1. Quality for Physician Reimbursement
Brenden Wynn, regional operations manager
Providence medical group

2. Quality Reporting Is No Longer Optional4%
- 4% 5%
- 5% 7%
- 7% 9%
- 9%
2019
2020
2021
2022
Over the past decade, programs have been implemented by the Centers for Medicare and Medicaid Services that directly tie reimbursement to quality.
Early programs had more upside than downside risk - but that balance is changing

3. Quality based programs are transforming into Merit Based Incentive Programs (MIPS)
25%
50%
15%
10%
25% Advancing Care Information – MU Measures
15% Clinical Practice Improvement – Care Coordination, PT Satisfaction, Access to Care
50% Quality PQRS
10% Resource Use – VBPM – Cost Measures

4. Unfortunately, Medical Groups have not excelled under PQRS
5477
Number of group practices hit with fines in 2014 for not meeting quality reporting standards
$79.5 Million
Dollar amount of VBM penalties for 5477 physician groups who did not meet quality reporting standards in 2014.
In 2014 more than 5000 physician groups failed to meet physician quality reporting standards. This equated to $79.5 million dollars in penalties.
These continuing adjustments for under performing physicians increase the urgency around improving your quality reporting structures.
Not only will poorly performing physicians or groups experience an adjustement, they will see their more successful peers receiving upward adjustments.
Those physicians or groups who don’t report at all will receive the largest penalties

5. Successfully navigating and managing quality reporting is no easy task
$15.4 Billion spent on quality reporting in 2015
15.1 hours of physician time per week spent on quality reporting
785 hours of physician time per year spent on quality reporting
Physician care teams and support staff are spending significant time and resources on activities such as tracking measures, reviewing, quality reports, collecting and transmitting quality data, and more.
15.4 Billion spent on reporting quality in 2015
15.1 hours of physician time per week reporting
785 hours - average time per physician per year.

6. Barriers To Quality Reporting
Too few FTE’s to support
quality reporting
Different measures
for each payer/program
Lack of healthcare provider buy-in
Missing quality infrastructure
Lack of physician buy in
Missing quality infrastructure
Lack of performance benchmarks
EMR Limitations
It’s okay to
Few FTE’s to support execution of Quality reporting
Abundance of quality measures
EMR limitations

7. Providence Quality Measure Progress
150 QM
33 QM
15 Quality Measures

9. Checklist for Quality Reporting Preparation
Strategy
Prioritize actionable measures
Prioritize measures that maximize financial returns
Track
Quality Data
Use data to emphasize opportunity
Timely and scheduled performance updates
Engage Stakeholders in Performance Risk
Tie payer incentives to compensation
Incentives to engage the entire care team
Governance
Structure
Dedicate quality resources
Determine quality mandate