Cardiology Practice Improvement Pathway

1. Cardiology Practice Improvement Pathway Orientation to the Content, Process, and Expected Outcomes November 2010

2. Presentation Format 60-minute presentation: • 2 minute introduction • 30 minute presentation • 23 minute question-and-answer • 5 minute wrap up

3. Learning Objectives Participants will be able to: • Describe the Cardiology Practice Improvement Pathway (CPIP) and the Cardiology Practice Recognition (CPR) program. • Understand the value of participating in the CPIP and achieving the CPR. • Understand how to complete the CPIP data collection and reporting requirements.

4. Cardiology practice improvement pathway

5. What is Quality in Cardiology? ACC has developed two practice-level solutions for assessing, improving, and quantifying quality in cardiovascular practice: • Cardiology Practice Improvement Pathway • Cardiology Practice Recognition

6. What is CPIP? • Group Practice Assessment (Structural Domain) Practice-level systems that promote safe, timely, effective, equitable, efficient, patient-centered (STEEEP) care • Patient-Level Assessment (Clinical Domain) Measure sets developed by the ACC with the AHA and the AMA to improve rates of providing evidence-based care, reduce variations in care, and improve patient outcomes: HTN, CAD, HF, AF/AFL • Individual Physician Assessment (Professional Domain) Commitment to professionalism at the practice-level is believed to have positive effects on STEEEP care

7. Group Practice Assessment The Practice Assessment is intended to evaluate: • Use of a CCHIT-approved electronic medical record • Use of an electronic prescribing system • Use of patient experience surveys • Use of accredited labs for non-invasive outpatient diagnostic imaging: Echo and Nuclear • Successful participation in the 2008 or 2009 CMS Physician Quality Reporting Initiative (PQRI) • Active participation in a nationally recognized Cath and PCI Registry • Active participation in a nationally recognized ICD Registry

8. Patient-Level Assessment The Patient-Level Assessment is intended to evaluate adherence to clinical process and intermediate patient outcome measures for: • Chronic Stable Coronary Artery Disease • Hypertension • Heart Failure • Atrial Fibrillation and Atrial Flutter

9. Individual Physician Assessment The Individual Assessment is intended to evaluate each cardiologist for: • Current Cardiovascular Board (ABIM or ABP) Certification • Current CV Subspecialty Board (ABIM) Certification: EP • Current CV Subspecialty Board (ABIM) Certification: Intervention • Current FACC or FAHA Designation • Current Cardiovascular Subspecialty Designation • Current Cardiovascular Subspecialty Certification • Documentation of Continuing Medical Education

10. CPIP Process: 12 months • Within 3 months of beginning the pathway, practices are expected to complete the data collection and submission requirements in order to attain their baseline performance (Stage A) . • Practices will identify the clinical measures where the team has opportunities to improve, and develop action plans for performance improvement. • Over a 6-month period, the practice team will implement their interventions (Stage B). • Within 3 months of completing Stage B, practices will re-measure their performance on their selected clinical measures (Stage C).

11. What Happens With My Practice Data? • With practice consent, CECity will send practice data to IPRO for Cardiology Practice Recognition evaluation. Practices will receive a scorecard from IPRO. • CECity will also send practice data to the ACC for analysis of patterns and trends in CV practice. • The ACC will benchmark performance • The ACC will identify and prioritize areas for population- based care improvement • Quality improvement resources and tools will be identified or developed to support interventions targeted to prioritized areas for improvement

12. CARDIOLOGY PRACTICE RECOGNITION

13. What is CPR? • The Bridges to Excellence (BTE) Cardiology Practice Recognition (CPR) is awarded to those cardiology practices that achieve performance thresholds for recognition established jointly by the ACC and BTE. • Upon completion of CPIP Stage A, practices can choose to have their assessment data submitted to IPRO, BTE’s performance assessment organization, for evaluation against established thresholds.

14. Who is BTE? Bridges to Excellence is a family of programs offered by the Health Care Incentives Improvement Institute (HCI3). HCI3 is a non-profit organization that has created and administered a broad range of programs to measure outcomes; reduce care defects; promote a team approach to caring for patients; realign payment incentives around quality; and reward excellence. BTE programs create mechanisms for recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable, and patient-centered (STEEEP) care.

15. What role does BTE play? BTE has partnered with the ACC to administer the Cardiology Practice Recognition Program. BTE will transmit the names of Recognized practices and individual cardiologists within the Recognized practice to: • Select health plans for associated rewards; • The ACC for display on our professional and consumer portals • HealthGrades, BTE’s consumer portal for recognition information The Cardiology Practice Recognition duration will be 2 years from the date on which IPRO awards recognition.

16. Who is IPRO? IPRO is one of the largest and most experienced not-for-profit quality assessment and improvement organizations. Their mission is to improve the quality and value of health care services by supporting the development and implementation of performance measures; increasing the capacity of providers and government agencies for performance improvement; and fostering an environment through transparency and payment reform efforts, that rewards high-quality, high-value care.

17. What role does IPRO play? IPRO is contracted by BTE to calculate and score the quality indicators collected in the CPIP against the performance thresholds for recognition established by the ACC and BTE. IPRO reports results to: The practice: Practices receive notice of their CPR pass/fail status with a scorecard of their results to facilitate quality improvement. BTE: Only Recognized Practices and the individual cardiologists within the Recognized practices are reported to BTE. No clinical data is shared with BTE at any point in the process.

20. CPR Process • Upon completion of CPIP Stage A, practices can choose to have their assessment data submitted to IPRO for evaluation against established thresholds. • There will be a handoff link to IPRO where the practice will register to apply for recognition and pay an assessment fee. • The assessment fee: $95 for one physician $190 for two physicians $295 for groups of 3 or more physicians • Results are produced within 30 days

21. Audit Process • BTE reserves the right to complete an audit of any practice application for Recognition. • Specified local organization subcontractors conduct audits of at least 5 percent of applicants each year. • Cardiology Practice audits may be completed by fax, mail, electronically or on site, as determined by the auditor. Any data identified by IPRO as irregular will be subject to audit. The remainder of the 5 percent will be selected through a random sampling methodology. • Obtaining final Recognition results will take longer for applicants chosen for audit.

22. VALUE PROPOSITION

23. Why CPIP? Internal Value Practice-level performance improvement program designed to enhance and support QI in practice Understand your practice achievement of quality goals established by your ACC Immediate feedback on performance and tools for improving and re-assessing your performance in targeted areas External Value Establish consistency in market by standardizing the methodology for CV practice assessment and recognition Demonstrate your commitment to CQI and achievement of established quality thresholds Foundation for practices to participate in value-based payment programs

24. CPIP Value Proposition How does a practice participate in CPIP? What does a practice get in return? • ABIM MOC Part IV Application submitted to ABIM • Recognition from Bridges to Excellence For practices that achieve the thresholds set by ACC • Pay for Performance Actively negotiating with national and regional health plans • Sign-up your practice via CardioSource • Enter a modest set of clinical, structural & professional data • See your results • Receive recommendations and tools to improve where you have gaps • Choose to send results to Bridges to Excellence

25. ACC/BTE Cardiology Practice Recognition Payment Model Trajectory Today, we are here… …our future is there EMR / REGISTRY INTEGRATION EFFICIENCY MEASURES Bundled Payments Performance- Based Contracting Fee Schedule Differentials;BonusPayments Shared Savings Programs BETTER DIFFERENTIATION Incentives for BTE Recognition MORE DATA

26. CPIP DATA COLLECTION AND REPORTING REQUIREMENTS

27. CPIP Materials • CPIP Registration Form • Practice Guide to Completing the CPIP • Practice Assessment Questionnaire • Patient Sampling and Reporting Requirements • Chart Abstraction Forms • Individual Physician Assessment Questionnaire • Quality Improvement Toolkit

28. Register your Practice • Complete the registration form included with your webinar materials • Send the completed registration form to: cpip@acc.org

29. Receive your Practice Guide Once your registration form is submitted, you will receive the Practice Guide to Completing the Cardiology Practice Improvement Pathway and Applying for Cardiology Practice Recognition.

30. Identify your Measurement Period • The measurement period is equal to 12 consecutive months. • The last day of the measurement period is equal to the last day of the month prior to beginning the CPIP activity. • Data should be collected and submitted within 3 months of beginning the CPIP activity (Stage A).

31. Identify Your Sampling and Reporting Requirements • Practices with one to seven cardiologists must achieve a reporting requirement of a minimum group average of 25 patients per cardiologist per eligible diagnosis measure set. • Practices with eight to twenty cardiologists must achieve a reporting requirement of a minimum of 200 patients per measure set. • Practices with 21 or more cardiologists are required to achieve a minimum group average of 10 patients per cardiologist per measure set. • If the pool of eligible patients per practice per measure set does not meet the minimum reporting requirement, report on 100% of eligible patients. • It is important to note that a patient may have one, some, or all eligible diagnoses and is therefore eligible to be included in more than one measure set.

32. Identify Your Sample Step 1. Query your claims (or other) system to identify eligible patients who had an office visit in the 4th quarter of your measurement period. Eligible patients: Meet the age requirement-- Are aged 18 years and older at the beginning of the measurement period Have any, some, or all of the following diagnoses--CAD, HTN, HF, A-fib, A-flutter-- per eligible diagnosis codes Had at least two eligible encounters-- per eligible encounter codes-- within the measurement period

33. Identify Your Sample: HTN Step 2: From that list of eligible patients with an office visit in the last month of the measurement period: Working back from the last day of the measurement period, identify patients with HTN until you have the minimum number of HTN patients for your practice sample Identify the co-morbidities of CAD, HF, and AF/ AFL among those patients with HTN to determine how many more patients with CAD you need to meet the minimum number of CAD patients for your practice sample

34. Build Your Practice Sample: HTN Example of 10 patient minimum per measure set

35. Identify Your Sample: CAD Step 3: Working back from the last day of the measurement period, identify patients with CAD who are not already in the sample and add them to your list Identify the co-morbidities of HF and AF/AFL among those patients with CAD to determine how many more patients with HF you need to meet the minimum number of HF patients for your practice sample

36. Build Your Practice Sample: CAD

37. Identify Your Sample: HF Step 4: Working back from the last day of the measurement period, identify patients with HF who are not already in your sample until you have the minimum number of HF patients for your practice sample • Identify the co-morbidities of AF/AFL among those patients with HF to determine how many more patients with AF/AFL you need to meet the minimum number of AF/AFL patients for your practice sample

38. Build Your Practice Sample: HF

39. Identify Your Sample: AF Step 5: Working back from the last day of the measurement period, identify patients with AF or AFL who are not already in your sample until you have the minimum number of AF or AFL patients for your practice sample • Continue to build your sample as needed with eligible patients who had an office visit during the last quarter of the measurement period.

40. Achieve Your Reporting Requirements Example of 10 patient minimum per measure set

41. Gather and Enter * Your Data Gather data to complete practice assessment questionnaire Abstract enough patient charts to achieve practice reporting requirements Gather data to complete individual assessment questionnaires for each cardiologist in practice Enter data to complete practice assessment module Enter data to complete patient assessment module for entire practice Enter data to complete individual assessment module for all cardiologists in the practice * Web-based tool available for data entry in 1st quarter 2011

42. Anticipated Resource Commitmentfor Stage A • Small Practice = 20-30 hours • Medium Practice = 40-60 hours • Large Practice = 80 hours

43. Attestations • Once the practice assessment and chart abstractions are completed and submitted, one physician (or delegate) in the practice will be required to attest that the information and data submitted for the practice assessment and patient-level assessments meet the reporting requirements and are true and correct to the best of their knowledge. • Each individual physician (or delegate) will be required to attest that the information and data submitted for the individual assessment meet the reporting requirements and are true and correct to the best of their knowledge.

44. Audit Process It is essential that practices keep supporting documentation of their methodology and results for completing all of the modules within the Cardiology Practice Improvement Pathway.

45. Value Statement CPIP/CPR is an unbiased, transparent, comprehensive, self-reported, all-payer assessment of a practice’s performance against national benchmarks to better and more consistently understand how we practice as a profession allowing us to demonstrate and quantify value while implementing practice improvements that facilitate efficient workflows and drive effective patient care.

46. CPIP Help E-mail the CPIP support staff as questions arise: cpip@acc.org

47. Questions and Answers

48. Next Steps • Register your practice • Receive program materials • Begin gathering data required to complete each module • Enter and submit data in 1st quarter 2011 • Understand your practice patterns and opportunities for improvement

49. Thank You CPIP Program Staff: Eileen Hagan Phone: (800) 253-4636, ext 6475 Chelsea Newhall Phone: (800) 253-4636, ext 6468 cpip@acc.org Mon through Fri : 9am - 5pm ET