1. Physician Accountability: In the Public Eye Jay Wish, MD Medical Director, Dialysis Program and Medical Director, Medical Quality Karen Boyd, RN, BSN, MBA Director Quality Institute UHCMC Karen Saidel, RN BSN Manager, Quality and Risk UHRMC Corinne M. Hurley, RN, MSN Director of Clinical Management UHPS Sri K. Madan Mohan, MD, FACC, MRCP Chief Quality Officer, Harrington Heart & Vascular Institute Program Director, Advanced Imaging Fellowship UHCMC Anka Meges, RN, BSN, MBA Senior Clinical Adoption Analyst Electronic Medical Records University Hospitals Raymond Krncevic Associate General Counsel University Hospitals Jennifer Carpenter, MSN, RN, CPHIMS Manager, UHCare Clinical Documentation University Hospitals

2. October 27, 2012University Hospitals2 Objectives Understand anticipated future regulation Understand how physician specific data are being collected and how they are shared Determine relevant physician specific metrics –Determine what physicians would like to see on a UHCare physician scorecard –Identify how physician accountability metrics can establish best practices Determine how to promote a win, win, win for patient, physicians, and the institution (aligning incentives)

3. October 27, 2012University Hospitals3 AHRQ Recommendations Regarding Provider Performance Measures 1. Have a solid evidence basis 2. Measure clinical performance (not cost or utilization) 3. Be actionable by a provider or professional 4. Cover the domains of interest 5. Specify methodologic considerations 6. Be biometrically tested for validity, sensitivity, specificity, reliability and reproducibility

4. October 27, 2012University Hospitals4 AHRQ Recommendations Regarding Provider Performance Measures cont. Furthermore, AHRQ recommended that public disclosure of provider profiles be postponed until 1. methodology regarding case mix adjustment is validated (providers accepting higher-risk patients should not be penalized for adverse outcomes), and 2. appropriate safeguards to avoid "cherry picking" (providers refusing to accept high-risk patients in order not to blemish their aggregate outcomes) must be specified.

5. October 27, 2012University Hospitals5 CMS Related Physician Measures ACO Quality Indicators Physician Quality Reporting Clinical Quality Measures for Meaningful Use E-Prescribing eRx Metric

6. October 27, 2012University Hospitals6 Examples of Patient Accessible Physician Profile Websites Minnesota HealthScores - University of Minnesota PhysiciansMinnesota HealthScores - University of Minnesota Physicians Minnesota HealthScores - Ratings by Condition Healthgrades Vitals

7. October 27, 2012University Hospitals7 Examples of Patient Accessible Physician Profile Websites cont. – Physician Compare Provider Profile Minnesota HealthScores - University of Minnesota PhysiciansMinnesota HealthScores - University of Minnesota Physicians Minnesota HealthScores - Ratings by Condition Healthgrades Vitals Physician Compare Provider Profile

8. October 27, 2012University Hospitals8 What are the Meaningful Use Requirements? Providers 15 core objectives Most require achievement of performance targets 5 objectives out of 10 from menu set Most require achievement of performance targets 6 total Clinical Quality Measures Do not have performance targets - 3 core or alternate core - 3 out of 38 from menu set Stage 1 Objectives and Measures Reporting

9. October 27, 2012University Hospitals9 Clinical Quality Measures Clinical Quality Measures align with other CMS Physicians Clinical Quality Reporting (for example: Medicare ACO; PQRS)

10. October 27, 2012University Hospitals10 Looking Ahead What has Giesinger done to align incentives? –Productivity –Adherence to quality measures –Citizenship UH ACO aligning incentives –UH leadership is working on how best to achieve this –What would you us to share with leadership?

11. October 27, 2012University Hospitals11 Available reports

12. October 27, 2012University Hospitals12 Physician Focus Report Source: Premier

13. October 27, 2012University Hospitals13 Physician Focus Report Source: Premier

14. October 27, 2012University Hospitals14 Physician Report Source: Midas

15. October 27, 2012University Hospitals15 Physician Report Source: Midas

16. October 27, 2012University Hospitals16 UHCare reporting Multiple reports for internal and external use look at physician performance & accountability Med Rec –Completion of admission & discharge Med Rec, sorted by attending CPOE –Rate of CPOE vs. written, verbal –Unsigned orders Order set utilization –Rates –Relevance b diagnosis Notes –H&P utilization by attending –Attestation compliance by attending Meaningful Use –CPOE, coded diagnoses, cause of death

17. October 27, 2012University Hospitals17 Joint Commission Standards for Focused & Ongoing Professional Practice Evaluation FPPE: privilege-specific evaluation for doctors lacking documented competency –Newly-requested privileges –Quality problems identified in doctor’s existing practice –Triggers & remedial measures clearly identified –Time-limited OPPE: process for identifying trends that impact quality of care and patient safety –Review period must be < 1 year (at UH, 8 months) –Departments responsible for setting criteria –Can give rise to FPPE

18. October 27, 2012University Hospitals18 Discussion How do you want to incentivize performance? Carrots vs sticks? Bonuses What metrics would be helpful/relevant? Barriers to consistent accountability Process vs outcome measures Aligning incentives

19. October 27, 2012University Hospitals19 Thank You.