NCQA Back Pain Recognition Program: getting provider buy in

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NCQA Back Pain Recognition Program getting
provider buy in

• John M Ventura, DC
• Rochester Chiropractic Group, LLP
• University of Rochester School of Medicine
• New York Chiropractic College

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John M Ventura, DC, DABCO

• Rochester Chiropractic Group, LLP,
  owner/clinician
• Board certified, chiropractic orthopedics
• Recognized status, NCQA Back Pain Recognition
  Program
• Assistant clinical professor, New York
  Chiropractic College
• Clinical instructor, family medicine, University
  of Rochester School of Medicine
• Medical director of chiropractic, Excellus BC/BS
• Staff clinician, Mercy Outreach Center, free
  health clinic
• Director, Integrative Health Care Practice
  Resources, Inc.
• New York State Chiropractic Association, American
  Chiropractic Association, American Public Health
  Association
• Training in Total Quality Management and Lean Six
  Sigma

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The only purpose of the physician is to amuse
the patient while nature cures the disease
Voltaire
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What is Evidence Based Practice?

• Sackett, at McMaster University in the 1980s
  recommended that physicians
• Search and critically evaluate the available
  research to create a gold standard for patient
  care ie. current, best use of evidence in
  making decisions about care of the patient
• Villaneuva-Russell, Social
  Science and Medicine, 2005

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Patient values
Clinical expertise
Research evidence
Haynes and Sackett, 1996
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This is what one company calls
Evidence Based Care
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• The goal of science is not to reveal everlasting
  truth, but merely to erect a modest barrier to
  perpetual error. Thats all were trying to do,
  really, avoid perpetual error.
• 
  C Nelson,
  2006

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Best Practices Document/Process

• CCGPP, NCQA, Pay-For-Performance
• Incorporates best available evidence, clinical
  judgment and experience, patient values, co-
  morbidities, psychosocial, functional
  limitations, prior surgery, ergonomic issues, age
  of patient
• Goal is to improve quality, safety, cost, time,
  performance to best serve patient
• 
  Triano, CCGPP 2005

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Quality Improvement

• Total Quality Management
• Continuous Quality Improvement
• Six Sigma
• Lean Six Sigma
• DMAIC
• Define, measure, analyze, improve, control

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Getting Provider Buy In
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Incentives/Disincentives

• Incentives
• - higher reimbursement
• - reduced administrative burden
• - marketing/promotion
• Disincentives
• - lower reimbursement
• - more administrative burden
• - closer scrutiny

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What is an MD looking for in a DC?

• Evidence influenced (rational approach)
• Patient centered
• Safe
• Effective communication (send reports)
• Clinically effective by valid/reliable outcome
  measures
• Cost effective
• Don Levy, MD
  2006

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Rochester Experience

• Preferred Care HMO with 300,000 subscribers
• Medical director embraced NCQA standards
• DC panel pay the 450 application fee, offer
  training and support to panel on achieving
  recognition, reduce administrative burden

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Changing Providers Behavior

• Little change in provider behavior from didactic
  lectures but some evidence of moderate change in
  practitioners behavior from interactive
  workshops
• Grimshaw, 2006

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Provider Training

• PC offered provider training support
• Introductory seminar about NCQA BPRP
• Template for tracking data in daily notes
• Online video training
• Follow up meetings to discuss problems
• Consultants from UofR on NYS quit smoking
• Phone support
• Meeting to discuss data entering online Tool

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NCQA support

• NCQA Back Pain Recognition Program standards and
  guidelines document
• Paper version of online data collection tool
• BPRP training document
• NCQA 1-888-275-7585
• CustomerSupport_at_ncqa.org
• WebEx training

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ACA support

• American Chiropractic Association has embraced
  NCQA BPRP as means to improve the quality of
  chiropractic services patient centered and
  evidence based
• http//www.acatoday.org/content_css.cfm?CID2720
•  

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Documentation Issues

• Template for data collection
• Consensus regarding some tools ie. PHQ-9
• Imaging standards community based and NCQA
• Consensus regarding structural standards of
  education, patient satisfaction, improvement
  program

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Training Program index visit date

• http//app.talkfusion.com/talkFusionStudio/view.as
  p?303242_2170642

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Training Program template

• Name____________________________ M / F
  Initial visit date________________
  ________
•  
• Date of birth______________
• Oswestry Disability Index Score
  today__________ Pain today (at this
  moment)___________
•  
• Chief Complaint___________________________________
  ______________________________________
•  
• Region
•  
• Quality
•  
• Palliative factors
•  
• Provocative factors
•  
• Radiation of symptoms NO / YES___________________
  _____________________________________
• Radicular symptoms NO / YES__________________
  ______________________________________
•  
• Temporal constant / comes and goes
  date onset this
  episode_________________

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Imaging Not ordered by this office /
ordered by this office(see below) X-Ray
region____________ date___________
rationale____________________________________
MRI region____________ date___________
rationale____________________________________
CT region____________ date___________
rationale____________________________________
Non Smoker_____ Smoker______ _____packs
for ______years Advice to quit smoking
given to patient NO / YES and

Referral to smoking cessation program NO /
YES program____________________ Advice
given to resume normal activities early in course
of condition NO / YES Advice given to patient
to avoid bed rest for more than 4 days NO / YES
Advice on exercise (includes
stretch/strengthen/aerobic) Supervised exercise
program NO / YES date referred______________
_ Or
Home exercise advice NO / YES
date given___________ follow up
date________________


Patient Education
information given to patient YES / NO
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• Patient Experience Survey
  
  Date____________________
• We are very much concerned with making your
  experience within our office pleasant and
  successful for you.
• Please answer the following questions to rate
  your experience in our office.
• Regarding making your appointment in our office
• I was able to have convenient appointment time on
  convenient date
• I was able to have convenient appointment date
  but not convenient time
• I was not able to have convenient date nor time
  for my appointment but I am OK
• I was not able to have convenient time nor date
  for my appointment and I am upset
• Comments__________________________________________
  __________________________________________________
  __________________________________________________
  _____________________________
• 2. Regarding how well your doctor explained your
  condition to you

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Why apply for NCQA recognition?

• To improve patient care
• Differentiates you to public, peers and payors
  that you provide high quality patient centered
  care
• Listing in NCQA promotional materials (goes to
  health plans across USA)
• Higher reimbursement and/or fewer documentation
  obstacles to reimbursement
• Clear demonstration of competency, which is first
  step in achieving cultural authority (legitimacy
  and competency)

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• "A conclusion is the place where you got
  tired of thinking."

THANK YOU