Quality Data Reporting: Generating Data Reports for Incentive Programs

1. Quality Data Reporting:Generating Data Reports for Incentive Programs Don Gettinger, BS, CPHIT, CPEHR Health Care Excel

2. Introductions

3. What we are going to cover • Overview of incentive programs and associated data measures • Generating accurate data reports • How to use the Model for Improvement to drive change • Learn what programs are available to assist you

4. Incentive Programs

5. Incentive Programs (Cont’d)

6. EHR Incentive Program • The Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs • Receive up to $63,750 incentive per provider over five to six years • Must use a certified EHR • Must meet 20 of 25 objectives to receive funding

7. EHR Incentive Program (Cont’d) • Report Clinical Quality measures • Must report six measures • Three core measures that all providers must report • Three additional measures chosen from a list of 38 • Requirement is met by simply reporting the numerator and denominator

8. Physician Quality Reporting System (PQRS) • The reporting program formerly known as Physician Quality Reporting Initiative (PQRI) and Physician Voluntary Reporting Program (PVRP) • Incentive payment is a percentage of Medicare-allowed charges • More than 200 measures to choose from

9. PQRS • Must successfully report at least three measures • Three different reporting methods • Incentive is met by successfully reporting data

10. E-Prescribing Incentive • Must report that you successfully e-prescribed on at least 25 unique visits • Three different reporting methods • Several exemptions to prevent payment adjustment in 2012

11. Patient Centered Medical Home • Many payers provide incentives or inclusion in preferred provider networks for achieving PCMH recognition • Collect and use data for population management • Use performance and patient experience data for continuous quality improvement

12. Quality Health First • Uses data in the Indiana Health Information Exchange (IHIE) to populate quality reports and clinical decision support alerts • Used by some local payers to provide incentives or inclusion in preferred provider networks

13. Clinical Quality Measures • Measures drive improvement • Measures inform consumers • Measures influence payment

14. Clinical Quality Measures (Cont’d) “Measurement matters. When clinicians see their numbers, they act to improve them, using their professional pride and competitiveness to find solutions.” Randall D. Cebul, MD, Director, Better Health Greater Cleveland

15. Clinical Quality Measures (Cont’d) Measure Number: NQF 0031, PQRI 111 Title: Preventive Care and Screening: Screening Mammography Description: Percentage of women aged 40 through 69 years who had a mammogram to screen for breast cancer within 24 months

16. Getting Accurate Data

17. IHI Model for Improvement What is the IHI Model for Improvement? • Model identifies four elements of successful process improvement • An approach for organizing and carrying out plans for improvement

18. Getting Accurate Data (Cont’d)

19. Getting Accurate Data (Cont’d)

20. Top 10 things to do if… You don’t care about your data 10. Keep your documentation processes the same as they have been 9. Assume that a scanned document will be pulled into quality reports 8. Don’t require injections and tests be documented in discrete fields

21. Top 10 list (Cont’d) 7. Don’t educate staff about why the quality measures are important to patient care 6. Don’t let your patients know you are working on these measures 5. Choose which quality measures to track without engaging providers in decisions

22. Top 10 list (Cont’d) 4. Only discuss preventive care with a patient during an annual physical • Wait to look at your data for the first time when it is time to report • Accept “I’m too busy” as a valid excuse 1. Don’t ask for help

23. Assistance Regional Extension Centers (RECs) • Provide training and support services to assist doctors and other providers in adopting EHRs • Offer information and guidance to help with EHR implementation • Give technical assistance as needed

24. Indiana RECs

25. Indiana RECs Indiana Health Information Technology Extension Center (I-HITEC) www.ihitec.purdue.edu HealthBridge www.healthbridge.org

26. Assistance Health Information Exchange A Health Information Exchange (HIE) is an electronic movement of health-related information among organizations utilizing nationally recognized standards and policies.

27. Indiana HIEs Indiana Health Information Exchange www.ihie.com Michiana Health Information Network www.mhin.com Healthlinc www.healthlinc.org HealthBridge www.healthbridge.org

28. Assistance Quality Improvement Organizations (QIOs) Focusing on Eight Quality Measures • CRC Screening • Mammography • Flu Immunization • Pneumonia • Immunization • Aspirin Therapy • LDL Control • BP Control • Smoking Screening • and Counseling

29. QIO Learning and Action Network Providers, practice managers, State and National Health stakeholders and the QIO. • Improve specific Clinical Quality Measures • Promote Meaningful Use (MU) • Support Health Information Exchange (HIE) • Encourage participation in PQRS • Address disparities in care.

30. QIO Learning and Action Network (Cont’d) • Webinars and teleconferences • Educational resources on current HIT subjects • Opportunities to network with and learn from peers • Tools and interventions for quality improvement

31. Indiana QIO Health Care Excel www.hce.org (812) 234-1499

32. Remember… • We get more of what we focus on • Focus on problems—more problems • Focus on success—more success • Focus on what works—more of what works • Focus on good stories—more good stories • Focus on results—more results We can choose what we focus on!

33. Questions? Don Gettinger Health Information Technologist Population and Community Health Health Care Excel Telephone:  812-234-1499, ext.336 This material was prepared by Health Care Excel, the Medicare Quality Improvement Organization for Indiana, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-IN-POPHEALTH-11-007 09/15/2011