Medicare Pay for Performance Quality Indicators: A Tool to

1
Medicare Pay for Performance Quality
IndicatorsA Tool to Measure Performance Quality
in Ophthalmology Residents

• Meagan Celmer, Maria Lim, Nancy Awender, Deepak
  Edward
• The authors of this presentation have no
  financial interests to disclose

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Introduction

• Committee for Medicare and Medicaid services
  (CMS) adopted a Pay-for-Performance (P4P) program
• P4P creates a financial incentive for involved
  health care providers to practice Evidence Based
  Medicine 1-3
• Improved patient outcomes
• Increased quality of care
• Reduced cost
• 2 bonus to physicians who voluntarily report
• Measure could potentially provide a tool to
  measure the quality of care provided by residents
  and provide systems based practice education
• Such data for resident based clinics does not
  exist
• Aim of the project to determine if the
  ophthalmology resident clinic at Summa Health
  Systems meets quality indicators set forth by CMS
  for Pay-for-Performance and educate the residents
  of these guidelines

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Materials and methods

• This study was approved by the Summa Health
  Systems IRB
• Inclusion Criteria
• All patients meeting diagnostic criteria for
• Primary open angle glaucoma (POAG)
• Diabetic Retinopathy (DR)
• Age related Macular degeneration (ARMD)
• ICD -9 bill coding charges submitted in 2009 were
  used to determine which records met diagnostic
  criteria (via Decision Support reports)
• Exclusion criteria
• POAG if the patient had no appointment in 2009,
  received treatment prior to transfer of care to
  resident clinic (unable to determine
  pre-treatment IOP), eye disease managed by
  outside physician, no diagnosis of POAG on chart
  (ie. Glaucoma suspect), not on Treatment/ IOP
  wnl, secondary glaucoma
• DR/ARMD if the patient had no appointment in
  2009

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Materials and Methods

• Medical records were reviewed for the indicators
  derived from the American Academy of
  Ophthalmology, National Committee for Quality
  Assurance, Physician Consortium of Performance
  Involvement for POAG, DR, and ARMD (see Table 1)
• A goal compliance of at least 80 in accordance
  with standards set by CMS 4

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Table 1
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Results Percentage of Compliance with P4P
Indicators
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Results
Not Provided
Not Provided
Provided
Yes
Provided
Non specific education
No
Non specific education
ARMD Patient Education
POAG patient education
DR Communication with PCP
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Discussion

• Residents met quality indicators for
• POAG decreased IOP from pre-intervention levels
  or indicating plan of care
• DR/ ARMD performing a dilated eye exam with
  documentation
• The data reveals that residents did not meet an
  80 compliance for
• POAG counseling patients on the benefits/risks
  of treatment compliance
• DR document communication with the patient's PCP
• ARMD counseling patients on the benefits/risks
  of AREDS use
• An overwhelming number of patients were provided
  with non-specific education

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Discussion

• Recommended practices may have been performed but
  not documented
• Possibly the result of current chart template in
  the resident clinic
• Ways to improve documentation in order to meet
  quality indicators
• Create a new chart template that is more
  conducive to documentation
• Lecture residents on the P4P quality indicators
  and documentation
• Future use of electronic medical record to
  increase quality and efficiency of documentation
  5,6

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Discussion

• A recent study found that 34 of recently
  graduated ophthalmologists felt unprepared with
  their knowledge of insurance, billing, coding,
  and reimbursement
• Rated the most surprising aspect of practice
  ????? After residency
• Integration of P4P guidelines into the curriculum
  of residency
• This data can be used as a baseline in the future
  to assess
• The quality of care residents provide
• Meet RRC requirements
• Help guide residents as they embark into practice

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References

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• 4. Centers for Medicare and Medicaid Measures
  Codes for Physician Quality Reporting Initiative.
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  MeasuresCodes.asp. Accessed July 13, 2010
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  A study comparing the accuracy and speed of data
  retrieval from glaucoma patient records. Eye.
  2006 2080-3
• 7. McDonnell PJ, Kirwan TJ, Krinton GS, et al.
  Perceptions of recent ophthalmology residency
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