National Committee for Quality Assurance (NCQA)  Physician Recognition Programs Colette Rush Quality Improvement Specialis...
Three Physician Recognition Programs <ul><li>Diabetes Physician Recognition Program (DPRP) </li></ul><ul><li>Heart/Stroke ...
Why the NCQA Recognition Programs are Important to the Alliance and DOH <ul><li>Advances and/or endorses tools and approac...
Recognition Encourages Practices to Transition by Adding a Population-based Focus and a Systems Approach to Improve Qualit...
Measurement  with  Systems Change Leads to  Sustained  Quality Improvement % of adult patients with Diabetes Physician Rec...
Why These Programs are Important for Physicians and Practice Groups <ul><li>Provides distinction </li></ul><ul><li>Enables...
Why NCQA Recognition is Important to Payers and Purchasers <ul><li>Drives quality and improved health, decreasing health c...
NCQA Physician Recognition  Program Features
<ul><li>Uses nationally recognized reliable, valid measures </li></ul><ul><li>Requires that the data is self-reported resu...
Who May Apply <ul><li>Individual primary care physicians OR physician groups </li></ul><ul><li>Specialists including: </li...
Patient Eligibility DPRP HSRP * See Standards and Guidelines for ICD-9 Codes for Diabetes and IVD Must meet all three requ...
Sample Size Requirements Data from medical records (electronic or paper), registries or administrative systems *  Alternat...
Diabetes Physician Recognition Program <ul><li>  Scored Measures  Threshold Weight </li></ul><ul><li>  (% of patients in s...
Heart/Stroke Physician Recognition Program <ul><li>  Scored Measures  Threshold   Weight* </li></ul><ul><li>  (% of patien...
Cost   $5 surcharge for every physician > 200 >200 $2,640  $2,640  10+ $2,640  $2,640  9 $2,640  $2,640  8 $2,640 (capped)...
Estimated Time Required for Recognition   Approximately 3-5 Months Total   *5% of applications randomly selected for audit...
Materials to Purchase and Download <ul><li>Access the DPRP or HSRP website at  www.ncqa.org/hsrp  or  www.ncqa.org/dprp </...
Enter Data Into Workbook <ul><li>Workbook is purchased from NCQA, by phone or at  www.ncqa.org/publication  for $60 </li><...
Support From the Department of Health <ul><li>Grants are available for some group and individual practices for application...
Contacts for Next Steps <ul><li>DOH:   To apply for a scholarship to assist with application fees </li></ul><ul><ul><ul><l...
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National Committee for Quality Assurance (NCQA)

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National Committee for Quality Assurance (NCQA)

  1. 1. National Committee for Quality Assurance (NCQA) Physician Recognition Programs Colette Rush Quality Improvement Specialist In collaboration with the Washington State Department of Health A Powerful Change Agent to Improve Quality and Affordability
  2. 2. Three Physician Recognition Programs <ul><li>Diabetes Physician Recognition Program (DPRP) </li></ul><ul><li>Heart/Stroke Physician Recognition Program (HSRP) </li></ul><ul><li>Physician Practice Connections (PPC) </li></ul>Recognition is for 3 years
  3. 3. Why the NCQA Recognition Programs are Important to the Alliance and DOH <ul><li>Advances and/or endorses tools and approaches that improve quality in the health care system </li></ul><ul><ul><li>Use of performance reporting to drive quality and affordability </li></ul></ul><ul><ul><li>Use of evidence-based measures and care </li></ul></ul><ul><ul><li>Use of the Chronic Care Model (CCM), a ‘systems’ approach </li></ul></ul><ul><ul><li>Use of registries and electronic medical records (EMRs) </li></ul></ul><ul><ul><li>Support of the work of the Washington State Collaborative </li></ul></ul><ul><ul><li>Use of recognition as an ‘aligned’ incentive </li></ul></ul>
  4. 4. Recognition Encourages Practices to Transition by Adding a Population-based Focus and a Systems Approach to Improve Quality Focus on individual patients only Evolution of Readiness Use of registries to care for individuals and populations of patients Use a systems approach to care, to improve quality based on clinical outcomes for populations of patients Apply for NCQA Recognition Infrastructure in place for continuous and consistent quality improvement
  5. 5. Measurement with Systems Change Leads to Sustained Quality Improvement % of adult patients with Diabetes Physician Recognition Program, average performance of applicants, 1999-2005 data
  6. 6. Why These Programs are Important for Physicians and Practice Groups <ul><li>Provides distinction </li></ul><ul><li>Enables practice against nationwide benchmarks </li></ul><ul><li>Encourages creation of ongoing ‘systems- driven’ quality improvement activities </li></ul><ul><li>Promotes excellence in patient care across all payer networks </li></ul><ul><li>Creates infrastructure for financial incentives (P4P), such as BTE </li></ul><ul><li>Supports what is important to patients (quality and affordability) </li></ul>
  7. 7. Why NCQA Recognition is Important to Payers and Purchasers <ul><li>Drives quality and improved health, decreasing health care costs, increasing employee productivity and decreasing sick days </li></ul><ul><li>Identifies best practices (best value) </li></ul><ul><ul><li>Recognize them </li></ul></ul><ul><ul><li>Reward them </li></ul></ul><ul><ul><li>Encourage members to choose them </li></ul></ul><ul><li>Provides infrastructure for P4P to drive practice change through aligned incentives </li></ul>
  8. 8. NCQA Physician Recognition Program Features
  9. 9. <ul><li>Uses nationally recognized reliable, valid measures </li></ul><ul><li>Requires that the data is self-reported resulting in physician confidence in the results </li></ul><ul><li>Defines ‘excellence’ in care through having to meet robust performance thresholds </li></ul><ul><li>Publicly recognizes physicians who meet criteria </li></ul><ul><li>Creates an infrastructure to reward recognized providers (financial and non-financial) </li></ul>NCQA Physician Recognition General Features
  10. 10. Who May Apply <ul><li>Individual primary care physicians OR physician groups </li></ul><ul><li>Specialists including: </li></ul><ul><ul><ul><li>Endocrinology for Diabetes Program </li></ul></ul></ul><ul><ul><ul><li>Cardiology for Heart in the Heart/Stroke Program </li></ul></ul></ul><ul><ul><ul><li>Neurology for Stroke in the Heart/Stroke Program </li></ul></ul></ul><ul><li>Applicants must have: </li></ul><ul><ul><ul><li>MD or DO license </li></ul></ul></ul><ul><ul><ul><li>Provided 12 months of continuing care to patients with ischemic vascular disease or diabetes </li></ul></ul></ul><ul><ul><ul><li>25 eligible patients </li></ul></ul></ul>
  11. 11. Patient Eligibility DPRP HSRP * See Standards and Guidelines for ICD-9 Codes for Diabetes and IVD Must meet all three requirements Under care of the applicant physician for at least 12 months Under care of the applicant MD or MD group for at least 12 months DX of ischemic vascular disease (IVD) for at least 12 months* Dx of Diabetes and/or notation of insulin or oral hypoglycemic/antihyperglycemic for at least 12 months* 18 yrs of age or older Pediatric patients 5-17 yrs of age Adult patients 18-75 yrs of age
  12. 12. Sample Size Requirements Data from medical records (electronic or paper), registries or administrative systems * Alternate methodology required for groups of 9 or more 200 200 8 or more* 175 175 7 150 150 6 125 125 5 100 100 4 75 75 3 50 50 2 35 25 1 HSRP DPRP Number of Physicians Sample Size  
  13. 13. Diabetes Physician Recognition Program <ul><li> Scored Measures Threshold Weight </li></ul><ul><li> (% of patients in sample) </li></ul><ul><li>HbA1c Control <7.0% 40% 10.0 </li></ul><ul><li>HbA1c Poor Control >9.0 %  15% 15.0 </li></ul><ul><li>Blood Pressure Control >140/90 mm Hg  35% 15.0 </li></ul><ul><li>Blood Pressure Control <130/80 mm Hg 25% 10.0 </li></ul><ul><li>LDL Control >130 mg/dl  37 % 10.0 </li></ul><ul><li>LDL Control <100 mg/dl 36% 10.0 </li></ul><ul><li>Eye Examination 60% 10.0 </li></ul><ul><li>Foot Examination 80% 5.0 </li></ul><ul><li>Nephropathy Assessment 80% 5.0 </li></ul><ul><li>Smoking Status and Cessation Advice 80% 10.0 </li></ul><ul><li>or Treatment </li></ul><ul><li>Total weight = 100.0 </li></ul><ul><li> Percent to Achieve Recognition = 75.0 </li></ul>
  14. 14. Heart/Stroke Physician Recognition Program <ul><li> Scored Measures Threshold Weight* </li></ul><ul><li> (% of patients in sample) </li></ul><ul><li>Blood Pressure Control <140/90 mm Hg 75 % 10.0 </li></ul><ul><li>Complete Lipid Profile 80% 10.0 </li></ul><ul><li>LDL Control <100 mg/dl 50% 10.0 </li></ul><ul><li>Use of aspirin or another anti-thrombotic 80% 10.0 </li></ul><ul><li>Smoking Status and Cessation Advice or 80% 10.0 Treatment </li></ul><ul><li> </li></ul><ul><li>Total weight = 50.0 </li></ul><ul><li> Points to Achieve Recognition = 40.0 </li></ul>*Partial points available – for this condition only
  15. 15. Cost $5 surcharge for every physician > 200 >200 $2,640 $2,640 10+ $2,640 $2,640 9 $2,640 $2,640 8 $2,640 (capped) $2,640 7 $2,100 $2,640 (capped) 6 $1,740 $2,190 5 $1,380 $1,740 4 $1,020 $1,290 3 $660 $840 2 $300 $390 1 Alliance/DOH Sponsored Program Discount Fee Schedule Application Fee Schedule # Physicians Applying for Recognition NCQA Workbook Price: $60 each (1 per site) & Cost of Staff Time
  16. 16. Estimated Time Required for Recognition Approximately 3-5 Months Total   *5% of applications randomly selected for audit, which extends time by 4-8 weeks   30 days* Granting of recognition 2-4 weeks Review, complete and submit materials variable, depending on number of MDs and staff resources Chart review, data pull and data entry 2-4 weeks Identify patient sample 4-8 weeks Research, training and preparation
  17. 17. Materials to Purchase and Download <ul><li>Access the DPRP or HSRP website at www.ncqa.org/hsrp or www.ncqa.org/dprp </li></ul><ul><ul><li>Purchase application package </li></ul></ul><ul><ul><li>Purchase the HSRP or DPRP workbook </li></ul></ul><ul><ul><li>Download and print “Quick Start” instructions </li></ul></ul><ul><ul><li>Download training calendar </li></ul></ul>
  18. 18. Enter Data Into Workbook <ul><li>Workbook is purchased from NCQA, by phone or at www.ncqa.org/publication for $60 </li></ul><ul><ul><li>Requires Microsoft Excel ( Office2000 version or later) </li></ul></ul><ul><ul><li>Enables user to collect and submit data for evaluation for recognition </li></ul></ul><ul><ul><li>Is non-refundable </li></ul></ul>
  19. 19. Support From the Department of Health <ul><li>Grants are available for some group and individual practices for application fees </li></ul><ul><ul><li>50% of funds will be awarded to apply for DPRP, 50% awarded to apply for HSRP </li></ul></ul><ul><ul><li>Grant process extends through June 30, 2007 </li></ul></ul><ul><li>Support is available to assist practices in pulling patient data from CDEMS (for practices who use CDEMS) </li></ul>
  20. 20. Contacts for Next Steps <ul><li>DOH: To apply for a scholarship to assist with application fees </li></ul><ul><ul><ul><li>Miriam Patanian, MPH </li></ul></ul></ul><ul><ul><ul><li>Heart Disease and Stroke Prevention Program Manager </li></ul></ul></ul><ul><ul><ul><li>Washington State Department of Health </li></ul></ul></ul><ul><ul><ul><li>360-236-3792 [email_address] </li></ul></ul></ul><ul><li>NCQA : For detailed information and training schedule www.ncqa.org/hsrp www.ncqa.org/dprp </li></ul><ul><li>Alliance : For interested providers to receive detailed presentation on what it takes to apply for recognition </li></ul><ul><li>Colette Rush, RN, BSN,CCM </li></ul><ul><li>Quality Improvement Specialist </li></ul><ul><li>206.448.2570, ext. 122 [email_address] </li></ul>

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