Transcript Document

Medicare’s Physician Performance Agenda:
Understanding Next Steps and Shaping the
Future Course
Overview and Key Issues
Based on Invitational Working Session
February 28, 2007
Debra Ness
Co-Chair, Consumer-Purchaser Disclosure Project
President, National Partnership for Women & Families
Peter V. Lee
Co-Chair, Consumer-Purchaser Disclosure Project
CEO, Pacific Business Group on Health
Agenda For Meeting
• Welcome and Introductions
– Debra Ness, Disclosure Project and NPWF
• Overview of Physician Measurement: Opportunities and
Obstacles
– Peter Lee, Disclosure Project and PBGH
• Shaping Medicare’s Physician Quality Reporting Initiative
– Herb Kuhn, Acting Deputy Administrator for CMS
– Tom Valuck, MD, Director of Special Program Office of
Based Purchasing for CMS
Value-
• Building for the Future: Moving to Administrative Sources and
Electronic Health Records
– Marc Overhage, MD, Indiana Health Information Exchange
– David Bates, MD, Partners HealthCare System
• Advancing Medicare’s Physician Quality Reporting Initiative
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CMS’ Physician Quality Reporting
Initiative (PQRI): Why Care?
• Foundation for providing information to consumers,
physicians and to inform payment
• Directionally correct, but imperfect: will need a strong,
united consumer/purchaser voice to offset physicians’
criticisms
• Key opportunity to shape near-term (2008-2009)
physician performance transparency
• Real money at play: $300 million estimated payout for
2007 PQRI program; $1.35 billion set aside for 2008
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Cost Pressures: Health Care/Earnings Disconnect
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Quality Shortfalls: Getting it Right 50% of the Time
Adherence to Quality Indicators
75.7%
Breast Cancer
73.0%
Prenatal Care
Low Back Pain
68.5%
Coronary Artery Disease
68.0%
Hypertension
64.7%
Congestive Heart Failure
63.9%
Depression
57.7%
Orthopedic Conditions
57.2%
Colorectal Cancer
53.9%
Asthma
53.5%
Benign Prostatic Hyperplasia
53.0%
Hyperlipidemia
Adults receive about half
of recommended care
54.9% = Overall care
54.9% = Preventive care
53.5% = Acute care
56.1% = Chronic care
Not Getting
the Right
Care at the
Right Time
48.6%
Diabetes Mellitus
45.4%
Headache
45.2%
40.7%
Urinary Tract Infection
32.7%
Ulcers
Hip Fracture
22.8%
Alcohol Dependence
10.5%
0%
20%
40%
60%
80%
100%
Percentage of Recommended Care Received
Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New
England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645
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Each Point on This Graph Represents a Physician
Which Ones Would You Prefer to See?
2.00
1.80
Quality Index (higher is better)
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
Efficiency Index (higher is better)
Rattray MC, Andrianos J, Stam DT. Used with the permission of The Regence Group, Copyright 2006. All rights reserved.
For full presentation on Efficiency Performance Measurement given at Electronic Data Discussion Forum, go to:
http://healthcaredisclosure.org/docs/files/PhysicianEfficiency092906.ppt
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Physician Performance Information … The “Good”
Physician Information:
Basics:
• Specialty
• Board Certification
• Hours/Contact
Performance:
• Disease management
• Preventive Care
• Patient Experience
Reporting Issues:
• Transparency of “Target Rate”
• Almost all look “above
average”
• Combines practice site and
individual physician results
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Physician Performance Information … The “Bad”
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Physician Performance Information … The “Ugly”
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PQRI is part of the
“deal” between the
AMA and Congress
to fix the SGR
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What is PQRI?
• Prevented 5% cut in 2007 Medicare physician
payment
• Allows for up to 1.5% bonus on all Medicare billings
for eligible professionals
• Providers must report on at least 3 measures (or all if
less than 3 available) for bonus out of total of 74
measures
• Confidential performance reports provided to
participants
• For complete information go to:
www.cms.hhs.gov/PQRI
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General Questions for Consideration
• How does PQRI relate to other existing
initiatives (e.g., AQA and NQF measures,
BQI’s, health plans, etc.)?
• How will performance results be shared and
with whom?
• What are the next steps for moving physician
performance transparency forward?
• What physician measures can be generated
from claims? electronic health records?
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Future Directions from a Consumer
and Purchaser Perspective
• Support more robust performance measures
• Required public disclosure
• Move from “pay to report” to “pay for
performance”
• Move BEYOND pay-for-performance to
broader payment reform
• ENGAGE – comments to CMS for 2008-2009
PQRI; discuss with policymakers and key
stakeholders
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Potential Consumer and Purchaser
Input on 2008 and Beyond
•
•
•
•
•
Expanded measures
– Address full spectrum of care (safe, timely, effective, efficient, equitable, patientcentered)
– Competency vs. standards of care
– Cross-cutting measures that apply to all providers
– Provide important information to consumers and purchasers
Measure selection
– Establishing criteria for provider self-selection
– Increasing the number of measures required by CMS
Measure collection
– Move beyond claims to other electronic data (e.g., lab, pharmacy, EHR)
– Providers need to be equipped to include CPT-II codes and g-codes on claims
– Not all measures have developed CPT-II or g-codes
Public reporting of provider-specific results
Incentives
– Link meaningful and significant payment to performance (move beyond reporting)
– Increase the portion of funds allocated to performance-based payment over time to
reach a substantial portion of Medicare payment
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About the Disclosure Project
The Consumer-Purchaser Disclosure Project is a coalition more than 50 of the
nation’s leading consumer, labor, and employer organizations that are working
to advance publicly reported, nationally standardized measures of clinical
quality, efficiency, equity, and patient centeredness for health plans, hospitals,
medical groups, physicians, other providers, and treatments. The Disclosure
Project is supported by financial and in-kind support of participating
organizations and by financial support from the Robert Wood Johnson
Foundation.
Previous Discussion Forums are available at:
http://healthcaredisclosure.org/activities/forums/
Using Electronic Data to Assess Physician Quality and Efficiency – September
29, 2006
Provider Payments: How They Work, Implications for Cost & Quality, and
Creating a Consumer/Purchaser Policy Agenda – July 26, 2006
Cost/Price Transparency – May 25, 2006
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