physician quality reporting in the usa
DESCRIPTION
Presentation given in Med-eTel 2011 - Describing the Quality Reporting Initiative in the USA as a stepping stone towards full adoption of EHR in the USA.TRANSCRIPT
Med@Tel April 2011Roberto Schliesser VP telemedicine SolutionseWave [email protected]
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 !