©PPRNet 2014 PRE-CONFERENCE WORKSHOP PPRNet 101. ©PPRNet 2014 INTRODUCTIONS Who you are Why you are here What you hope to learn

PPRNet2014 Annual Meeting

©PPRNet 2014

PRE-CONFERENCE WORKSHOP

PPRNet 101


©PPRNet 2014

INTRODUCTIONS

• Who you are

• Why you are here

• What you hope to learn


©PPRNet 2014

WORKSHOP GOALS

• To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”

– Introduce (or reintroduce) PPRNet and its mission– Provide an overview of PPRNet reports– Share examples of how practices use PPRNet

reports to achieve recognition and/or incentives– Allow time for participants to use reports and

network with one another


©PPRNet 2014

AGENDA

1:00pm-1:15pm IntroductionsVanessa Congdon

Andrea Wessell

1:15pm-1:30pm What is PPRNet? Andrea Wessell

1:30pm-2:00pm PPRNet Performance Reports and FAQs Vanessa Congdon

2:00pm-2:30pmUsing PPRNet Tools for Recognition and

Incentive ProgramsAndrea Wessell

2:30pm-2:45pm Break

2:45pm-3:00pmRecognition/Incentive Programs,

continuedAndrea Wessell

3:00pm-3:15pmPPRNet Top 10 List for Quality

ImprovementAndrea Wessell

3:15pm-4:00pmOpen Session

Demonstrations, Follow-up DiscussionsAll Participants


©PPRNet 2014

REVISE AGENDA?

1:00pm-1:15pm IntroductionsVanessa Congdon

Andrea Wessell

1:15pm-1:30pm What is PPRNet? Andrea Wessell

1:30pm-2:00pm PPRNet Performance Reports and FAQs Vanessa Congdon

2:00pm-2:30pmUsing PPRNet Tools for Recognition and

Incentive ProgramsAndrea Wessell

2:30pm-2:45pm Break

2:45pm-3:00pmRecognition/Incentive Programs,

continuedAndrea Wessell

3:00pm-3:15pmPPRNet Top 10 List for Quality

ImprovementAndrea Wessell

3:15pm-4:00pmOpen Session

Demonstrations, Follow-up DiscussionsAll Participants


©PPRNet 2014

WHAT IS PPRNET?

“A practice-based learning and research organization designed

to improve health care in its member practices and elsewhere

in the United States.”


©PPRNet 2014

WHAT IS PPRNET?

• Primary (care) Practices Research Network

• A virtual network of primary care practice teams and researchers that aims to:– Turn EHR data into actionable information for

clinicians and practice staff– Empirically test theoretically sound primary care

quality improvement interventions– Disseminate interventions that improve primary

health care


©PPRNet 2014

“Blur the distinction between quality improvement and

research”

PPRNET AIMS TO…


©PPRNet 2014

PPRNET: PRIMARY CARE PRACTICE-BASED RESEARCH AND

LEARNING NETWORK


©PPRNet 2014

PPRNET

Agency for Healthcare Research and Quality Center for Primary Care Practice-Based Research and Learning

– Answer questions relevant to practice– Disseminate findings


©PPRNet 2014

PPRNET RESEARCH

• Primary Care-Relevant Questions– “Preventive Services Delivery in Patients With Chronic

Ilnesses: Parallel Opportunities Rather Than Competing Obligations”

– “Learning from Primary Care Meaningful Use Exemplars”

• Translating Research into Practice (TRIP) Interventions– Impact studied across a variety of clinical areas

• Prevention, chronic disease management, acute care and medication safety

– A-TRIP, C-TRIP, SO-TRIP, MS-TRIP, AM-TRIP, CKD-TRIP…


©PPRNet 2014

PRACTICE SPOTLIGHT: NEW LONDON FAMILY MEDICINE

http://healthit.ahrq.gov/AHRQHealthITSuccessStoriesNemethVideo


©PPRNet 2014

DISSEMINATING “LESSONS LEARNED”

• Ongoing PPRNet Activities– Annual meetings– Monthly webinars– Listserv– Social media

• Publications • Presentations


©PPRNet 2014

PPRNET PERFORMANCE REPORTS

Practice-Level Performance Report Patient & Provider- Level Report


©PPRNet 2014

CLINICAL PRACTICE QUALITY MEASURES

MEASURE CONDITION#

Diabetes Mellitus 12

Cardiovascular Disease 17

Women’s Health Care 2

Cancer Screening 3

Immunizations 8

Mental Health & Substance Abuse 6

Respiratory Disease 4

Medication Safety 15TOTAL: 67


©PPRNet 2014

PRACTICE PERFORMANCE REPORT

67 Quality Indicators

3 Summary Measures

SPC Methodology

Time trends – Monthly over 2 years

Comparison with PPRNet benchmark (ABC)

Comparison with national benchmarks (when available)


©PPRNet 2014

PATIENT-LEVEL REPORT (PLR)

Excel Spreadsheet with 78 tabs:• PPRNet Switchboard• Practice Performance on Individual Measures• Provider Performance on Individual Measures• Patient Registry• PPRNet Measure Groupings (8 tabs)• Patient Lists of those not meeting criteria for

each of 67 Individual Measures

Same indicator criteria as practice report All “active” patients ≥ 3 months age


©PPRNet 2014

PPRNET SWITCHBOARD


©PPRNet 2014

PRACTICE PERFORMANCE ON INDIVIDUAL MEASURES


©PPRNet 2014

PROVIDER PERFORMANCE ON INDIVIDUAL MEASURES


©PPRNet 2014

PATIENT REGISTRY


©PPRNet 2014

CMS MU CQM


©PPRNet 2014

CMS ACO CQM


©PPRNet 2014

USPSTF RECOMMENDATIONS

(GRADE A AND B)


©PPRNet 2014

CDC ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES

RECOMMENDATIONS


©PPRNet 2014

NIAAA ALCOHOL SCREENING AND INTERVENTION RECOMMENDATIONS


©PPRNet 2014

CDC GET SMART TREATMENT GUIDELINES

FOR URI’S


©PPRNet 2014

CMS PQRS CQM GROUPINGS


©PPRNet 2014

PQRS DM TABAll Pts 18-75 with

DM


©PPRNet 2014

PQRS DM LIST


©PPRNet 2014

ACC/AHA CHOLESTEROL GUIDELINES FOR ASCVD RISK

REDUCTION


©PPRNet 2014

ACC/AHA CHOLESTEROL GUIDELINES FOR ASCVD RISK REDUCTION

HIERARCHICAL STATIN BENEFIT GROUPS

ADULTS >=21 years old

• Diagnosis of ASCVD (CHD or Atherosclerosis)

• Highest LDL-C >=190 mg/dL

• Diagnosis of Diabetes Mellitus; age 40-75 yr

• Estimated 10-yr ASCVD Risk >=7.5% age 40-75

yrs


©PPRNet 2014

ACC/AHA CHOLESTEROL GUIDELINES FOR ASCVD RISK REDUCTION

ESTIMATED 10-YR ASCVD RISK EQUATIONS

Age

Sex

Race

Total Cholesterol

HDL-CSystolic BP

Hypertension Dx

Diabetes Mellitus

Dx Smoking Status

Systolic BP

Hypertension Dx

Diabetes Mellitus Dx

Smoking Status


©PPRNet 2014

Q: WHAT DATA ARE USED FOR CALCULATING PERFORMANCE?


©PPRNet 2014

A (PART 1): REPORT GUIDE DETAILS DATA SOURCE FOR EACH MEASURE


©PPRNet 2014

A (PART 2): PPRNET MEASURES ARE NOW ALIGNED WITH MEANINGFUL USE CLINICAL

QUALITY MEASURES

• Applies to some new measures (ie, eye exam in patients with diabetes) and new categories (ie, ACO CQMs)

• Identifiers (ie, CMS id, NQF # or PQRS id) cited in reports


©PPRNet 2014

HOW DO I UPLOAD MY DATA EXRACT AND ACCESS MY REPORTS?

https://pprnetportal.musc.edu/

https://pprnetportal.musc.edu/


©PPRNet 2014

NEW DATA EXTRACT

• PP users will be migrating to a new extract process for October reports

• McKesson support for prxtract ends in October

• The MUSC OCIO has worked with us to develop a “vendor neutral” extraction process

• New reports will include patient identifiers!


©PPRNet 2014

SUMMARY: PPRNET REPORTS IN PRACTICE

• Evaluate performance over time• Identify patients overdue for care• Engage, motivate, and incentivize practice team• Demonstrate quality of care for quality recognition

and incentive programs


©PPRNet 2014

QUESTIONS






©PPRNet 2014

USING REPORTS FOR RECOGNITION AND INCENTIVE

PROGRAMS


©PPRNet 2014

RECOGNITION AND INCENTIVE PROGRAMS

• PPRNet practices use reports for a variety of local and national quality recognition and pay for performance programs

• During this session, we will highlight: – NCQA Patient-Centered Medical Home– CMS Physician Quality Reporting System


©PPRNet 2014

PPRNET 101: GLOSSARY

• NCQA• PCMH• CMS• PQRS• ABFM• PLR• SQUIDWhat is your experience with these recognition programs?

How has your practice benefited from recognition?


©PPRNet 2014

NCQA PCMH 2014 STANDARDS

• Published in March 2014 (must be used by March 2015)• Revisions to align with MU Stage 2, reflect PCMH

evidence base and from stakeholder input• Major edits in the areas of:

• Care management of high-need populations• Team-based care• Focus on triple aim domains (patient experience, cost, clinical

quality)• Sustaining transformation• Integration of behavioral health


©PPRNet 2014

NCQA PCMH 2014 Content and Scoring(6 standards/27 elements)

1: Enhance Access and Continuity A. *Patient-Centered Appointment AccessB. 24/7 Access to Clinical AdviceC. Electronic Access

Pts4.53.52

10

2: Team-Based CareA. Continuity B. Medical Home Responsibilities C. Culturally and Linguistically Appropriate

Services (CLAS) D. *The Practice Team

Pts32.5

2.54

12

3: Population Health Management A. Patient Information B. Clinical Data C. Comprehensive Health AssessmentD. *Use Data for Population ManagementE. Implement Evidence-Based Decision-

Support

Pts3445

4

20

4: Plan and Manage Care A. Identify Patients for Care ManagementB. *Care Planning and Self-Care SupportC. Medication ManagementD. Use Electronic PrescribingE. Support Self-Care and Shared Decision-Making

Pts44435

20

5: Track and Coordinate CareA. Test Tracking and Follow-UpB. *Referral Tracking and Follow-UpC. Coordinate Care Transitions

Pts666

18

6: Measure and Improve PerformanceA. Measure Clinical Quality PerformanceB. Measure Resource Use and Care CoordinationC. Measure Patient/Family ExperienceD. *Implement Continuous Quality Improvement E. Demonstrate Continuous Quality ImprovementF. Report PerformanceG. Use Certified EHR Technology

Pts3344330

20*Must Pass Elements

Scoring Levels Level 1: 35-59 points.Level 2: 60-84 points.Level 3: 85-100 points.


©PPRNet 2014

• Element 2D: The Practice Team• The practice uses a team to provide a range of patient

care services by:1. Defining roles for clinical and nonclinical team members 2. Identifying practice organizational structure and staff

leading and sustaining team based care3. Having regular patient care team meetings or a

structured communication process focused on individual patient care*

4. Using standing orders for services5. Training and assigning members of the care team to

coordinate care for individual patients

(continued)

PCMH 2: TEAM-BASED CARE


©PPRNet 2014

6. Training and assigning members of the care team to support patients/families/caregivers in self-management, self-efficacy and behavior change

7. Training and assigning members of the care team to manage the patient population

8. Holding regular team meetings addressing practice functioning

9. Involving care team staff in the practice’s performance evaluation and quality improvement activities

10. Involving patients/families/caregivers in quality improvement activities or on the practice’s advisory council

PCMH 2: TEAM-BASED CARE


©PPRNet 2014

• PPRNet Improvement Model as background

• Build team meeting agendas based on PPRNet reports, webinars or network meeting topics

• Use plans for Element 3D (Population Management) or 4A (Care Management and Support) to document responsibilities for team-based care

PPRNET TOOLS


©PPRNet 2014

• Element 3D: Use Data for Population Management (MUST PASS)

• At least two different preventive care services• At least two different immunizations• At least three different chronic or acute care

services• Patients not recently seen by the practice• Medication monitoring or alert

PCMH 3: PLAN AND MANAGE CARE


©PPRNet 2014

PPRNet Patient-level Report (PLR) includes lists of patients:

• With specific diagnoses• Needing preventive services,

including immunizations• Requiring clinician review or action• Taking specific medications

PCMH 3: PLAN AND MANAGE CARE


©PPRNet 2014

• Add narrative describing who does what

• Save examples of letters or chart flags

• Pick 2-3 areas to work on every quarter to “complete” all in 12 months

PPRNET TOOLS


©PPRNet 2014

• Element 4A: Identify Patients for Care Management • Systematic process and criteria for identifying

patients who may benefit from care management The process includes consideration of the following:1. Behavioral health conditions

2. High cost/high utilization

3. Poorly controlled or complex conditions

4. Social determinants of health

5. Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver

6. The practice monitors the percentage of the total patient population identified through its process and criteria*

PCMH 4: CARE MANAGEMENT AND SUPPORT


©PPRNet 2014

• Performance Reports • Use Summary Quality Index (SQUID)

as marker of “poorly controlled or complex conditions” – Define your practice’s target SQUID

• Patients that fall below this = patients that may benefit from care management

– Use a screen shot of PLR to document the number of patients that fall into this category

– Track this number (and % of total patients) – Design and implement care management

plan for Element 4B (MUST PASS)

PCMH 4: CARE MANAGEMENT AND SUPPORT


©PPRNet 2014

PCMH 6: MEASURE AND IMPROVE PERFORMANCE

“The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.”

A.Measure Clinical Quality PerformanceB. Measure Resource Use and Care Coordination

C.Measure Patient/Family Experience

D.*Implement Continuous Quality Improvement

E. Demonstrate Continuous Quality Improvement

F. Report Performance

G.Use Certified EHR Technology


©PPRNet 2014


• Element 6A: Measure Clinical Quality Performance

• At least annually, the practice measures or receives data on: – At least 2 immunization measures– At least 2 other preventive care

measures– At least 3 chronic or acute care

clinical measures– Performance data stratified for

vulnerable populations (to assess disparities in care)


©PPRNet 2014


• Element 6D: Implement Continuous Quality Improvement (MUST PASS)

• Ongoing QI process that includes regular review of performance data and evaluation of performance against goals or benchmarks to: – Set goals and analyze at least 3 CQM from A– Act to improve at least 3 CQM from A– Set goals and analyze at least 1 measure from B– Act to improve at least one measure from B– Set goals/analyze at least 1 patient experience measure from C– Act to improve at least one patient experience measure from C– Set goals and address at least one identified disparity in

care/service for identified vulnerable populations


©PPRNet 2014


• Element 6E: Demonstrate Continuous Quality Improvement

• Ongoing effort of assessing, improving and reassessing

• Emphasis on ongoing QI to demonstrate that practice has gone beyond setting goals – Measuring effectiveness of actions it takes to improve

measures selected in D– Achieving improved performance on at least 2 CQM– Achieving improved performance on one utilization or care

coordination measure– Achieving improved performance on at least one patient

experience measure


©PPRNet 2014


• Element 6F: Report Performance• Results reflect care provided to all patients in the

practice, not only patients covered by a specific payer and shares:– Individual clinician performance results with the practice– Practice-level performance results with the practice– Individual clinician or practice-level performance results

publicly– Individual clinician or practice-level performance results

with patients


©PPRNet 2014

• Use PPRNet reports to show how your practice measures clinical quality performance, implements QI, demonstrates QI and reports performance across:– Clinical processes

– Clinical outcomes



©PPRNet 2014

MORE ON PPRNET RESEARCH AND PCMH SATURDAY…

• Engaging patients in upcoming and planned projects as part of the “Practice Team” element


©PPRNet 2014

OTHER PCMH EXAMPLES

• What other ways have you applied PPRNet tools to PCMH work?

• How has your practice benefited from PCMH recognition?


©PPRNet 2014

BREAK


©PPRNet 2014

CMS PHYSICIAN QUALITY REPORTING SYSTEM (PQRS)

“A reporting program that uses a combination of incentive payments and payment adjustments to

promote reporting of quality information by eligible professionals (EPs).”

• Evolved from the Physician Quality Reporting Initiative (PQRI)

• Aims to reach 50% of EPs by 2015


©PPRNet 2014

PQRS

• Is this “old news”?

• Have you used PPRNet reports for this program in the past?


©PPRNet 2014

PQRS INCENTIVES/ADJUSTMENTS

• 2014: +0.5% of total estimated allowed charges for Medicare Part B Physician Fee Schedule during reporting period

• 2015: -1.5% based on 2013 participation• 2016-: -2% based on 2014 participation

• Additional +0.5% incentive with Maintenance of Certification Program participation


©PPRNet 2014

PQRS REPORTING MECHANISMS

• Claims

• Registry

• Qualified Clinical Data Registry (QCDR)

• Certified EHR Technology

• Group Practice Reporting Options

Stay tuned – PPRNet

will apply for 2015!


©PPRNet 2014

TAB IN PPRNET PLRAll Pts 18-

75 with DM


©PPRNet 2014


©PPRNet 2014

• PQRS is pay for reporting• See note regarding > 0% requirement for

full sample


©PPRNet 2014


©PPRNet 2014


©PPRNet 2014

USING PPRNET REPORTS FOR PQRS

• For 2014, use October 2014 PLR to fill out ABFM registry/report to CMS– ABIM diplomates, check PQRS page for other

registry options ($)

• For 2015, look for news of PPRNet becoming a Qualified Clinical Data Registry– More tomorrow!


©PPRNet 2014

PHYSICIAN COMPAREhttp://www.medicare.gov/physiciancompare/


©PPRNet 2014

PPRNET’S “TOP 10” LIST FOR QUALITY IMPROVEMENT


©PPRNet 2014

1. Identify a Clinician Leader


©PPRNet 2014

2.Use PPRNet reports to identify opportunities for improvement and monitor progress.


©PPRNet 2014

3. Select a limited number of priorities for improvement and build on incremental

successes


©PPRNet 2014

4. Adopt standing orders and have all staff function at the top of their licenses


©PPRNet 2014

5. Educate staff members as needed for their expanded roles


©PPRNet 2014

6. Hold regular practice “PPRNet meetings”


©PPRNet 2014

7. Use HM broadly and establish a practice goal to “get the red out”


©PPRNet 2014

8. Use PPRNet patient-level reports (PLRs) for patient case management and/or outreach.


©PPRNet 2014

9. Provide staff incentives for achieving improvement goals.


©PPRNet 2014

10. Participate in PPRNet projects and attend PPRNet meetings.


©PPRNet 2014

OPEN SESSION

“MAKING THE MOST” OF PPRNET


©PPRNet 2014

RECAP

• First time attendees, how many new acronyms have you learned today?

• “Refresher” attendees, what new thing(s) did you learn?


©PPRNet 2014

RECAP






©PPRNet 2014

OPEN SESSION

• Use your reports! Talk to each other!

– Identify patients for NCQA PCMH population management or care management standards

– Identify 1 or 2 areas for improvement from your practice report


©PPRNet 2014

AGENDA

5:30 pmHappy Hour

Rooftop at Vendue Inn, 19 Vendue Range

7:00 pmPresenters Dinner (Invitation only)

Blossom, 171 East Bay Street

Friday, August 22, 2014

7:15 am Breakfast & Registration

8:00 am Welcome

8:15 amPlenary: Improving the Quality of Primary Care

Through "Meaningful" EHR Use


©PPRNet 2014

FOLLOW-UP NEEDS ASSESSMENT

• Webinar topic suggestions

Documents

©PPRNet 2014 PRE-CONFERENCE WORKSHOP PPRNet 101. ©PPRNet 2014 INTRODUCTIONS Who you are Why you are here What you hope to learn