Pathway for Rewarding Better Care II

P4P St. John’s Clinic Story • • • • Cultural changes PGP Demo description Practice modifications Results St. John’s Health System • # 20 among America’s Top 100 Health Systems (Verispan, February 2004) • Institute for Healthcare Improvements (IHI) National Recognition (March 2004) • Among Nation’s Top Ten Clinic for Patient Satisfaction (Press Ganey , February 2004) St. John’s Clinic • 509 Physicians, 42 specialties – PCP 199 – Specialists 310 • 150 mid-level providers and 2,000 coworkers • 70 sites in 35 communities • 1.4 million patient visits per year P4P Experience • Collaboration with hospital efforts • Four years of CMAP $4,000 – $13,000 • • • • Net operating income Patient satisfaction Length of stay Quality markers Provider Quotes “The right care, to the right patient, at the right time, every time” “To do the best, for the most, with what we have” “Crap! Another unfunded mandate” “All of my patients already get ____” PGP Demo Overview • Three-year project • Base Year 2004 • Project started April 1st, 2005 • Inflation and Risk adjustment formulas • Share what is saved, if quality measures are met Financial Details • Savings shared CMS=20% and PGP=80% (after 2 % threshold) • Savings capitated = 5% • Financial/quality payout * • Yr. 1=70/30 • Yr. 2= 60/40 • Yr. 3 = 50/50 *Total payout requires both financial performance and quality achievement Quality Measures • 32 Measures (Disease & Preventive) • Year One: Diabetic module & prevention (diabetic influenza and pneumococcal vaccinations) • Year Two: adds CHF and CAD modules • Year Three: adds HTN module and prevention (colorectal & breast cancer - population ) Quality Measures - First Year • DM-1 HbA1c Management • DM-2 HbA1c Control • DM-3 Blood Pressure Management • DM-4 Lipid Measurement • DM-5 LDL Cholesterol Level • DM-6 Urine Protein Testing • DM-7 Eye Exam • DM-8 Foot Exam • DM-9 Influenza Vaccination • DM-10 Pneumonia Vaccination Quality Measures - Second Year • HF-1 Left Ventricular Function Assessment • HF-2 Left Ventricular Ejection Fraction Testing • HF-3 Weight Measurement • HF-4 Blood Pressure Screening • HF-5 Patient Education • HF-6 Beta-Blocker Therapy Pt w/LVSD • HF-7 Ace Inhibitor Therapy Pt w/LVSD • HF-8 Warfarin Therapy for A. Fib/HF • HF-9 Influenza Vaccination • HF-10 Pneumonia Vaccination • CAD-1 Antiplatelet Therapy • CAD-2 Drug Therapy for Lowering LDL Cholesterol • CAD-3 Beta-Blocker Therapy – Prior MI • CAD-4 Blood Pressure • CAD-5 Lipid Profile • CAD-6 LDL Cholesterol Level • CAD-7 Ace Inhibitor Therapy Quality Measures – Third Year • HTN-1 Blood Pressure Screening • HTN-2 Blood Pressure Control • HTN-3 Plan of Care • PC-5 Breast Cancer Screening • PC-6 Colorectal Cancer Screening Operational Strategy • • • • EHR shortcomings Critical necessity for a patient registry Recognize the work involved Champion future direction P4P Strategies • Cost savings – CHF, hospice care, COPD, nursing home communication, avoid unnecessary admits • Measurable quality – Patient registry • Align incentives – CMAP changes – Business unit manager incentives Practice Modifications • Focused cost savings efforts • Education for appropriate coding • Patient registry – Data capture – Ad hoc reporting – exception lists – Corrective action Patient Registry Description • Developed in JAVA, Oracle Database, Webbased system on intranet • Features – Interfaces with existing billing and clinical systems – Tracks patient information, identifies gaps in care, ensures appropriate and timely care is provided – Security and HIPAA audit tracking compliant – Visit Planner – Ad hoc reporting Patient Registry Visit Planner • Contained within established workflow • “To do list” with that visit • Prints based on appointment schedule for that day Registry Reports • • • • “Current” exception list Ad hoc reporting Telephone Call Lists/Labels/Patient Letters Unblinded Provider and Clinic Outcomes Summaries Magnitude of Data Total Medicare database = > 60,000 • Diabetics = 8,857 • CHF = 6,070 • CAD = 14,000 Average number of annual visits • Diabetics = 6.07 • CHF = 6.39 • CAD = 4.83 Results St John's Clinic MCR MRR Diabetes Markers CY2004 and PGP Year Ending March 31, 2006 100.00% 91.55% 90.00% 80.00% 69.74% 70.00% 88.99% 91.23% 84.82% 81.36% 68.16% 67.48% 61.04% 65.01% 61.22% 61.05% 55.64% 60.00% 50.00% 52.56% 41.11% 48.99% 40.00% 30.00% 20.00% 10.00% 0.00% HbA1c Assessed HbA1c <9% Blood Pressure <140/90 mm Hg LDL Assessed LDL <130 mg/dl UPT Assessed Retinal Eye Exam Assessed Foot Exam Assessed Flu Vaccine Pneumonia Vaccine 18.92% 17.71% 3.41% 1.88% 2004 2005 target Conclusions • • • • • P4P experience “Best Practice” registry use Significant issues with financial rewards Cultural change toward measurable quality Needed industry infrastructure development PGP Demonstration Project “Better Care for Medicare” James T. Rogers, M.D. FACP