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Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
Keep Your Practice Alive
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Keep Your Practice Alive

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  • 1. Six Things You Must Know About Quality to Keep Your Practice Alive Sandy Pogones, Primaris MGMA Joplin Chapter Meeting March 20, 2012Publication MO-12-08-PREV March 2012This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with theCenters for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contentspresented do not necessarily reflect CMS policy
  • 2. Who is Primaris Founded in 1983 by the Missouri State Medical Association, Missouri Hospital Association and Missouri Association of Osteopathic Physicians and Surgeons Primaris serves as the federally-designated Quality Improvement Organization (QIO) for the state of Missouri. – Mission of QIOs: To improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Subcontractor with the Missouri Health Information Technology Assistance Center (MO-HIT) to assist providers in reaching Meaningful Use
  • 3. What do the following have in Common? Medicare Value-based Modifier Physician Quality Reporting System E-Prescribe Incentive Program Meaningful Use/EHR Incentive Program Patient Centered Medical Home Comprehensive Primary Care Initiative Accountable Care Organizations Medicare Wellness and Preventive Benefits
  • 4. Answer QUALITY = $$$
  • 5. Countdown
  • 6. #1: Value-Based Purchasing is a Reality Medicare Value-Based Purchasing is Required by Law ―Value‖ will be determined by both Cost and Quality – Cost: Total per capita and per capita costs for selected conditions – Quality: Medicare focus
  • 7. #2: Quality Will be Measured Using PQRS Individual Quality Measures – PQRS Cardiovascular Measures Group – MU Core and Alternate Core – Additional Measures for Chronic and Preventive Care GPRO Measures Future Measures: – More measures for Clinical Processes/Effectiveness and Population/Public Health, specialty – Functional Status, Care Coordination, Patient Safety, Efficient Use of health services
  • 8. #3: 2013 is a Pivotal Year for Reporting Base year for determining the VBM applied in 2015 MU Required to Avoid Penalty in 2015 – Years 2+ : MU for entire year 2013 – Year 1: Attest by 10/1/2014 for 90 day period PQRS required to avoid penalty in 2015 Performance on measures reported in 2013  $$$
  • 9. #4: e-Quality Measures are the Future of Reporting Measure Development is focused on using EHRs Data abstraction for manual reporting will become increasingly difficult Structured data capture is crucial Standard vocabularies are being required for use by all vendors to allow data exchange Vendors must be ―Qualified‖ to report PQRS or CQMs directly (―Qualified‖ is not the same as ―Certified‖)
  • 10. Sample e-Quality Measure Percent of patients age 18+ who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco User. Data Elements – Age (BD) - Visit Date (during reporting period) – Encounter Code - Tobacco User / Non User (screen done) – Counseling provided & Type – Date of Counseling – Pharmacotherapy (drug, dose, order) Logic—determines denominator & numerator, then combines for Performance Rate
  • 11. #5: Use Population Management and Rapid Cycle Improvement to Close Performance Gaps Run Population-based reports – Generate Baseline data and patient lists – Establish a team to address performance gaps Apply Rapid Cycle Improvement Methodology – Determine possible root cause(s) of performance gaps – Assign responsibility for improvement – Test small changes and re-measure for improvement – Implement successful changes practice-wide – Track your changes and results
  • 12. #6: Take Advantage of Opportunities to Increase Revenue Expanded Medicare Coverage for Prevention Services Annual Wellness Visit PQRS reporting bonuses through 2014; e-Rx 2013; Meaningful Use Medicare 2016/Medicaid 2021 Medicare Comprehensive Primary Care Initiative Patient-Centered Medical Home bonus payments for Medicaid and Privately-Insured Patients
  • 13. ResourcesPrimaris—Missouri’s Quality Improvement Organization– Sandy Pogones: spogones@primaris.org; 573-673-4531– Primaris.org; PQRSMO.orgCMS INFORMATION RESOURCES: http://www.cms.govMedicare Prevention Services Info for Physicians:http://www.cms.gov/PrevntionGenInfoMedicare Information for Patients:http://www.medicare.govMillion Hearts: http://millionhearts.hhs.gov/index.html
  • 14. Conclusion―The healthcare organization that seeks merely to meet minimal standards may not ever reach any higher, and certainly will not achieve excellence.‖ (Janet Brown, RN, CPHQ, The Healthcare Quality Handbook, 2010-2011)
  • 15. QUESTIONS?

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