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Heart/Stroke Recognition Program Workshop May 2010

Heart/Stroke Recognition Program Workshop May 2010. Session Agenda. NCQA Overview NCQA Recognition Programs HSRP Basics Steps to Recognition Making the Most of Recognition Contact Information. A Brief Introduction….

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Heart/Stroke Recognition Program Workshop May 2010

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  1. Heart/Stroke Recognition Program WorkshopMay 2010

  2. Session Agenda • NCQA Overview • NCQA Recognition Programs • HSRP Basics • Steps to Recognition • Making the Most of Recognition • Contact Information

  3. A Brief Introduction….. NCQA is a private, independent non-profit health care quality oversight organization founded in 1990 NCQA is committed to measurement, transparency, and accountability NCQA unites diverse groups around a common goal: improving health care quality MISSION To improve the quality of health care VISION To transform health care through quality measurement, transparency, and accountability

  4. Current programs: DRP, HSRP, BPRP, PPC, PCMH What measures included: Structure, process and outcomes of excellent care management Where they come from: partnership with leading national health organizations Who rewards recognized physicians: many health plans and coalitions of employers Who is recognized: over 16,000 physicians nationally NCQA Recognition Programs

  5. NUMBER OF CLINICIAN RECOGNITIONS BY STATE As of 4/30/10 WA ME ND MT VT MN OR NH WI SD ID NY MA MI RI WY CT IA PA NJ NV NE OH IN DE IL UT WV MD CO CA MO VA KS KY NC TN NM AZ OK AR SC MS AL GA 0 Recognitions LA TX 1-25 Recognitions FL AK 26-100 Recognitions 101-500 Recognitions HI 16312 Total Recognitions 501+ Recognitions

  6. Developed in partnership with: American Heart Association (AHA) American Stoke Association (ASA) Launched July 30, 2003 Only report physicians who earn Recognition Use nationally recognized reliable valid measures HSRP Basics… Over 2,900 Physicians Recognized Nationally 3-year recognition period

  7. HSRP MeasuresPerformance Criteria and Scoring

  8. Scoring of Measures

  9. Who May Apply? • An individual clinician or a clinician group • To be eligible, applicants must: • have current license: doctor of medicine (MD), doctor of osteopathy (DO), nurse practitioner (NP) or physician assistant (PA) • provide continuing care to patients with ischemic vascular disease (IVD) for at least 12 months • have had face-to-face contact with and submit data on a sample of patients with IVD

  10. Eligible Patient Definition • Is 18 years of age or older • Has had a diagnosis of ischemic vascular disease for at least 12 months • Has been under the care of the applicant clinician for at least12 months

  11. What is the HSRP applicationand survey process?

  12. Framework for Achieving Recognition Review program information www.ncqa.org/hsrp Purchase the “2009 HSRP Package” from Customer Support Package contains all the information needed to apply for Recognition Review materials & sign Agreement HSRP Requirements Recognition Review Agreement and BA Agreement Data Collection Tool (Web-based) Identify the patient sample Patient sample must be identified using the HSRP patient selection methodology or a random sample methodology approved in advance by NCQA Abstract medical record data Enter data in Data Collection Tool Submit completed materials to NCQA *

  13. Identifying the Patient Sample The patient sample must: • be identified using the HSRP patient identification methodology or a random sample methodology approved in advance by NCQA. • be selected across the entire patient population regardless of the patient's method of payment (e.g., health plan, Medicare, Medicaid, employer, self-pay or other payment mechanism.) • include all eligible patients (i.e., eligible patients must not be excluded from the sample).

  14. Sample Size Requirement – Individual1 clinician applying Individual Applicant • 1 clinician practicing in any setting who provides continuing care to patients with ischemic vascular disease • either solo clinician or one clinician from practice site applying separately from other clinicians at the site Sample Size • 35 patients per clinician Public reporting on Web Site • Listed by individual names

  15. Sample Size Requirement – Individual (2 or more clinicians applying together) Individual Applicants • 2 or more clinicians from the same practice site who are applying/submitting at the same time • Applicants must have same start date and submit data on same date Sample Size • 25 patients per clinician Public reporting on Web Site • Listed by individual names

  16. Sample Size Requirement – Individual (9 or more clinicians applying together) • Optional alternate methodology for practice sites of 9 or more clinicians • NCQA selects sample of clinicians • Group abstracts data for the sample of clinicians • Recognition decision based on data for the sample of clinicians (see HSRP Requirements, Appendix 3 for details) Sample Size • 25 patients per clinician Public reporting on Web Site • Listed by individual names

  17. Sample Size Requirement – Group Sample Size • A maximum of 200 patients as shown in the table below: Public reporting on Web Site • Listed by group or site name only Clinician Group • An entity (e.g., group practice) of 2 or more clinicians: • who practice at the same site (physical location) • who share responsibility for a common panel of patients

  18. Patient Selection Methodology • Pick a “Start Date” • The date applicants begin to select the patient sample • On each day moving backward from the start date, consecutively evaluate the eligibility of each patient seen for an office visit • Select patients meeting the 3 eligibility criteria until the required sample size is met • May not go back more than 12 months from the start date to select patients

  19. Select the Patient Sample Step 1 – Establish a Start Date Step 1 Establish a Start Date The Start Date is the date you begin to select the patient sample   Attention Applicants must submit the completed DCT and supporting materials to NCQA within 180 calendar days of the start date. Example You select April 1, 2010

  20. Select the Patient Sample Step 2 – Identify Eligible Patients Step 2 Identify eligible patients On each day moving backward from the start date, consecutively evaluate the eligibility of each patient seen for an office visit Select patients who meet the 3 eligibility criteria Identify eligible patients until the required sample size is met May not go back more than 12 months from the start date to select patients Example Selecting first 10 patients Moving consecutively backward from 4/1/10, you identify 25 or 35 eligible patients who had office visits on the following dates:

  21. Abstract Medical Record Data • After selecting the patient sample,abstract data for patient care completed: • for a12-month period going back from the last visit date that occurred prior to the start date • from medical record documentation (electronic or paper), administrative data systems or registries

  22. Abstract Medical Record Data Determine the 12-month Abstraction Period Determine 12-month Abstraction Period When moving backward from the start date, the visit date that a patient is identified as eligible establishes that patient’s 12-month abstraction period After determining each patient’s 12-month abstraction period, abstract data for care completed for each patient in the sample. Example 12-month abstraction periods for the first 10 patients identified:

  23. Abstract Medical Record Data Data elements Record date and value of most recent blood pressure measurement performed within the abstraction period Tips To receive full credit for B/P both the systolic and diastolic readings must be below the goal, e.g., 139/89 Partial credit available Blood Pressure Measurement Proportion <140/90

  24. Abstract Medical Record Data Data element Record date of most recent lipid profile (including value for LDL) within the abstraction period Tips Abstract from official laboratory sheets, reports or administrative data Use date drawn or date received To receive full credit for control, LDL must be less than 100 (e.g., 99) Partial credit available for LDL control Lipid Profile and Cholesterol Control Proportion w/LDL<100mg/dl

  25. Abstract Medical Record Data Data Element Record date of documentation of use of aspirin or another antithrombotic during the abstraction period Tips Abstract data from medical records, reports or administrative data Patient self-report is not acceptable Use of Aspirin or Antithrombotic

  26. Abstract Medical Record Data Data Element Document smoking status Tips If there is documentation that the patient is a non-smoker, no further documentation is required Smokers: Record date that documents smoking cessation counseling or treatment within the abstraction period Smoking Status

  27. Data Collection Tool

  28. Data Submission Materials to submit: • Signed HSRP Recognition Review Agreement (2 copies) • Completed Data Collection Tool • Submitted via secure portal • Application fee • Payable by check or credit card

  29. What Happens Next? When NCQA has received all information needed to complete the application, NCQA reviews and makes recognition determinations 5 percent of applications are randomly selected for audit clinicians achieving Recognition receive: Posting to the Recognized Clinician Directory Recognition packet Letter of recognition Certificate of recognition Media kit/marketing and advertising guidelines Reporting to health plans, Pay for Performance programs

  30. NCQA’s Recognition ProgramPhysician Directory Recognition dates visible Clinicians with multiple recognitions clearly identified © 2002, 2008 National Committee for Quality Assurance ©National Committee for Quality Assurance - 1100 13th Street NW - Suite 1000 - Washington, DC 20005 - (202) 955-3500 Webmaster@ncqa.org Use of this website constitues acceptance of NCQA's Privacy Policy.

  31. Benefits of Recognition Provider Directories Data CollectionAssistance Network Entry Active Steering To Recognized MDs Fee Schedules, P4P Financial Incentives Specialty BoardMaintenance of Certification PQRI Qualification

  32. HSRP Contact Information • Mailing Address • NCQA • Heart/Stroke Recognition Program • 1100 13th Street NW, Suite 1000 • Washington, DC 20005 • Customer Support(questions on HSRP in general, purchasing the DCT, etc.) • 1-888-275-7585 • HSRP Staff (questions on sampling methodology, measures, etc.) • hsrp@ncqa.org • Web • www.ncqa.org/hsrp

  33. NCQA would like to thank our Heart/Stroke Recognition Program (HSRP) Sponsors Champion Sponsors

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