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?