Transcript No Slide Title

Diabetes Physician Recognition Program
(DPRP)
May 2009
Session Agenda
• NCQA Overview
• NCQA Physician Recognition Programs
• DPRP Application & Survey Process
• P4P and Physician Recognition
DPRP Workshop
May 2009
2
A Brief Introduction
• NCQA is a private, independent non-profit
health care quality oversight organization founded in 1990
• NCQA is committed to measurement, transparency, and
accountability
• NCQA unites diverse groups around a common goal: improving
health care quality
MISSION
To improve the quality of health care
VISION
To transform health care through quality measurement, transparency,
and accountability
DPRP Workshop
May 2009
3
NCQA Achieving the Mission
• Over 800 plans report HEDIS® data to NCQA (Commercial,
Medicaid, Medicare, HMO/PPO)
• Over 250 commercial MCO plans are accredited by NCQA
• Over 75 Medicaid plans are accredited by NCQA
• Over 100 Medicare Advantage plans are accredited by
NCQA (more than any other accrediting body)
• Over 85.9 million patients are impacted through the plans
NCQA accredits
• Over 12,000 physicians are recognized nationally by NCQA
programs
DPRP Workshop
May 2009
4
NCQA Recognition Programs
Physician-Level Measurement
• Current programs: DPRP, HSRP, BPRP, PPC, PCMH
• What measures included: Structure, process and
outcomes of excellent care management
• Where they come from: partnership with leading national
health organizations
• Who rewards recognized physicians: many health plans
and coalitions of employers
• Who is recognized: over 12,000 physicians nationally
DPRP Workshop
May 2009
5
Number of Recognitions by State
(as of 1/31/09)
•WA
•ME
•ND
•MT
•OR
•SD
•ID
•WY
•N
V
•CA
•AZ
•CO
•IL
•KS
•NM
•WI
•OK
•MO
•IN
OH
•VA
•AR
•NJ
•DE
•MD
•G
A
•FL
•AK
•MA
•CT•RI
•N
C
•SC
•TN
•LA
•PA
•WV
•KY
•MS •AL
•TX
•NY
•MI
•IA
•NE
•UT
•VT
•NH
•M
N
•0 Recognitions
•1-25 Recognitions
•HI
•26-100 Recognitions
•101+ Recognitions
DPRP Workshop
May 2009
6
What is the DPRP application
and survey process?
DPRP Workshop
May 2009
7
DPRP Basics…
• Developed in partnership with American Diabetes
Association (ADA); released in 1997
• Voluntary program; non punitive
• Report only physicians who earn Recognition
• Use nationally recognized reliable, valid measures
DPRP Workshop
May 2009
8
2006 DPRP Adult Measures
•
Outcome Measures
– HbA1c Control <7.0%
– HbA1c Control >9.0%*
– Blood Pressure Control <130/80 mm Hg
– Blood Pressure Control ≥140/90 mm Hg*
– LDL Control <100 mg/dl
– LDL Control ≥130 mg/dl*
•
Process Measures
– Eye Examination
– Foot Examination
– Nephropathy Assessment
– Smoking Status and Cessation Advice or Treatment
* A measure of poor control
** Pediatric measures available
DPRP Workshop
May 2009
9
Improvement In Key Clinical Measures
% of adult patients with
7.5
10.9
15.8
Poor HbA1c Control* (>9.0%)
55.1
Good HbA1c Control (<7.0%)
44.1
33.8
75.4
BP Control (< 140/90 mm Hg)
64.1
56.4
83.8
``
LDL Control (<130 mg dl)
74.1
51.6
61.2
LDL Control (<100 mg dl)
45.3
26.7
0
20
40
1999
2002
60
80
100
2005
* Lower is better for this measure.
DPRP Workshop
May 2009
10
Who May Apply?
• An individual physician or a physician group
• To be eligible, applicants must:
– have a current, non restricted license as a doctor of
medicine (MD) or doctor of osteopathy (DO)
– provide continuing care to patients with diabetes
– have had face-to-face contact with and submit data on
a sample of patients with diabetes
DPRP Workshop
May 2009
11
What is the Process?
•
Review program information
-
•
www.ncqa.org/dprp
Purchase the “Diabetes Physician Recognition Package”
-
•
•
Review materials & sign Agreement
-
Standards and Guidelines
-
Agreement and BA Addendum
-
Data Collection Tool (an Excel® workbook)
Identify the patient sample
-
•
•
•
Package contains all the information needed to apply for Recognition
Patient sample must be identified using the DPRP patient selection methodology
or a random sample methodology approved in advance by NCQA
Abstract medical record data
Enter data in Data Collection Tool
Submit completed materials to NCQA
DPRP Workshop
May 2009
12
Guidelines for Identifying Patient Sample
• The patient sample must:
- be identified using the DPRP patient identification
methodology or a random sample methodology
approved in advance by NCQA.
- be selected across the entire patient population
regardless of the patient's method of payment (e.g.,
health plan, Medicare, Medicaid, employer, self-pay or
other payment mechanism.)
- include all eligible patients (i.e., eligible patients must
not be excluded from the sample).
DPRP Workshop
May 2009
13
Sample Size Requirement - Individual
Individual Physician
Sample Size
• 1 physician practicing in any
setting who provides continuing
care to patients with diabetes
• 25 patients per physician
Public reporting on Web Site
• Listed by individual names
DPRP Workshop
May 2009
14
Sample Size Requirement – Group A
Group A physicians
Sample Size *
•
•
An entity of 2 or more physicians:
– that have used detailed protocols
directly related to diabetes care for
at least 1 year
– that apply and monitor the
protocols across all physicians
– that provide feedback to physicians
regarding performance against the
protocols
•
At time of application, must submit
a letter that documents:
– diabetes management protocols
– date protocols instituted
– how physician compliance with
protocols is monitored
– how feedback on performance is
provided to physicians
A maximum of 200 patients as shown
in the table below:
Number of
Physicians in
Group
Sample Size
Requirement
2
50
3
75
4
100
5
125
6
150
7
175
8
200
9 or more
200
* If group operates more than one site every site
must contribute patients to the total sample.
Public reporting on Web Site
•
Listed by group or site name only
DPRP Workshop
May 2009
15
Sample Size Requirement – Group B
Group B physicians
Sample Size
•
•
An entity of 2 or more physicians:
– who practice at the same site
– who share responsibility for a
common panel of patients
– who do not use detailed protocols
directly related to diabetes care.
A maximum of 200 patients as shown
in the table below:
Number of
Physicians in
Group
Sample Size
Requirement
2
50
3
75
4
100
5
125
6
150
7
175
8
200
9 or more
200
Public reporting on Web Site
•
Listed by group or site name only
DPRP Workshop
May 2009
16
Identifying the Patient Sample
• Pick a “Start Date”
– an arbitrary date within the last 12 months
• Choose to go forward or backward from the start date to
identify eligible patients until the required sample size is
met
• An eligible patient:
-
is 5 years of age or older
•
•
-
pediatric patients 5 – 17 years
adult patients 18 – 75 years
has had a diagnosis of diabetes for at least 12 months
has been under the care of the applicant physician (or
physician group*) for at least 12 months
*Does not apply to physicians seeking individual recognition
DPRP Workshop
May 2009
17
Abstracting Medical Record Data
After identifying the patient sample, abstract
medical record data:
• for a12-month period going back from the last visit
date that occurred prior to the start date
• from medical record documentation (electronic or
paper), administrative data systems or registries to
identify required data elements
DPRP Workshop
May 2009
18
How to Identify Eligible Patients
Moving Backwards from Start Date - Step 1
Step 1
• Establish a "Start Date"
within the past 12 months
•
Example
• You select May 1, 2009
The start date is an
arbitrary date set at your
convenience
DPRP Workshop
May 2009
19
How to Identify Eligible Patients
Moving Backwards from Start Date – Step 2
Step 2
• Identify eligible patients
– On each day moving
backward from the start date,
consecutively evaluate each
patient for eligibility who were
seen at an office visit
– Select patients who meet the
3 eligibility requirements
– Identify eligible patients until
the required sample size is
met
Example
• Moving consecutively backward
from 5/1/09, you identify 25
eligible patients who had office
visits on the following dates:
Visit Date
Identified
as Eligible
Number of
Patients
identified
4/30/09
3
4/29/09
6
4/22/09
5
3/26/09
7
3/04/09
4
DPRP Workshop
May 2009
20
How to Determine the 12-month Abstraction Period
Moving Backwards from Start Date – Step 3
Step 3
Example
• Determine 12-month Abstraction
Period
– When moving backward from
the start date, the visit date
that a patient is identified as
eligible establishes that
patient’s 12-month abstraction
period
• 12-month abstraction periods for
the 25 patients identified :
– After determining each
patient’s 12-month abstraction
period, abstract data for care
completed for each patient in
the sample.
Visit Date
Identified
as Eligible
12-month
Abstraction Period
Number
of
Patients
4/30/09
4/30/09 – 4/29/08
3
4/29/09
4/29/09 – 4/28/08
6
4/22/09
4/22/09 – 4/21/08
5
3/26/09
3/26/09 – 3/25/08
7
3/04/09
3/04/09 – 3/03/09
4
DPRP Workshop
May 2009
21
How to Identify Eligible Patients
Moving Forward from Start Date – Step 1
Step 1
• Establish a "Start Date"
within the past 12 months
•
Example
• You select May 1, 2009
The start date is an
arbitrary date set at your
convenience
Attention
Moving forward is in “real-time”.
Patients are identified as they
present for an office visit.
DPRP Workshop
May 2009
22
How to Identify Eligible Patients
Moving Forward from Start Date – Step 2
Step 2
• Identify eligible patients
– On each day moving forward
from the start date,
consecutively evaluate each
patient for eligibility at the
time the patient presents for
an office visit
Example
• Moving consecutively forward
from 5/1/09, you identified 25
eligible patients who had office
visits on the following dates:
Visit Date
Identified
as Eligible
Number of
Patients
identified
– Select patients who meet the
3 eligibility requirements
5/05/09
3
5/07/09
6
– Identify eligible patients until
the required sample size is
met
5/18/09
5
6/04/09
7
6/11/09
4
DPRP Workshop
May 2009
23
How to Determine the 12-month Abstraction Period
Moving Forward from Start Date – Step 3
Step 3
Example
• Determine 12-month Abstraction
Period
– When moving forward from
the start date, the last office
visit prior to the start date
establishes the patient’s 12month abstraction period
• 12-month abstraction periods for
the 5 patients identified on
5/18/09.
– After determining each
patient’s 12-month abstraction
period, abstract data for care
completed for each patient in
the sample.
Start Date: May 1, 2009
Patient Identification Direction: Forward
Visit Date
Patients (5)
Identified as
Eligible
Visit Date
prior to
Start Date
12-month Abstraction
Period
5/18/09
12/31/08
12/31/08 – 1/1/08
5/18/09
4/17/09
4/17/09 – 4/16/08
5/18/09
4/03/09
4/03/09 – 4/02/08
5/18/09
1/1/09
1/1/09 – 12/31/08
5/18/09
2/4/09
2/04/09 – 2/03/08
DPRP Workshop
May 2009
24
Scoring of Measures
Scored Measures
Threshold
Weight
(% of patients in sample)
HbA1c Control <7.0%
HbA1c Control >9.0 %*
Blood Pressure Control <130/80 mm Hg
Blood Pressure Control >140/90 mm Hg*
LDL Control <100 mg/dl
LDL Control >130 mg/dl*
Eye Examination
Foot Examination
Nephropathy Assessment
Smoking Status and Cessation Advice or
Treatment
40%
15%
25%
35%
36%
37%
60%
80%
80%
80%
10.0
15.0
10.0
15.0
10.0
10.0
10.0
5.0
5.0
10.0
Total Points = 100.0
Points to Achieve Recognition = 75.0
* A measure of poor control
DPRP Workshop
May 2009
25
Data Abstraction
HbA1c Testing and Control
Proportion w/HbA1c > 9.0%*
Proportion w/HbA1c  7.0%
• Data elements
– Date and value of most
recent HbA1c performed
within the 12-month
abstraction period
(2-month grace period allowed)
• Tips
– To receive credit for the
measure of poor control,
no more than 15% of
patients can have HbA1c
results >9.0%
– May use date drawn or
date received
* A measure of poor control
DPRP Workshop
May 2009
26
Data Abstraction
Blood Pressure Measurement
Proportion >/= 140/90 mm Hg*
Proportion < 130/80 mm Hg
• Data elements
– Record date and value of
most recent blood
pressure measurement
performed within the 12month abstraction period
• Tips
– To receive credit for the
measure of poor control, no
more than 35% of patients
can have B/P
measurements >/= 140/90
* A measure of poor control
DPRP Workshop
May 2009
27
Data Abstraction
Lipid Control
Proportion w/LDL >/=130mg/dl*
Proportion w/LDL <100mg/dl
• Data element
– Record date and value
of most recent LDL
within the 12-month
abstraction period
• Tips
– To receive credit for the
measure of poor control,
no more than 37% of
patients can have LDL
results >/= 130 mg/dl
(2-month grace period allowed)
* A measure of poor control
DPRP Workshop
May 2009
28
Data Abstraction
Eye Exam or Retinal Photographs
• Data element
– Record date of most recent
dilated retinal exam or
retinal photograph
performed within the 12month abstraction period
• May use date within the
past two years if patient
showed no evidence of
retinopathy in the 12
months prior to the
abstraction period
• Tips
– Patient self-report is not
acceptable
– Use notes, reports, letters
or photographs from eye
care professionals
– If exam performed by a
non eye care professional
documentation must state
dilated exam
DPRP Workshop
May 2009
29
Data Abstraction
Foot Examination
• Data element
– Record date of most
recent foot exam within
the 12-month
abstraction period
(2-month grace period allowed)
• Tips
– May use notes, reports,
letters or assessments
from podiatrists, PCP or
your own examination
– Documentation must
support that feet were
examined with shoes and
socks off
DPRP Workshop
May 2009
30
Data Abstraction
Nephropathy Assessment
• Data Element
– Record date of most
recent nephropathy
assessment within the
12-month abstraction
period
(2-month grace period allowed)
• Tips
– Documentation must
include one of the
following:
– Microalbuminuria test
– Positive urinalysis for
protein
– Medical attention for
nephropathy
– Evidence of ACE/ARB
therapy
DPRP Workshop
May 2009
31
Data Abstraction
Smoking Status
• Data Element
– Document smoking
status
• Tips
– If there is documentation
that the patient is a nonsmoker, no further
documentation is
required
– Smokers: Record date
that documents smoking
cessation counseling or
treatment within the
abstraction period
DPRP Workshop
May 2009
32
Data Collection Tool
DPRP Workshop
May 2009
33
Data Submission
Materials to submit:
• Completed physician/physician group Application
Form
• Signed DPRP Agreement (2 copies)
– Includes Business Associate Addendum
• Completed Data Collection Tool
• Application fee
– Payable by check or credit card
DPRP Workshop
May 2009
34
What Happens Next?
• Within 30 days of receiving all information needed to
complete the application, NCQA reviews and makes
recognition determinations
– 5 percent of applications are randomly selected for
audit
• Physicians or groups achieving Recognition receive:
– letter of recognition
– posting to the Recognized Physician Directory
– certificate of recognition
– media kit/marketing and advertising guidelines
DPRP Workshop
May 2009
35
RECOGNITION: REWARDED IN MANY WAYS
Provider Directories
Network Entry
Financial Incentives
Specialty Board
Maintenance of Certification
Active Steering
To Recognized MDs
Data Collection
Assistance
DPRP Workshop
May 2009
36
(Examples of Current and Past Initiatives)
Recognition Program Rewards
Pay rewards and/or
applications fees
Distinction in
Provider
Directory
Help practices with
data collection
1. Aetna
BTE (KY, MA, OH,
NY)
2. BCBS Delaware
3. CareFirst
Oxford (NY)
United (4 areas)
4. CIGNA
5. GeoAccess
6. HealthAmerica
Use for network
entry
7. Humana
BCBS (SC)/
BlueChoice
BTE (KY, MA, NY, OH,
GA, CO)
CareFirst (DC-MDGA)
Actively steer
patients to
recognized MDs
BTE (KY, OH)
ConnectiCare
8. Lumenos
HealthAmerica (PA)
9. Medical Mutual (OH)
Oxford (NY)
10. MVP Healthcare
11. United
BCBS Alabama Alabama Health
Improvement
Initiative
Health First (FL)
Aetna, CIGNA,
Silicon Valley (CA)
United
DPRP Workshop
May 2009
37
Bridges to Excellence (BTE)
BTE Programs
NCQA Measure Set
Physician Activation
Cardiac Care Link
(CCL)
Heart/Stroke Recognition
Program (HSRP)
Up to $200 pcppy
Diabetes Care Link
(DCL)
Diabetes Physician
Recognition Program
(DPRP)
Up to $100 pdppy
Physician Office Link
(POL)
Physician Practice
Connection
Up to $50 pmpy
Spine Care Link (SCL)
Back Pain Recognition
Program
Up to $50 pscppy
DPRP Workshop
May 2009
38
DPRP Contact Information
• Mailing Address
NCQA
Diabetes Physician Recognition Program
1100 13th Street, NW, Suite 1000
Washington, DC 20005
• Customer Support
(questions on DPRP in general, purchasing the workbook, etc.)
1-888-275-7585
• DPRP Staff
(questions on sampling methodology, measures, etc.)
[email protected]
• Web
www.ncqa.org/dprp
DPRP Workshop
May 2009
39
NCQA would like to thank our Diabetes Physician
Recognition Program (DPRP) Sponsors
Founding Sponsor
Champion Sponsor
DPRP Workshop
May 2009
40