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Clinician Report Cards Daren Wu, MD Open Door Family Medical Centers, Inc.

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Presentation on theme: "Clinician Report Cards Daren Wu, MD Open Door Family Medical Centers, Inc."— Presentation transcript:

1 Clinician Report Cards Daren Wu, MD Open Door Family Medical Centers, Inc.

2 Who We Are… A federally-qualified community health center in Westchester County 4 primary care sites, 5 school-based sites 60 clinicians, 32 in primary care 36,000 patients 200,000 visits expected by year-end

3 Who We Are… EMR implementation in 2007 Level 3 Medical Home in November 2009 Won the HIMSS Davies Award for best implementation of an EMR in a community health center

4 Why Have a Report Card?

5 It sure beats running on a hamster wheel!

6 Why Have a Report Card? The desire to excel is wired in most clinicians’ DNA Quality concerns should outweigh Quantity concerns

7 What Report Cards are NOT It is impossible to judge any clinician solely by a report card It is impossible to capture all the work and effectiveness of a clinician by a simple set of metrics

8 What Report Cards are NOT They are not a substitute for bad management…

9 What Report Cards are NOT They are not a substitute for coaching…

10 Not a Cakewalk Difficult to create a reliable, reproducible, valid report card Can take away from the emphasis on team-based care when focusing on a single individual Do not want clinicians to cherry pick patients to inflate their measures Often what needs attention are systemic changes, not just individual clinician improvements

11 A Report Card Must Be… Non-Punitive!!

12 Instead, it Should Be… Done in the spirit of continuous lifelong learning Looked upon as a way to improve upon one’s clinical weaknesses Viewed by senior administration as a means to help make systemic organizational changes

13 What Makes a Good Report Card? Transparent Reproducible Clinically relevant

14 How We Do It Quarterly Provider meeting format Single one-on-one (all providers annually; selected providers quarterly) What might be contributing to this measure? What would you like to work on? A great resource on this that I’ve used is… How do you think your team can help you with this?

15 Provider Name% with A1c%A1c <7.0% A1c 7.0 to 9.0%A1c >9.0 Hypertension w/o DM with BP <140/90 % DM/ HTN with BP <130/80 % with Asthma Action Plan % well-controlled Asthma % of Persistent Asthma on Controller Med % Screened for Colon Cancer % Screened w/ pap smear % Screened w/ mammogram % HIV Tested (ever) % with Depression screening Unlocked Notes % of meds done by e-Rx % of visits with PCG Total96%48%34%18%63%41%48%69%94%27%67%45%32%14%209048%54% Amenedon/a 71%100% n/a0%n/a0%50%1263%n/a Anderson100% 0% 87%33%0%n/a50%24%88%42%47%12%35524%38% Arraiano95%52%33%10%72%48%9%38%93%31%80%44% 18%326%37% Begum90%38%34%17%65%59%8%50%100%24%65%42%26%12%10480%40% Caamano100%50%17%33%58%50%24%50%100%24%58%43%35%14%3450%43% Carlsen100%50%13% 79%38%42%71%100%23%57%40%15%22%823%45% Cohen98%30%39%29%74%55%15%64%96%35%58%41%19%10%4911%59% Dillonn/a 97%87%93%n/a 67%101%85% Dunn97%50%31%16%61%41%33%75% 29%58%38%29%9%225%30% Gallin50%0% 50% 65%94%64%n/a24%100%22%55%1491%88% Gerson92%23%69%0%78%31%30%100%80%15%77%52%31%11%2379%53% Guerra100%30%40%30%60%30%0% 100%62%17%15%30%28%3680%1% Islam100%52%33%14%56%38%33%100% 31%52%35%29%21%16055%42% Meyer96%32%51%13%54%43%n/a73%100%49%57%44%42%8%31689%78% Moysak95%40%35%20%70%40%0%100% 21%82%55%44%13%5154%49% Michelsonn/a 50%n/a50%100% 35%97%54%75%14%1n/a47% Neptunen/a 100%96% n/a 685%97% Pacen/a 78%68%97%n/a 45%10%5084%81% Pozzuolin/a 21%86%100%n/a 15%8%4265%75% Puthiyamadam100%54%35%11%61%48%57% 97%54%77%63%53%32%7189%79% Rai100%42%33%25%78%58%33%67%100%23%76%61%17%7%385%35% Rajan99%42%30%26%56%43%9%50%84%21%53%35%23%12%30574%42% Rovito96%46%41%23%69%43%50% 100%29%55%36%3%8%855%76% Samuel0% n/a0%21%77%100%n/a 7% 3561%56% Statile100%36% 27%52%36%27%100%71%14%58%31%36%18%1053%28% Steinberg100%50%25% 50%63%36%50%92%19%80%52%51%21%5595%41% Uribe94%31%56%6%76%44%18%70%76%23%81%56%41%12%858%51% Wu100%65%29%6%60%44%50%86%95%30%63%60%33%36%1493%58% Yuen99%46%31%22%55%30%33%78%90%27%53%36%30%10%3310%63% Zeppieri100%52%30%18%67%39%24%67%96%20%54%37%39%34%3431%49% Total96%48%34%18%63%41%48%69%94%27%67%45%32%14%209048%54% Cruelty to Eyeballs

16 August 2010TotalRaiRajanRovitoStatileSteinbergUribeWuYuenZeppieriTotal % with A1c 96%100%99%96%100% 94%100%99%100%96% % with A1c between 7 and 9 34%33%30%41%36%25%56%29%31%30%34% % with A1c >9 18%25%26%23%27%25%6% 22%18% % DM/ HTN with BP Controlled <130/80 41%58%43% 36%63%44% 30%39%41% % with AAP 48%33%9%50%27%36%18%50%33%24%48% % with asthma well controlled 69%67%50% 100%50%70%86%78%67%69% % persistent asthma with controller med 94%100%84%100%71%92%76%95%90%96%94% % with PAP in 3 years 67%76%53%55%58%80%81%63%53%54%67% % with mammogram 45%61%35%36%31%52%56%60%36%37%45% % Screened Colon Cancer 27%23%21%29%14%19%23%30%27%20%27% Hypertension no DM Well Controlled <140/90 63%78%56%69%52%50%76%60%55%67%63% % HIV Tested 32%17%23%3%36%51%41%33%30%39%32% % Depression screening 14%7%12%8%18%21%12%36%10%34%14% % RX eprescribed 48%5%74%5%53%95%8%93%10%31%48% % of visits PCG 54%35%42%76%28%41%51%58%63%49%54% Partial Group Shot

17 Trending Over Time… D. Wu Dec-09Apr-10Aug-10Open Door % with A1c 100% 96% %A1c <7 61%68%65%48% %A1c 7-8.9 29%34% % A1c > 9 6%18% % Lipid 70%84% % Microalbumin 65% % DM/ HTN with BP Controlled <130/80 40%42%44%41% % with AAP 45%49%50%48% % with asthma well controlled 96%87%86%69% % with PAP in 3 years 52%71%63%67% % with mammogram 54%60% 45% % with Colorectal Screening 30%27% Hypertension no DM Well Controlled <140/90 66%64%60%63% % HIV Tested20%25%33%32% % with Depression screen 36%14% % e-prescribing 93%48%

18 Hypertensives with BP < 140/90

19 Diabetics with A1c < 7.0

20 Next Steps… We will begin modeling a P4P component to compensation starting June 2011 Implement P4P payments to our primary care providers in 2012

21 Questions?

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