Preparing for NCQA Diabetes Physician Recognition 2007

1. Preparing for NCQA Diabetes Physician Recognition 2007 Affiliate Conference Call April 19, 2007 Elaine Sullivan, MS, RN, CDE

2. April 19, 2007, 12-1 pm (EDT)NCQA Conference Call Participants • Alle-Kiski Medical Center, New Kensington, PA • Baltimore Washington Medical Center, Glen Burnie, MD • Doctors Community Hospital, Lanham, MD • Floyd Memorial Hospital, New Albany, IN • Forbes Regional Hospital, Monroeville, PA • Lawrence and Memorial Hospital, New London & Mystic, CT • Maryland General Hospital,  Baltimore, MD • Providence Hospital, Novi, MI • Southern New Hampshire Medical Center, Nashua, NH • Southview Hospital, Dayton, OH • St. Mary's, Evansville, IN • St. Vincent Charity Hospital, Cleveland, OH • SUNY Upstate Medical University, Syracuse, NY • The Hospital of Central Connecticut, New Britain, CT • The Western Pennsylvania Hospital, Pittsburgh, PA • UC Irvine, Irvine, CA • University of Maryland, Baltimore, MD 

3. Special participants on the call • Cindy Roberts, RN, BSN, CDE, Southview Affiliate, Dayton, OH & NCQA/DPRP Consultant • Nancy Earnley, Director, Health Information Management, Joslin Boston • Cathy Carver, Director, Patient Care and Education, Joslin Boston

4. Why bother with NCQA/DPRP? • Verifies quality of Joslin physicians • We are the best in diabetes care, so this shouldn’t be hard criteria for us to meet • Some insurers are requesting lists of NCQA/DPRP physicians for PFP • Individual physicians and sites will be listed on the NCQA website

5. Physician Eligibility • Seen patients in your site for at least 12 months • Seen at least 25 diabetes patients at your site for more than 12 months • If a physician wants to be recognized at multiple sites, would need workbook for each site • If physicians do not meet the requirement by May 1, 2007, they can still apply within Joslin’s application if they become eligible before May 1st 2008 • Boston needs to be notified of the full list of physicians who will be applying

6. The 12 Month Rule • Joslin Boston will submit the application with its workbook on June 1, 2007 • Boston is also required to submit a list of all Affiliates and all physicians that will be part of the Boston application • Each Affiliate submits its own workbook • Affiliates who were part of the 2004 Boston application need to submit their workbooks to NCQA by November 1, 2007 • Affiliates who are new to this process need to submit their workbooks to NCQA before May 31, 2008

7. Preparation • Do you have the electronic workbook? • Have you reviewed the instructions and standards? • Have you saved at least 2 copies of the workbook – blank and working copies? • Have you tried entering data on 1 physician and a few patients in your working copy? • What did you learn with your trial entry?

8. Workbooks • Always keep a blank workbook • Each workbook can hold up to 8 physician’s charts • If you have more than 8 physicians, copy the workbook and enter up to 8 physicians in the second workbook file • If you are doing pediatric as well as adult, copy the pediatric workbook and plan to submit a separate pediatric workbook

9. Important Tips • Save a blank copy of the workbook • Review special instructions carefully so you don’t accidentally delete your data • To delete the contents of a cell with a drop down list, use backspace or delete keys • Do not copy and paste responses from column to column • We will not be doing optional patient surveys

10. Time Line • May 1, 2007 is the date we have chosen as the start of our data collection • Go back starting with patients seen April 30th • Why we will move backward from start date rather than forward • Options for a different start date??? • Each workbook can only have 1 start date • If some physicians are ready now and some will be ready later, you will need to purchase a second workbook

11. Entering Data • Work on 1 physician at a time • Pull charts of all patients seen by the eligible physician on April 30th • In case of an NCQA audit, keep a master list of all patients reviewed & the NCQA identifier for each • Start entering data in working copy of the workbook • Remember to save every time you enter data in the workbook

12. Entering Data • For each patient seen April 30th answer the 3 questions to determine eligibility • Continue entering patients and answering eligibility questions until you have 25 eligible patients • This may require going back several days or longer • Do not skip any patients or any days the physician worked • Do not start to enter clinical data until you have identified the full sample of eligible patients

13. Abstraction Period • If patient was seen on April 30, 2007, the abstraction period is from April 30, 2007 back to May 1, 2006 • Most standards ask for most recent value & date • Read the definition for each standard carefully • Do you have any specific questions about standards or abstraction period?

14. Scoring • Results for each standard are automatically calculated while you are entering data • Points required for recognition • Adult 75 • Pediatric 30 • Total possible points • Adult 100 • Pediatrics 40 • If the results show the physician won’t meet recognition, delay the application until the deficiency can be corrected

15. Submitting Your Workbook • When you have: • entered 25 patients for each of your eligible physicians • the summary worksheet shows you have met criteria for recognition • Save 2 copies of your workbook on CD; label per NCQA instructions • Submit after June 15, 2007 • 1 copy to NCQA with letter identifying your site as part of Joslin application • 1 copy to Elaine Sullivan at Joslin

16. Questions??? • Ordering workbook • http://web.ncqa.org/tabid/160/Default.aspx • Elaine.sullivan@joslin.harvard.edu • 617-226-5866 • NCQA • http://web.ncqa.org/ • Cynthia Martin 202-955-1721 • Don’t wait until the last minute to do this • If you suspect you have documentation problems, do the audit now to pinpoint the problems and correct before the deadline