Avoidable Imaging Wave II. How MIPS, CPIA, CEDR metrics relate to E-QUAL Clinician Engagement in Avoidable Imaging Initiatives
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1 Avoidable Imaging Wave II How MIPS, CPIA, CEDR metrics relate to E-QUAL Clinician Engagement in Avoidable Imaging Initiatives
2 Presenters Dr. Jay Schuur Dr. John Sverha
3 Disclaimer The project described is supported by Funding Opportunity Number CMS-1L from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
4 Drive to Transform Clinical Practice
5 MACRA Timeline
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7 MIPS Credit 217 Emergency clinicians only to be measured on Quality and CPIA 15% % % 15% 85% Quality Clinical Practice Improvement Activities Resource Use Advancing Care Information
8 CPIA Activity Scoring Participation not Performance Activities High (2 points) Medium (1 points) Maximum Points 217: 4 points Future: 6 points
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10 Medium Value Activities (1 points each) Participation in EQUAL will satisfy IA_PSPA_19 IA_PSPA_18 IA_PSPA_16 IA_PSPA_17 IA_PSPA_2 IA_BE_14 IA_BE_21 IA_BE_12 IA_PSPA_4 Earn a total of 9 points by completing all 1-12 activities in the collaborative.
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13 engage emergency clinicians and leverage emergency departments to improve clinical outcomes, coordination of care and to reduce costs Improving outcomes for patients with sepsis Reducing avoidable imaging in low risk patients by implementation of ACEP s Choosing Wisely recommendations Improving the value of ED evaluation for low risk chest pain by reducing avoidable testing and admissions
14 5 Targets CT for minor head trauma CT for low risk suspected PE All imaging for low risk back pain CT for recurrent renal colic CT for syncope
15 Avoidable Imaging Wave II Over 35 EDs across the nation have joined! 1 month learning period (March December) Build upon Wave I offerings
16 Which ACEP Choosing Wisely recommendations is your ED either engaged in or interested in? Currently engaged in QI activities Interested in starting a QI activity Avoid CT of the abdomen and pelvis in young patients with recurrent renal colic Avoid lumbar imaging in patients with atraumatic low risk back pain without red flags Avoid chest CT imaging for PE in low pre-test probability patients with a negative D-Dimer or PERC rule Avoid CT imaging of the head in atraumatic syncope with a normal neurological exam Avoid CT imaging of the head for mild traumatic head injury meeting established clinical criteria 32% 69% 49% 53% 45% 57% 39% 63% 57% 45%
17 Which of the following QI approaches have been used in your ED? Provider-specific feedback reports on imaging utilization or appropriateness 64% Computerized decision support 21% Radiologist review or consultation for imaging 45% % 2% 4% 6% 8% 1%
18 Avoidable Imaging Wave II Activities Recruitment & Enrollment Enrollment Pledge Quality Readiness Assessment Survey Learning Period (1 months) Monthly Webinars, Office Hours Tool kit Publicize guidelines Disseminate CME Submit benchmarking data Wrap Up Data Reports Summary Report Lessons Learned ecme, MOC, MIPS credit
19 Updates on most recent imaging literature E-QUAL: Avoidable Imaging Toolkit Webinar/Podcast series Initiation & implementation of reducing avoidable imaging initiatives Latest developments in imaging diagnostics and treatment Quality Improvement guides from leading national experts
20 Monthly Activity Tracker
21 Monthly Activity Tracker
22 E-QUAL and MOC Part IV Credit E-QUAL will be listed on the ABEM drop down list of opportunities ED Director will need to be listed attesting that the individual participated in E-QUAL E-QUAL hopes to develop automatic credit soon E-QUAL and CME Credit All E-QUAL webinars/podcasts will be associated with ecme credit To obtain credit visit the E-QUAL homepage
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24 CEDR Goals CEDR seeks to accept patient data from practicing emergency clinicians in a registry seeking to: 1. Provide a unified method for ACEP members to collect and submit Physician Quality Reporting System (PQRS), MOC, OCC, Ongoing Professional Practice Evaluation (OPPE) data to meet quality improvement and regulatory requirements. 2. Promote the highest quality of emergency care for patients. 3. Demonstrate the value of emergency care. 4. Facilitate appropriate emergency care research.
25 CEDR: Qualified Clinical Data Registries (QCDRs) Data aggregator platform Utilize data from all sources (billing, EHR) for all patients Allows ACEP to develop clinically meaningful and feasible quality measures QCDR allows for Benchmarking reports in real-time CMS payment incentives TJC OPPE/FPPE Compliance MOC Part IV activities (in conjunction with ABEM)
26 Flavors of Data Registries Clinical Data Registries Manually Abstracted Data Research Focus PQRS Registries Claims-data Billing supported Qualified Clinical Data Registries EHR data Quality focused Hospital reporting Minimal payment incentive EP reporting PQRS focus EP and Group and Hospital reporting MIPS focus
27 Why use a QCDR (CEDR)? More measure options PQRS & Non-PQRS Measures ACEP developed measures in CEDR Electronic clinical quality measures All payer (not just Medicare beneficiaries) Pick measures before reporting Also meet TJC OPPE and ABEM MOC Part IV
28 Example Dashboard
29 How Do We Measure Quality? Donabedian Framework of Quality Measurement Structure Process Outcome PCI Capability Door to Balloon Time 3 day AMI Mortality
30 Clinician Engagement in Avoidable Imaging Initiatives John Sverha, MD, FACEP ED Director of Clinical Operations, Virginia Hospital Center Chief Value Officer, Emergency Medicine Associates
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33 How do you get clinicians engaged in your avoidable imaging initiative? Opportunities to encourage engagement can be described in relation to the phases below: 1) Initiative Development 2) Initiative Implementation 3) Initiative Sustainment
34 Engagement Strategies - Development Obtain feedback from your clinicians to determine which topics related to avoidable imaging to prioritize Clinicians often have a good sense as to where variability in practice patterns exist and where the greatest gaps exist between current practice and best practice
35 Engagement Strategies - Development Provide data on variability in resource utilization CHEST CT UTILIZATION Chest CT scans per 1 patients Consider also conducting survey to detect variability in response to standardized questions or scenarios
36 Engagement Strategies - Development Identify a champion or project lead preferably other than site director Allow all clinicians to provide feedback in imaging guideline development Clinician feedback allows confidence that their peers have vetted the guidance for their practice environment
37 Engagement Strategies - Implementation Consider targeted education at the time of go live Make sure the why is addressed when reducing avoidable imaging Radiation harm IV contrast harm Costs to patient/system Quality measure Length of stay Reassure clinicians that well-reasoned and documented variations from guideline acceptable Consider education to other ED stakeholders RN s and scribes
38 Engagement Strategies - Implementation Feedback to clinicians after implementation is encouraged Utilization of imaging resource Adherence to imaging guideline Imaging guideline adherence typically requires chart abstraction Data registry feedback option Manual chart audit option Clinicians can perform limited audits Audit burden limits sample size Performance results should be transparent
39 Engagement Strategies - Sustainment Periodic performance feedback allows continued engagement despite other competing initiatives and departmental priorities Incorporate imaging guidelines into orientation and onboarding of new clinicians Periodically review and revise your group s imaging guidelines to insure they continue to represent best practice Consider incorporating imaging guideline adherence into performance evaluations
40 Measuring Engagement
41 Summary Clinician engagement is necessary for successful implementation of your initiative to reduce avoidable imaging During guideline development, consider allowing providers to prioritize potential initiatives and allow them to have input in developing the imaging guideline During implementation, consider targeted education emphasizing the why behind the pathway and provide transparent feedback related to imaging resource utilization and guideline adherence Include periodic clinician feedback after implementation, orient new clinicians to imaging guidelines, and periodically revise imaging guidelines to sustain clinician engagement
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43 What's Next? Activate your E-QUAL portal Portal invites will be sent out by Friday Register for the April Webinar Questions? Contact the E-QUAL team at
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