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Physician quality reporting in the USA
 

Physician quality reporting in the USA

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Presentation given in Med-eTel 2011 -

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 Physician quality reporting in the USA Presentation Transcript

    • Physician Quality Reporting Initiative (PQRI)
      The stepping stone towards EHR adoption in the USA
      Med@Tel April 2011
      Roberto Schliesser
      VP telemedicine Solutions
      eWave MD
      schliesser@ewavemd.com
    • The Cost of Healthcare Is Destroying the Competitiveness of the U.S.A.
      The Average cost of an MRI is $100 in Japan and $1,000+ in the U.S.
      Source: World Health Organization
      OECD 2005-2006 - CDC 2006 - CIA Fact Book 2007
      2
    • Bush and Obama Have Created The New World Order of Healthcare
      3
    • Winston Churchill
      “The Americans will always do the right thing . . . After they've exhausted all the alternatives.”
      4
    • Kathleen Sebelius
      Secretary of the Department of
      Health and Human Services
      “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.”
      5
    • Dr. David Blumenthal
      National Coordinator for H.I.T
      “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.”
      6
    • 2000“To Err Is Human”Would You Fly if a 747 Crashed Every Day?
      Centers for Disease Control and Prevention
      American Cancer Society, Cancer Facts & Figures 2008
      National Highway Traffic Safety Administration, Traffic Safety Facts, August 2010
      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)
    • 2002McGlynn’s “U.S. Adults Receive 55% of Recommended Care”
      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.
    • President Bush’s Healthcare Legislation
      • Medicare Modernization Act of 2003 (MMA)
      • Mandatory hospital quality reporting
      • Deficit Reduction Act of 2005 (DRA)
      • Fee for Valueby 2014
      • 30% reduction in physician payments by 2014
      • Tax Relief and Health Care Act of 2006 (TRHCA)
      • Physician Quality Reporting Initiative (PQRI)
      • Medicare Improvements for Patients and Providers of 2008 (MIPPA)
      • eRx Incentive Program (Penalties)
    • Baseline Best Medical Practice Quality Measures For Hospitals
    • CMS Quality Initiative for Hospitals“The Hawthorne Effect”
      92%
      91%
      70%
      64%
      2006
      2003
      2006
      2003
      CMS/Premier Hospital Quality Incentive Demonstration
    • Dramatic Improvement in Surgery Related Infections Due to Checklist Measures Instituted by CMS in 2006-7
      DR. ATUL GAWANDE on PBS NEWSHOUR:
      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.
      See the video and complete transcript here:
      http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html
    • CMS Hospital Quality InitiativeFrom Voluntary to Mandatory Reporting
      Mandatory 2% payment deduction
      Mandatory 0.4% payment deduction
      13
    • 2006Physician Quality Reporting Initiative (PQRI)
      2%
      1.5 %
      Voluntary
    • Reporting Methods
      PQRI
      Registry Based Reporting
      Claim Based Reporting
      Group Measure Reporting
      Individual Measures Reporting
    • PQRI Bonuses and Penalties
    • 2009Medicare E-Prescribing
    • PQRI and E-Prescribing Initiatives Are Getting Easier to Complete
      2009
      2010
      PQRI Requirement
      30
      Consecutive Encounters
      PQRI Requirement
      30
      Non-consecutive
      Encounters
      eRx Requirement
      50% of Prescriptions
      eRx Requirement
      25
      Prescriptions
    • Carrots and Sticks
      PQRI Bonus
      2% in 2009
      PQRI Penalty
      2012
      ePrescribing Bonus
      2% in 2009
      ePrescribing Penalty
      2012
      ARRA Medicare Payments
      $44,000 for 2011-2016
      ARRA Medicare Penalty
      2015
      ARRA Medicare and Medicaid Payments
      $44,000-$63,750
      for 2011-2016
    • ‘Meaningful Use’
    • $50,000,000,000+Of ARRA* Funding To Revolutionize Healthcare I.T.
      Sections 3011-3016
      Section 6001 and Titles I, XII
      Sections 4101, 4102, 4201
      Grants
      $10 Billion
      Entitlements
      $42 Billion
      For Healthcare Providers and Hospitals
      For HIEs, Rural Broadband,
      Regional Extension Centers,
      Education and Training
      *Title IV Health Information Technology for Economic and Clinical Health Act (HITECH)
    • ELIGIBLE Professionals for Medicare or Medicaid EMR Funding of $44,000 to $63,750
      • Physicians
      • MD/DO
      • Podiatrist
      • Optometrist
      • Oral Surgeon
      • Dentist
      • Chiropractor
      • Therapists
      • Physical Therapist
      • Occupational Therapist
      • Qualified Speech-Language Pathologist
      • Practitioners
      • Physician Assistant
      • Nurse Practitioner
      • Clinical Nurse Specialist
      • Certified Registered Nurse
      • Anesthetist
      • Certified Nurse Midwife
      • Clinical Social Worker
      • Clinical Psychologist
      • Registered Dietician
      • Nutrition Professional
      • Audiologist
      ELIGIBLE professionals are defined by the Tax Relief and Health Care Act of 2006.
    • ARRA Section 4101 – Up to $44,000 For Medicare Providers and Penalties
      Assumes a Minimum of $25,000 of Medicare Part B Payments
      Source: Avalere Health LLC
    • Section 4201 — Up to $63,750 For Medicaid Providers
      Assumes a Minimum of 30% of Medicaid or Underprivileged Patients*
      *20% for pediatricians ** Subject to reduction
      This schedule also applies to eligible professionals in a Federally Qualified Health Center or Rural Clinic.
      24
    • Examples of “Meaningful Use”
      Quality Reporting
      ePrescribing
      Medication Reconciliation
      Availability of Lab Results
      Interoperability
      Certified by CCHIT*
      Etc.
      “Meaningful Use” Will Be Determined By Both the Federal Government and the States
      *Certification Commission for Healthcare Information Technology
    • Automated PQRI Reporting
      Using the eHealth Made EASY Registry
    • Login Screen
    • Reporting Homepage
    • Reporting Wizard #1
    • Reporting Wizard #2
    • Reporting Wizard #3
      List of available codes is calculated relative to the selected QM settings
    • Reporting Wizard #3
      Rule Based engine calculates eligible QM for the encounter and patient, leading the provider in coding the PQRI
    • Sample Compliance Report
    • Thank you!