Presentation on theme: "Ongoing Professional Practice Evaluation (OPPE)"— Presentation transcript:
0 Meeting The Joint Commission Ongoing Physician Practice Evaluation Standards January 2009 Kenneth J. Abrams, MD, MBASenior Vice President, Clinical Operations, Associate Chief Medical Officer, North Shore-Long Island Jewish Health System
1 Ongoing Professional Practice Evaluation (OPPE) The intent of the standard is that organizations are looking at data on performance for all practitioners with privileges on an ongoing basis rather than at the two year reappointment process, to allow them to take steps to improve performance on a more timely basis.A clearly defined process would include but not be limited to:who will be responsible for reviewing performance dataMEC, Credentialing Committee, Department Chair, Department, etc.how often the data will be reviewed3, 6, 9 Month intervals. 12 Month intervals considered “periodic” not ongoingthe process to be implemented to use the data to make decision as to whether to continue, limit or revoke privileges. Who can make and approve an actionhow data will be incorporated into the credentials files.The decision resulting from the review, whether it be to take an action or to continue the privilege would need to be documented along with the supporting data. - Adopted from The Joint Commission
2 Joint Commission Physician Credentialing Requirements The following information is suggested to be reviewed on a regular basis as part of “ongoing practice evaluations” of physician performance, in addition to the every 2 year credentialing cycle:Review of operative & other clinical procedures performed and their outcomesAdverse events / sentinel eventsPattern of blood and pharmaceutical usageRequests for tests & proceduresLength of stay patternsMorbidity and mortality dataPractitioner’s use of consultants“Other relevant criteria as determined by the medical staff”Departments need to define the type of data to be monitored. Departments would know best which data would best reflect good and problem performanceSuggestions for collection of data:periodic chart reviewdirect observationmonitoring of diagnostic and treatment techniquesdiscussion with other individuals involved in the care of each patient including consulting physicians, assistants at surgery, nursing, and administrative personnel. - Adopted from The Joint Commission
3 Premier Tools Are Designed to Shift the Data Collection Effort Curve Typical EffortIdeal EffortImproving Clinical Practice PatternsGreatly alleviates the need to do chart-reviews by using readily available electronic data (UB92 patient-level) in conjunction with our data loading and validation tool.Data CollectionData ReportingData AnalysisStrategy Development& DeploymentLeveraging automated data reduces manual chart review and allows increased time for analysis and problem solving – the key to improving care!
4 Results of the Evaluation The information resulting from the evaluation needs to be used to determine whether to continue, limit, or revoke any existing privilege(s) at the time the information is analyzed. Examples:determining that the practitioner is performing well or within desired expectations and that no further action is warranteddetermining that issues exist that require a focused evaluationrevoking the privilege because it is no longer requiredsuspending the privilege, which suspends the data collection, and notifying the practitioner that if they wish to reactivate it they must request a reactivationdetermining that the zero performance should trigger a focused review (MS.4.30 EP 5) whenever the practitioner actually performs the privilege.determining that the privilege should be continued because the organization's mission is to be able to provide the privilege to its patients- Adopted from The Joint Commission
5 Focused Professional Practice Evaluation An intense assessment of a practitioner’s credentials and current performanceNew doctors applying for staff privilegesPractitioners requesting new or expanded privilegesLack of documentation of competencyTriggered by a negative evaluation (criteria should be specified)Practitioner lacks required case volumeProctoring – a form of Focused Professional Practice EvaluationEvaluation of a practitioner’s performance by another peerReal time – direct observationRetrospective evaluation by “same specialty” internal or external review.
6 Engage Medical Staff with Severity-Adjusted Data Premier Clinical Advisor™Strategic PlanningPatient SafetyClinical PerformancePhysician PerformanceNow lets move into how Clinical Advisor can work with your organization around physician performance.Regulatory ComplianceFinancial Performance
7 Physician Profiles Engage Your Medical Staff PerformanceKey Applications:Support physician re-credentialing processIdentify physician practice pattern variancesIdentify cost reduction opportunitiesValue:Improve compliance with JCAHO PI standardsReduce staff time generating reportsClinical Advisor has a number of methods that allows for analysis on physician performance. This is the Physician Profile report is a great report with CA that provides a snapshot of a physician’s performance on clinical outcomes and cost, as compared to other physicians in the hospital and a peer group.Many hospitals use these reports-as part of the re-credentialing process-compliance with JCAHO standardsThey allow you to-identify opportunities at the physician level in outcomes and costPhysician Profile Report
8 Physician Profiles Engage Your Medical Staff Performance8/01/2006 through 10/30/2006Compare performance for:Individual physiciansPhysician groupsUnderstand physician performance for:OutcomesCosts & ALOSResource Utilization9/01/2005 through 10/30/2006The Physician Profiles use severity-adjusted data, using the same 3M APR-DRG methodology we discussed earlier.The Physician Profiles can be run for an individual physician or a group of physicians as an aggregate.In the highlighted section of the Physician Profile report (section blown up) we can see how the report compares an individual physicians performance (red bar) on ALOS, Average Cost, and Mortality versus:-the performance of the other physicians at their hospital in the same practice (dark blue bar)-the performance of all other physicians at their hospital (white bar)-the performance of all other physicians in the same specialty at hospitals in a defined peer group-the performance of all other physicians at the hospitals in a defined peer group (purple bar)The highlighted section of this report uses severity-adjusted index values to show how a physician is performing vs. other physicians.-We can see that the physician’s (red bar) ALOS is 34% higher than what is expected for their patient population.-We can see that the physician’s (red bar) Cost per Case is 96% higher than expected-We can see that the physician’s (red bar) Mortality rate is 58% higher than expected, and the other physicians in the same specialty in the hospital have a 41% better than expected mortality rate.This report takes into account all patients that the physician treated by physician role. For example, you can run this report for a physician, where the physician was the attending physician. The data/patients included in the report will be all patients in the timeframe the physician treated as the attending physician. The Physician Profile report can be run for multiple physician roles, which include:-Attending Physician-Admitting Physician-Consulting Physician-Procedure PhysicianPresenter’s Note:technical note: the severity-adjusted indexes are a measure of how a physician (or group of physicians) performs against how they are “expected” (expected values from the database) to perform. This comparison of actual vs. expected results in an index value, where:-an index of 1.0 = performing as expected-an index of 1.10 = performing 10% higher than expected-an index of 0.90 – performing 10% better than expected)Physician Profile Report
9 Drill to Physician Performance from any Report Analyze Physician Performance on Clinical Outcomes & EfficiencyALOS / Cost Analysis ReportThe Physician Profile report is just one way to analyze physician performance within Clinical Advisor. Within other reports, you can drill down to the physician to better understand their performance.The first report is an ALOS/Cost analysis report. Here we are looking at our Pneumonia population, and have drilled down to the attending physicians that treated these pneumonia patients, to better understand how the physicians perform on cost and los within this population.The second report was built using Report Builder, Clinical Advisor’s ad hoc reporting tool. Report Builder allows you to analyze any set of data you choose.Here our interest is looking at the outcomes and PSI event rates for physicians.Physician Performance on outcome metrics using Report Builder
10 Physician Activity & Outcome Report State of the ArtPerformance Based Measurement
11 Pre 2008 - Practitioner Measurement Process measures dominatedRaw numbers were substitutes for performanceData was not risk adjustedBenchmarks were not utilizedPeer performance was not a standardLimited focus on resource consumptionNo patient satisfaction data
12 Evolution in Measurement Multiple domains are necessary to evaluate complex performanceOutcome trumps processRisk adjustment levels the playing fieldExcess resource consumption consistently associated with poor outcomes (Dartmouth)Patient comments on perception care offer valuable insight beyond statistical rankingsSafety indicators offer insight into benchmarked rates of complications of care
13 Medical Record Data Source - Input Medical Record ContentAnd Data SourcesADTPatient IDMedical RecordAdmit SourceAdmit TypeAdmit DatePatient TypePatient ClassificationDischarge StatusPatient OriginPatientDemographicsBirth DateAgeRaceGenderClinicalDRG3M APR-DRG™PX (Primary & SecondaryDX (Primary & Secondary)Days on MVQty OrderedService DateCPT4/HCPCSFinancialPayorSecondary PayorCharges (Dept & Procedure)Costs ( Dept & Procedure)Fixed Cost/PxVariable Cost/PxPhysicianSpecialtyAttendingConsultingSurgeonOutcomesALOSReadmitsComplicationsMortalityOutliersORYX IndicatorsBirth WeightNot abstracted data. Pt level existing data. Calculated based on administrative data.13
24 Limitations Administrative data Does not capture activities for: RadiologyAnesthesiologist (except interventional)Currently, most non-procedural consultants are not mapped for activityAttribution in group practices not developedLow volume reports have limited valueCost data is based charges
25 Improvement Timetable October 2008Begin data capture for Ambulatory ProceduresJanuary 2009Start data capture for Consulting ActivitiesSeptember 2008Begin mapping groups (Hospitalist, OB/Gyn, etc.)Winter 2009Web access for individual MD reports
26 QualityAdvisor Practitioner Profiles Conceptual Design and PrototypesRichard Bankowitz, MD, MBA.Vice President, Medical Director, Premier Healthcare Informatics
27 QualityAdvisor Practitioner Profile Interactive online reportingCustom Comparison Groups“All Provider” type option to capture all patients, regardless of roleReport SectionsDemographicsOutcomes (in aggregate and trended)Customize inclusionsMortality, Morbidity, Complications, LOS, Cost, Charges, ReadmissionsComplicationsCareScience, AHRQ PSI, CMS HACs, Premier HACsCustomized Resource UseTop OpportunitiesMortality, LOS, HACsCore Measure CompliancePatient FlowDrilldown to Patient Level DataMortality, Complications, and ReadmissionsFor the practitioner profile itself, the following features are included. Specifically, users will be able to create a custom comparison group at the facility level – allowing customers to create a group that best fits who is being measured, like a group of hospitalists or splitting out hip and knee orthopedic surgeons from spine surgeons. The report will be flexible so that you can design it to only include a subset, or batch, of reports. In addition, it will offer drilldown to patient level data for specific outcomes like mortality and hospital acquired conditions.
28 Design Principles for Physician Reports It should be easy to see where there are problems (opportunities) – There should be a “summary” view and an “opportunity” viewPut all high level information in one placeUse green, yellow, red or other easy to interpret icons (consider printing)Every metric needs some sort of target (expected value or other target)The report must display variance from target and flag opportunities (red)Make the summary level clear and concise and put supporting information in “drill down” detail section – graphs etc. can go in detailUsers should be able to select which metrics they will see in the “top level” summary display, and alter this by physician group (med vs surg)Users should have the ability to customize the peer comparison groupUsers should be able to see best practice performanceUsers should be able to choose which “drill downs” will display / printUsers should see trended data over timeUsers should be able to drill to find “special cause” variationData must be aggregated in meaningful, actionable clusters
29 Define the patient population and peer group. Mock-upDefine the patient population and peer group.Highlight priorities for action.Describe population characteristics.Graphically display key metrics and comparisons.
31 QualityAdvisor Premier Hospital Acquired Conditions There are a number of secondary diagnoses that, when they occur after admission, Premier considers morbid, and should both be tracked for incidence and for patient identificationExamples includeAnaphylactic ShockFat EmbolismAdverse Drug EventOther ’99’ codesSurgical CompsUrinary CompsNeurologic CompsC. Diff EnteritisSepsis/Bacteremia2ndary ThrombocytopeniaPhlebitis/ThrombophlebitisHemorrhageCardiac ArrestEtc.In addition to the CMS Hospital Acquired Conditions, Premier has developed what we are calling “Premier Hospital Acquired Conditions”. These are conditions that we felt were morbid and should be tracked if they occur admission. We will be calculating them like the CMS HACs, where they will be defined using coded data (eg, will be one or more diag and/or procedure codes), looking for when specific diagnoses did NOT have a POA flag present, meaning they occurred after admission.Premier has developed about 50 or so HACs that you will be able to track in QualityAdvisor, and you can see some of them, like the C. Diff enteritis, are under consideration by CMS. Therefore, you will be able to proactively track your performance on these measures well in advance of CMS deeming them non-reimbursable.
32 System Level Reporting Capability CorporateRegion ARegion BRegion CRegion D…System 1System 2System 3Outcomes and resource utilization tied from patient level all the way to corporateSecurity access defined for each levelStart at any level in the roll up…QualityAdvisor, in conjunction with all Premier Products, is introducing new entity management to support system level reporting.At first release, QualityAdvisor will Support Corporate, Hospital, Physician, and Patient-level reporting. The additional Regional & System levels will be introduced in subsequent releases following the initial release.Our goal is to allow you to enter reporting at different levels, and control drilldown from that level. Security will be defined for each level.Hospital AHospital BHospital CMDIMDIIMDIIIPatient
33 Targeted Population Analysis Specific populations targeted for detailed analysisHeart FailureAcute Myocardial InfarctionPneumoniaStrokeLayered “Dashboard” reporting for online interactionControl ChartsDrilldown to physician & patient level dataIntegrated Evidenced-based dataCore MeasuresResource UtilizationHip & Knee SurgeryPregnancyCardiac Bypass SurgerySpine Surgery
35 Readmission Reporting Risk-adjusted 30-day Readmission ReportRisk of being readmitted based off of initial diagnosesReadmission Diagnosis Summary ReportActual readmission rates for specific diagnosesFlexible readmission timeframes (eg, 7, 14, 30 days, or user defined)DrilldownsReadmission Detail (all patients)Readmission Individual Patient Detail (one patient, multiple admissions)Here is an example of the Risk-adjusted 30 day readmission report. This was designed with customer feedback as well as input from Premier Research Services and Richard Bankowitz, MD – VP and Medical Director. You’ll see that we not only show the risk for 30-day readmissions, but also information on length of stay for the readmission and the initial admission.The user is able to drilldown from this report to identify exactly which patients were readmitted, and then from the patient list, and drilldown to a single patient view of a side-by-side comparison of that patients multiple admissions.