Physician Group Practice Demonstration
Performance Year 2 Quality Measures Results
AcademyHealth Annual Conference
Chicago, June 2009
Musetta Leung, Ph.D.
Michael Trisolini, Ph.D., M.B.A.
Gregory Pope, M.S.
John Kautter, Ph.D.
Sherry Grund, R.N.
Mary Schrader
Francis Landiza
IFMC
RTI International
www.rti.org
1440 Main Street ■ Suite 310 ■ Waltham, MA 02452-8414
Phone 781-434-1700 ■ Fax 781-434-1701 ■ E-mail: mleung@rti.org
RTI International is a trade name of Research Triangle Institute
Presentation Outline
• Quality Measures
• Data Collection and Measurement
• Quality Performance Targets
• Results
• Discussion
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PGP Demonstration Quality Measures
•
32 quality indicators in five ‘topics’
•
Based on Doctors Office Quality (DOQ) project
•
Developed by CMS, in conjunction with the National Committee
for Quality Assurance (NCQA) and the American Medical
Association (AMA)
•
Similar uses in other CMS operations:
– Medicare Care Management Performance (MCMP) demonstration
– Electronic Health Records (EHR) demonstration
– PGP option in Physician Quality Reporting Initiative (PQRI) (to be) proposed
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PGP Demonstration Quality Measures (cont.)
Diabetes Mellitus
Congestive Heart Failure
Coronary Artery Disease
Hypertension
& Cancer Screening
HbA1c Management
LVEF Assessment
Antiplatelet Therapy
Blood Pressure Screening
HbA1c Control
LVEF Testing
Drug Therapy for Lowering
LDL Cholesterol
Blood Pressure Control
Blood Pressure Management
Weight Measurement
Beta-Blocker Therapy – Prior
MI
Blood Pressure Plan of Care
Lipid Measurement
Blood Pressure Screening
Blood Pressure
Breast Cancer Screening
LDL Cholesterol Level
Patient Education
Lipid Profile
Colorectal Cancer Screening
Urine Protein Testing
Beta-Blocker Therapy
LDL Cholesterol Level
Eye Exam
Ace Inhibitor Therapy
Ace Inhibitor Therapy
Foot Exam
Warfarin Therapy
Influenza Vaccination
Influenza Vaccination
Pneumonia Vaccination
Pneumonia Vaccination
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Note: Claims based measures in italics
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PGP Demonstration Quality Measures (cont.)
Topic
Claimsbased
Measures
Chartbased
Measures
Total
Number of
Measures
Diabetes Mellitus (DM)
4
6
10
Heart Failure (HF)
1
9
10
Coronary Artery Disease (CAD)
1
6
7
Hypertension (HTN)*
0
3
3
Preventive Care (PC)*
1
1
2
7
25
32
Total =
* Not measured in Performance Year 2
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Data Collection
• Medicare claims data
– On all eligible assigned beneficiaries (~1,000 to ~6,000
patients)
• PGP-Performance Assessment Tool (PGP-PAT)
– Clinical record review:
• Minimum of 411 patient records
– Manual medical record review
– Importing from an electronic health record
• Claims/chart hybrid
– For improving scores on claims-based measures
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Calculating Quality Performance
For each measure:
Quality
performance =
Counts of Numerator hits
x 100%
Counts of Denominator hits

Denominator: All cases eligible for assessment for the measure
- Example: All patients with diabetes between the ages of 18 and 75

Numerator: All cases in the denominator that meet the intention of the measure (“YES” flags)
- Example: All patients with diabetes between the ages of 18 and 75 who had an HbA1c
test in the measurement year
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Quality Performance Targets and Scoring
Assessing Targets:
•
Performance target for each measure in Performance Year 2 is the lowest of:
(A) the higher of 75% compliance or the 2004 Medicare HEDIS mean; or
(B) the 70th percentile Medicare HEDIS level in 2004; or
(C) the quality improvement target
– A 10% reduction in the gap between the base year level for the measure and 100%
compliance
•
HEDIS results available for 8 of the 27 PY2 measures (5 DM and 3 CAD);
75% compliance and quality improvement target evaluated otherwise
Scoring:
•
Points earned: 4 points/claims-based measure; 1 point/chart-based measure
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Results: Quality Points Earned
Source: RTI International
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Results: Quality Measure Performance (DM)
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Source: RTI International
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Results: Quality Measure Performance (HF)
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Source: RTI International
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Results: Quality Measure Performance (CAD)
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Source: RTI International
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Results: Range of Change in DM Scores
from BY to PY2 across the 10 PGPs
60
50
Percentage points (%
40
30
20
10
0
-10
DM-1
DM-2
DM-3
DM-4
DM-5
DM-6
DM-7
DM-8
DM-9
DM-10
-20
Diabetes Quality Measures
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Source: RTI International
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Results: Range of Change in HF Scores
from BY to PY2 across the 10 PGPs
60
50
Percentage points (%
40
30
20
10
0
-10
HF-1
HF-2
HF-3
HF-4
HF-5
HF-6
HF-7
HF-8
HF-9
HF-10
-20
Heart Failure Quality Measures
Source: RTI International
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Results: Range of Change in CAD Scores
from BY to PY2 across the 10 PGPs
60
50
Percentage points (%
40
30
20
10
0
-10
CAD-1
CAD-2
CAD-3
CAD-4
CAD-5
CAD-6
CAD-7
-20
CAD Quality Measures
Source: RTI International
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Results: Number of PGPs Missing Diabetes
Targets from Base Year to PY2
Base Year
Performance Year 1
Performance Year 2
Number of physician group practices
10
9
8
7
6
5
4
3
2
1
0
HbA1c test
HbA1c
control
BP Mgt
LDL-C test
LDL-C
control
UPT
Eye Exam Foot Exam Flu Shot
Pneumo
Shot
Quality measures
NOTE: No PGPs missed any quality targets in the Heart Failure or Coronary Artery Disease
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Source: RTI International
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Summary
• Marked improvement in some process of care
quality indicators over baseline and over
comparison group
• Improvement may be attributed to various
practice redesigns
– Examples
• Several diabetes quality measures remain
challenging
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Limitations and Discussion
• Improvement due to better documentation and
reporting?
• Process measures only, outcomes less clear
• Burden on PGPs and CMS
• PGPs do not provide all the care for their assigned
beneficiaries
• Should quality measures reporting be risk adjusted?
• Reset quality targets?
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… Final Thoughts
• Quality of care measurement and reporting allows
practices to:
– evaluate their patterns of care
– improve care delivery and documentation, and
– track improvements over time
• Paying for increased quality of care may provide
additional resources or incentives for groups to
implement improvements
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