician or practice-level performance results with patients
59PCMH 6: measure and improve performance Use PPRNet reports to show how your practice measures clinical quality performance, implements QI, demonstrates QI and reports performance across:Clinical processesClinical outcomes
60More on PPRNet research and PCMH saturday… Engaging patients in upcoming and planned projects as part of the “Practice Team” element
61Other pcmh examplesWhat other ways have you applied PPRNet tools to PCMH work?How has your practice benefited from PCMH recognition?
63CMS 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 2015Regulations made permanent in 2008
64PQRSIs this “old news”?Have you used PPRNet reports for this program in the past?
65PQRS incentives/adjustments 2014: % of total estimated allowed charges for Medicare Part B Physician Fee Schedule during reporting period2015: % based on 2013 participation2016-: -2% based on 2014 participationAdditional +0.5% incentive with Maintenance of Certification Program participationRegulations made permanent in 20082009 avg payment (2% incentive) ~$1100MOC with practice assessment
66PQRS Reporting Mechanisms ClaimsRegistryQualified Clinical Data Registry (QCDR)Certified EHR TechnologyGroup Practice Reporting OptionsStay tuned – PPRNet will apply for 2015!CMS recognized Registry or EHR – not the same as MU30 pts seen Jan – Dec 2011Registry options:NCQA DRP for exClinicians Applying for Recognition and Submitting Data for PQRS:For clinicians who achieve Recognition in 2011 or who apply for Recognition in 2011 with the appropriate fee, the PQRS application fee is $50.00 per clinician in addition to the Recognition application fee of $500.Clinicians Already Recognized and Submitting Data for PQRS Only:For clinicians who have a current Recognition with a start date prior to 2011, i.e., 2008, 2009, 2010, the application fee is $150 per clinician.
72Using pprnet reports for pqrs For 2014, use October 2014 PLR to fill out ABFM registry/report to CMSABIM diplomates, check PQRS page for other registry options ($)For 2015, look for news of PPRNet becoming a Qualified Clinical Data RegistryMore tomorrow!
86recapFirst time attendees, how many new acronyms have you learned today?“Refresher” attendees, what new thing(s) did you learn?
87recapTo (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”Introduce (or reintroduce) PPRNet and its missionProvide an overview of PPRNet reportsShare examples of how practices use PPRNet reports to achieve recognition and/or incentivesAllow time for participants to use reports and network with one another
88Use your reports! Talk to each other! Open sessionUse your reports! Talk to each other!Identify patients for NCQA PCMH population management or care management standardsIdentify 1 or 2 areas for improvement from your practice report
89agenda 5:30 pm Happy Hour Rooftop at Vendue Inn, 19 Vendue Range Presenters Dinner (Invitation only)Blossom, 171 East Bay StreetFriday, August 22, 20147:15 amBreakfast & Registration 8:00 amWelcome 8:15 amPlenary: Improving the Quality of Primary Care Through "Meaningful" EHR Use