Physician Office Breakout Session

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Physician Office Breakout Session
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8th Statement of Work Physician Practice

• Steve Cramer BS
• Bonnie Hollopeter LPN, CPHQ

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Objectives

• Describe the Doctor Office Quality -
  Information Technology (DOQ-IT) project.
• Discuss Cultural Competency educational
  opportunities in the Physician Office.
• Describe Ohio KePRO's role in Medicare Part D.

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Quality How Are We Doing?

• Institute Of Medicine Report 98,000 preventable
  deaths.
• Rand Study only 55 of patients receive
  recommended best practices.
• New England Journal of Medicine One quarter of
  outpatients have adverse drug events in a 3 month
  period.
• JAMA Clinicians are missing essential patient
  information at 13.6 of visits.

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Quality How Are We Doing?

• 7th SOW
• 485 Identified Providers
• Clinical Measures
• Biennial Mammography
• Annual Influenza Vaccination
• Pneumococcal Vaccination after age 65
• Annual A1c
• Biennial Lipid Profile
• Biennial Eye Exam

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Quality How Are We Doing
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Quality How Are We Doing
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Quality How Are We Doing
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Quality How Are We Doing
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Quality How Are We Doing
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Quality How Are We Doing
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What Can Help?

• In its Winter 2002 newsletter, the IOM documented
  abbreviated findings of its report Crossing the
  Quality Chasm. It called for a design of new
  systems that prevent, detect, and minimize
  hazards and the likelihood of error. They also
  wanted a system in which it is hard to make a
  mistake and easy to do the right thing.
• Information technology must play a central role
  in in the redesign of the of the healthcare
  system if a substantial improvement in quality
  and safety is to be achieved over the coming
  decade.

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In the Next 10 Years

• President Bush declares that the majority of
  Americans should be on electronic health records.
• To that end, Dr. David Brailer is appointed the
  National Health Information Technology
  Coordinator in July 2004.

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Quality Concerns IT DOQ-IT

• Doctors Office Quality-
• Information Technology
• Significant piece of the next CMS contract.
• QIOs Tasked to
• Promote adoption of EHRs.
• Promote workflow changes as related to population
  management/patient self management.
• Promote data reporting to a clinical warehouse.

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Data Reported on these Clinical Measures

• Chronic Disease Measures
• Diabetes
• CAD
• Heart Failure
• Hypertension
• Prevention Measures
• Blood Pressure Measures
• Cancer Screening
• Immunization
• General Preventive Measures
• Required submission to the QIO data warehouse

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Down the Road

• Pay for Performance
• BTE in Ohio Massachusetts.
• The Care Management Performance (CMS)
  Demonstration P4P 3-year pilot with physicians
  to promote the adoption and use of health
  information technology to improve quality and
  reduce avoidable hospitalizations for chronically
  ill patients.
• Public Reporting
• Hospitals
• Nursing Homes
• Home Health Agencies

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• What are QIOs doing to get ready for the DOQ-IT
  Initiative in the 8th SOW?

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Preparation Includes

• Staffing
• Stakeholder Partnerships
• Building Capacity
• Working with Pilot Sites
• Developing Information/Tools

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Are You Ready for DOQ-IT?

• Use any form of IT currently?
• Emotional, logical, and financial decision for an
  EHR.
• Budget
• IT Champions?
• Motivation
• Willingness to CHANGE! (NOT about making bad
  practices/habits faster!)

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Why Would I Want to be Part of DOQ-IT?

• Wholly funded CMS resources
• Vendor Selection
• Vendor Comparison Tools
• Vendor Questions
• Vendor Relationships
• Project Management
• Support for reporting and data submission
• Develop or strengthen your relationship with Ohio
  KePRO

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How Do I Become Part of DOQ-IT?

• CMS Application Process
• Practice Profile
• Workflow Assessment
• Agree to the DOQ-IT Time Lines and Parameters
• Receive Work Plan Workbook
• Sign Participation Agreement
• If You Are Committed To Us, We Are Committed To
  You!

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If Youre Not Convinced Yet

• EHR Functionality Helps You
• Reduce Transcription Costs
• Eliminate Defensive Down Coding
• 30,000/physician/year
• Manage Patient Populations To Help Keep Your
  Schedules Full/Gain Reimbursement
• Gain Efficiencies To Grow Practice (or just have
  more time!)
• Access From Home
• Access To Charts
• Proactive (Vioxx)

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What happens when we do not change the way we
think?
What the Home Computer was projected to look like
in 2004? How did they do?
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Timeframes

• 8th SOW- 8/05-8/08
• 5 of Primary Care Physician Practices
• Internal Medicine
• Family Practice
• Cardiology
• Endocrinology
• Effective timeframe of 24 months.
• We have a lot of work in a short period of time,
  and we look forward to working together.

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• Questions?

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8th Statement of Work

• Physician Practice
• Underserved Populations

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Physician Practice Underserved Populations

• To reduce healthcare disparities
• To increase the adoption of IT among physicians
  treating diverse populations
• To increase the adoption of CLAS standards in
  physician office practices
• To provide cultural competency training to
  individual physicians

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Physician Practice Underserved Populations

• Ohio Medicare Beneficiaries 1.8 m
• White 1.6 m 88.8
• Underserved
• (Non-White) 185,000 10.3
• Black 175,000 9.7
• Asian 5,500 0.3
• North Am Native 700 0.04
• Hispanic 4,000 0.2

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Physician Practice Underserved Populations

• Baseline Clinical Measures
• March 31, 2004
• Mammography 58.6
• Diabetes
• Annual A1c 79.5
• Biennial Lipid Profile 80.5
• Biennial Eye Exam 63.5
• Influenza Vaccination 34.3
• Pneumococcal Vaccination 32.0
• Combined Rates 58.1

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Physician Practice Underserved Populations

• DOQ-IT
• 11 of physician practices providing care to the
  underserved population

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Physician Practice Underserved Populations

• CLAS Standards
• Organized by themes
• Culturally Competent Care
• Language Access Services
• Organizational Supports for Cultural Competence
• Minimum of 20 and maximum of 50 practice sites

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Physician Practice Underserved Populations

• Cultural Competency Training
• Office of Minority Health (OMH) Module
• Web based or DVD
• 9 hours Category 1 AMA CME Credit
• http//ccm.thinkculturalhealth.org
• Minimum of 20 physician and maximum or 100
  physicians completing the modules

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Physician Practice Underserved Populations

• Why OMH Modules?
• Eliminate racial and ethnic health disparities
• Improve patient compliance
• Enhance patient satisfaction
• Enable physicians to work effectively in
  crosscultural situations
• Train physicians to provide culturally and
  linguistically appropriate care

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Physician Practice/Pharmacy Part D Benefit

• Medicare Modernization Act (MMA) of 2003
• Ohio KePRO to offer quality improvement
  assistance pertaining to prescription drug
  therapy to
• All Medicare providers and practitioners
• Medicare Advantage organizations offering
  Prescription Drug Plans (PDPs)
• Organizations offering PDPs

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Physician Practice/Pharmacy Part D Benefit cont.

• Information Acquisition and Outreach
• Quality Improvement Projects

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Physician Practice/Pharmacy Part D Benefit cont.

• Option 1 Improve prescribing using Part D data
• Use of avoidable drugs in the elderly.
• Frequency of selected, clinically important drug
  interactions.
• Generic prescribing ratios within certain
  therapeutic categories.
• Use of selected medications within certain
  therapeutic categories .
• Duplication of drugs in a therapeutic class.

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Physician Practice/Pharmacy Part D Benefit cont.

• Option 2 Improving patient self-management
  through medication therapy management services
  (MTMS)
• Medication management services
• Process measures
• Outcome measures

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Physician Practice/Pharmacy Part D Benefit cont.

• Option 3 Improving disease-specific therapy
  using integrated Part A, B, and D data
• Avoidance of specific drugs in beneficiaries with
  certain conditions (drug-disease interaction)
• Therapeutic monitoring for patients receiving
  specific drugs
• Option 4 QIO directed project

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Ohio KePRO Physician Practice Team Members
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8th SOW

• Questions?

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Publication No. 4031-OH-029-7/2005. This
material was prepared by Ohio KePRO, the Medicare
Quality Improvement Organization for Ohio, under
contract with the Centers for Medicare Medicaid
Services (CMS), an agency of the U. S. Department
of Health and Human Services. The contents
presented do not necessarily reflect CMS policy.