physician quality reporting in the usa

Med@Tel April 2011Roberto Schliesser VP telemedicine SolutionseWave MDschliesser@ewavemd.com

Physician Quality Reporting Initiative (PQRI)

The stepping stone towards EHR adoption in the USA

USA Germany Italy Japan Israel China

Health Care Costs $ 8,000 $ 3,500 $2,700 $ 2,700 $ 2,200 $ 100

% GDP 17% 10% 9% 8% 8% 4%

Life Expectancy 78 80 82 83 81 73

Smokers 20% 32% 22% 30% 24% 32%

Obesity 37% 14% 10% 4% 27% 4%

Ambulatory Visits/Capita 4 10 6 13 10 N/A

Gross National Income/Capita

$46,000 $34,000 $31,000 $34,000 $27,000 $5,000

Source: World Health OrganizationOECD 2005-2006 - CDC 2006 - CIA Fact Book 2007

The Average cost of an MRI is $100 in Japan and $1,000+ in the U.S.

The Cost of Healthcare Is Destroying the Competitiveness of the U.S.A.

2

Bush and Obama Have Created The New World Order of Healthcare

3

Winston Churchill

“The Americans will always do the right

thing . . . After they've exhausted all the

alternatives.”

4

Kathleen SebeliusSecretary of the Department of

Health and Human Services

“When electronic health records are well-designed and

implemented correctly, they can be a powerful force for reducing

errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction ”.

5

Dr. David Blumenthal National Coordinator for H.I.T

“We need a system in place to be sure that patient information is where it’s needed. It is a core

technical competence for physicians to know how to use an EHR”.

6

2000“To Err Is Human”

Would You Fly if a 747 Crashed Every Day?

U.S. Deaths/Year

Hospital Acquired Infections4 – 1.7 million 63,000Adverse Drug Events, Medical Errors4 35,000Traffic Accidents3 34,000Breast Cancer2 41,000AIDS1 15,000

1. Centers for Disease Control and Prevention2. American Cancer Society, Cancer Facts & Figures 2008 3. National Highway Traffic Safety Administration, Traffic Safety Facts, August

20104. To Err is Human, Building a Safer Health System By Linda T. Kohn, Janet M.

Corrigan, and Molla S. Donaldson, Editors. Committee on Quality of Healthcare in America, Institute of Medicine, National Academy Press, Washington, D.C. (2000)

2002McGlynn’s “U.S. Adults Receive 55% of Recommended

Care”

55

76

65

54

39

23

45

0

20

40

60

80

Overall BreastCancer

Hypertension Asthma Pneumonia Hip Fracture DiabetesM ellitus

Percent of Recommended Care Received

Source: McGlynn, et. al., “The Quality of Health Care Delivered to Adults in the United States,” The New England Journal of Medicine, June 26, 2003: 2635-

2645.

• Medicare Modernization Act of 2003 (MMA)–Mandatory hospital quality reporting

• Deficit Reduction Act of 2005 (DRA)–Fee for Value by 2014–30% reduction in physician payments by 2014

• Tax Relief and Health Care Act of 2006 (TRHCA)–Physician Quality Reporting Initiative (PQRI)

• Medicare Improvements for Patients and Providers of 2008 (MIPPA)–eRx Incentive Program (Penalties)

President Bush’s Healthcare Legislation

Baseline Best Medical Practice Quality Measures For Hospitals

CMS Quality Initiative for Hospitals“The Hawthorne Effect”

70%

92%

64%

91%

20062003 20062003

CMS/Premier Hospital Quality Incentive Demonstration

Dramatic Improvement in Surgery Related Infections Due to Checklist Measures Instituted

by CMS in 2006-7

DR. ATUL GAWANDE on PBS NEWSHOUR:

In Michigan, when the -- every hospital there adopted a cleanliness checklist to keep infected lines from happening, they had a two-thirds reduction in infections within a year. They saved more than 1,500 lives and more than $200 million. Spreading this across the country multiplies that by 50-fold.

See the video and complete transcript here:http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html

CMS Hospital Quality InitiativeFrom Voluntary to Mandatory Reporting

13

Number of Reporting Hospitals

434

1407

1952

41924043

Oct. 2003 Feb. 2004 May 2004 Oct. 2004 Mar. 2005 Oct. 2006

Mandatory 0.4% payment deduction

Mandatory 2% payment deduction

2006Physician Quality Reporting Initiative (PQRI)

020406080

100120140160180

Number of Quality

Measures

2006 2007 2008 2009 2010

1.5%

2%

Voluntary

Reporting Methods

PQRI

Registry Based

Reporting

Claim Based

Reporting

Group Measure

Reporting

Individual Measures Reporting

PQRI Bonuses and Penalties

Year Bonus Penalty

2010 2%2011 1%

2012 - 2014 0.5%

2015 -1.5%

2016 and forward - 2%

2009Medicare E-Prescribing

Year Bonus for Adopting Penalty for Not Adopting

2009 - 2010 2%2011 1%

2012 1% -1%

2013 0.5% -1.5%

2014 -2%

PQRI and E-Prescribing Initiatives Are Getting Easier to Complete

2009

PQRI Requirement

30 Consecutive Encounters

PQRI Requirement

30 Non-consecutiveEncounters

2010

eRx Requirement

50% of Prescriptions

eRx Requirement25

Prescriptions

Carrots and Sticks

PQRI Bonus2% in 2009

PQRI Penalty

2012

ePrescribing Bonus

2% in 2009

ePrescribing Penalty

2012

ARRA Medicare Payments

44,000$ for 2011-2016

ARRA Medicare Penalty2015

ARRA Medicare and Medicaid Payments

44,000$-63,750$ for 2011-2016

‘Meaningful Use’

$50,000,000,000+Of ARRA* Funding To Revolutionize

Healthcare I.T.

Grants10$ Billion

Entitlements42$ Billion

For Healthcare Providers and Hospitals

For HIEs, Rural Broadband,Regional Extension Centers,

Education and Training

Sections 3011-3016

Section 6001 and Titles I, XIISections 4101, 4102, 4201

*Title IV Health Information Technology for Economic and Clinical Health Act (HITECH)

ELIGIBLE Professionals for Medicare or Medicaid EMR Funding of $44,000 to

$63,750

ELIGIBLE professionals are defined by the Tax Relief and Health Care Act of 2006.

• Physicians

- MD/DO- Podiatrist- Optometrist- Oral Surgeon- Dentist- Chiropractor

• Therapists- Physical Therapist- Occupational Therapist- Qualified Speech-

Language Pathologist

• Practitioners- Physician Assistant- Nurse Practitioner- Clinical Nurse Specialist- Certified Registered

Nurse- Anesthetist- Certified Nurse Midwife- Clinical Social Worker- Clinical Psychologist- Registered Dietician- Nutrition Professional- Audiologist

ARRA Section 4101 – Up to $44,000 For Medicare Providers and Penalties

Source: Avalere Health LLC

Assumes a Minimum of $25,000 of Medicare Part B Payments

Adopt in2011

Adopt in2012

Adopt in2013

Adopt in2014

Failure to adopt by

2015

Failure to adopt by

2016

Failure to adopt by 2017

2011

$18,000

- - - - - -

2012

$12,000

$18,000

- - - - -

2013

$8,000 $12,000

$15,000

- - - -

2014

$4,000 $8,000 $12,000

$12,000

- - -

2015

$2,000 $4,000 $8,000 $8,000 -1% - -

2016

- $2,000 $4,000 $4,000 - -2% -

2017

- - - - - - -3%

Total $44,000

$44,000

$39,000

$24,000

-1% -2% -3%

24

Section 4201 — Up to $63,750 For Medicaid Providers

Current User

Adopt in 2011

Adopt in 2012

Adopt in 2013

Adopt in 2014

Adopt in 2015

Adopt in 2016

2011 $21,250

$21,250 ‐ ‐ ‐ ‐ ‐

2012 $8,500 $8,500 $21,250 ‐ ‐ ‐ ‐

2013 $8,500 $8,500 $8,500 $21,250 ‐ ‐ ‐

2014 $8,500 $8,500 $8,500 $8,500 $21,250 ‐ ‐

2015 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 ‐

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

2017 ‐ ‐ $8,500 $8,500 $8,500 $8,500 $8,500

2018 ‐ ‐ ‐ $8,500 $8,500 $8,500 $8,500

2019 ‐ ‐ ‐ ‐ $8,500 $8,500 $8,500

2020 ‐ ‐ ‐ ‐ ‐ $8,500 $8,500

2021 ‐ ‐ ‐ ‐ ‐ ‐ $8,500

TOTAL $63,750

$63,750 $63,750 $63,750

** $63,750

** $63,750

** $63,750 ** *20% for pediatricians ** Subject to reduction

This schedule also applies to eligible professionals in a Federally Qualified Health Center or Rural Clinic.

Assumes a Minimum of 30% of Medicaid or Underprivileged Patients*

• Examples of “Meaningful Use”

– Quality Reporting– ePrescribing – Medication Reconciliation– Availability of Lab Results– Interoperability– Certified by CCHIT*– Etc.

“Meaningful Use” Will Be Determined By Both the Federal Government and the

States

*Certification Commission for Healthcare Information Technology

Automated PQRI Reporting

Using the eHealth Made EASY Registry

Login Screen

Reporting Homepage

Reporting Wizard #1

Reporting Wizard #2

Reporting Wizard #3

List of available codes is calculated relative to the selected QM settings

Reporting Wizard #3

Rule Based engine calculates eligible

QM for the encounter and

patient, leading the provider in coding the PQRI

Sample Compliance Report

Thank you !