Physician quality reporting in the USA

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Presentation given in Med-eTel 2011 -
Describing the Quality Reporting Initiative in the USA as a stepping stone towards full adoption of EHR in the USA.

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Physician quality reporting in the USA

  1. 1. Physician Quality Reporting Initiative (PQRI)<br />The stepping stone towards EHR adoption in the USA <br />Med@Tel April 2011<br />Roberto Schliesser<br />VP telemedicine Solutions<br />eWave MD<br />schliesser@ewavemd.com<br />
  2. 2. The Cost of Healthcare Is Destroying the Competitiveness of the U.S.A.<br />The Average cost of an MRI is $100 in Japan and $1,000+ in the U.S.<br />Source: World Health Organization<br />OECD 2005-2006 - CDC 2006 - CIA Fact Book 2007<br />2<br />
  3. 3. Bush and Obama Have Created The New World Order of Healthcare<br />3<br />
  4. 4. Winston Churchill<br />“The Americans will always do the right thing . . . After they've exhausted all the alternatives.”<br />4<br />
  5. 5. Kathleen Sebelius<br />Secretary of the Department of <br />Health and Human Services<br />“When electronic health records are well-designed and implemented correctly, they can be a powerful force for reducing errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction.” <br />5<br />
  6. 6. Dr. David Blumenthal <br />National Coordinator for H.I.T<br />“We need a system in place to be sure that patient information is where it’s needed. It is a core technical competence for physicians to know how to use an EHR.”<br />6<br />
  7. 7. 2000“To Err Is Human”Would You Fly if a 747 Crashed Every Day?<br />Centers for Disease Control and Prevention<br />American Cancer Society, Cancer Facts & Figures 2008<br />National Highway Traffic Safety Administration, Traffic Safety Facts, August 2010<br />To Err is Human, Building a Safer Health System By Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors. Committee on Quality of Healthcare in America, Institute of Medicine, National Academy Press, Washington, D.C. (2000) <br />
  8. 8. 2002McGlynn’s “U.S. Adults Receive 55% of Recommended Care”<br />Source: McGlynn, et. al., “The Quality of Health Care Delivered to Adults in the United States,” The New England Journal of Medicine, June 26, 2003: 2635-2645.<br />
  9. 9. President Bush’s Healthcare Legislation<br /><ul><li>Medicare Modernization Act of 2003 (MMA)
  10. 10. Mandatory hospital quality reporting
  11. 11. Deficit Reduction Act of 2005 (DRA)
  12. 12. Fee for Valueby 2014
  13. 13. 30% reduction in physician payments by 2014
  14. 14. Tax Relief and Health Care Act of 2006 (TRHCA)
  15. 15. Physician Quality Reporting Initiative (PQRI)
  16. 16. Medicare Improvements for Patients and Providers of 2008 (MIPPA)
  17. 17. eRx Incentive Program (Penalties)</li></li></ul><li>Baseline Best Medical Practice Quality Measures For Hospitals<br />
  18. 18. CMS Quality Initiative for Hospitals“The Hawthorne Effect”<br />92%<br />91%<br />70%<br />64%<br />2006<br />2003<br />2006<br />2003<br />CMS/Premier Hospital Quality Incentive Demonstration<br />
  19. 19. Dramatic Improvement in Surgery Related Infections Due to Checklist Measures Instituted by CMS in 2006-7<br />DR. ATUL GAWANDE on PBS NEWSHOUR: <br />In Michigan, when the -- every hospital there adopted a cleanliness checklist to keep infected lines from happening, they had a two-thirds reduction in infections within a year. They saved more than 1,500 lives and more than $200 million. Spreading this across the country multiplies that by 50-fold.<br />See the video and complete transcript here:<br />http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html<br />
  20. 20. CMS Hospital Quality InitiativeFrom Voluntary to Mandatory Reporting<br />Mandatory 2% payment deduction<br />Mandatory 0.4% payment deduction<br />13<br />
  21. 21. 2006Physician Quality Reporting Initiative (PQRI)<br />2%<br />1.5 %<br />Voluntary<br />
  22. 22. Reporting Methods<br />PQRI<br />Registry Based Reporting<br />Claim Based Reporting<br />Group Measure Reporting<br />Individual Measures Reporting<br />
  23. 23. PQRI Bonuses and Penalties<br />
  24. 24. 2009Medicare E-Prescribing<br />
  25. 25. PQRI and E-Prescribing Initiatives Are Getting Easier to Complete<br />2009<br />2010<br />PQRI Requirement<br />30 <br />Consecutive Encounters<br />PQRI Requirement<br />30 <br />Non-consecutive<br />Encounters<br />eRx Requirement<br />50% of Prescriptions<br />eRx Requirement<br />25 <br />Prescriptions<br />
  26. 26. Carrots and Sticks<br />PQRI Bonus<br />2% in 2009<br />PQRI Penalty<br />2012<br />ePrescribing Bonus<br />2% in 2009<br />ePrescribing Penalty<br />2012<br />ARRA Medicare Payments<br />$44,000 for 2011-2016<br />ARRA Medicare Penalty<br />2015<br />ARRA Medicare and Medicaid Payments<br />$44,000-$63,750 <br />for 2011-2016<br />
  27. 27. ‘Meaningful Use’<br />
  28. 28. $50,000,000,000+Of ARRA* Funding To Revolutionize Healthcare I.T. <br />Sections 3011-3016<br />Section 6001 and Titles I, XII<br />Sections 4101, 4102, 4201<br />Grants<br />$10 Billion<br />Entitlements<br />$42 Billion <br />For Healthcare Providers and Hospitals<br />For HIEs, Rural Broadband,<br />Regional Extension Centers,<br />Education and Training<br />*Title IV Health Information Technology for Economic and Clinical Health Act (HITECH) <br />
  29. 29. ELIGIBLE Professionals for Medicare or Medicaid EMR Funding of $44,000 to $63,750<br /><ul><li>Physicians
  30. 30. MD/DO
  31. 31. Podiatrist
  32. 32. Optometrist
  33. 33. Oral Surgeon
  34. 34. Dentist
  35. 35. Chiropractor
  36. 36. Therapists
  37. 37. Physical Therapist
  38. 38. Occupational Therapist
  39. 39. Qualified Speech-Language Pathologist
  40. 40. Practitioners
  41. 41. Physician Assistant
  42. 42. Nurse Practitioner
  43. 43. Clinical Nurse Specialist
  44. 44. Certified Registered Nurse
  45. 45. Anesthetist
  46. 46. Certified Nurse Midwife
  47. 47. Clinical Social Worker
  48. 48. Clinical Psychologist
  49. 49. Registered Dietician
  50. 50. Nutrition Professional
  51. 51. Audiologist</li></ul>ELIGIBLE professionals are defined by the Tax Relief and Health Care Act of 2006.<br />
  52. 52. ARRA Section 4101 – Up to $44,000 For Medicare Providers and Penalties<br />Assumes a Minimum of $25,000 of Medicare Part B Payments<br />Source: Avalere Health LLC<br />
  53. 53. Section 4201 — Up to $63,750 For Medicaid Providers<br />Assumes a Minimum of 30% of Medicaid or Underprivileged Patients*<br /> *20% for pediatricians ** Subject to reduction<br />This schedule also applies to eligible professionals in a Federally Qualified Health Center or Rural Clinic.<br />24<br />
  54. 54. Examples of “Meaningful Use”<br />Quality Reporting<br />ePrescribing<br />Medication Reconciliation<br />Availability of Lab Results<br />Interoperability<br />Certified by CCHIT*<br />Etc.<br />“Meaningful Use” Will Be Determined By Both the Federal Government and the States<br />*Certification Commission for Healthcare Information Technology <br />
  55. 55. Automated PQRI Reporting<br />Using the eHealth Made EASY Registry<br />
  56. 56. Login Screen<br />
  57. 57. Reporting Homepage<br />
  58. 58. Reporting Wizard #1<br />
  59. 59. Reporting Wizard #2<br />
  60. 60. Reporting Wizard #3<br />List of available codes is calculated relative to the selected QM settings<br />
  61. 61. Reporting Wizard #3<br />Rule Based engine calculates eligible QM for the encounter and patient, leading the provider in coding the PQRI<br />
  62. 62. Sample Compliance Report<br />
  63. 63. Thank you! <br />

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