3/2/17. 2 Parts Today: Quality is increasingly important. Score More Points with Clinical Improvement Activities

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1 S029 Rewards and Awards: How to Make QI Pay off DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Score More Points with Clinical Improvement ivities Margo Reeder, MD Assistant Professor Director of Quality Improvement UWSMPH March 4, 2017 Margo Reeder, MD F039: Contact Allergens of the Year DISCLOSURES I do not have any relevant relationships with industry. 2 Parts Today: 1. MACRA and Practice Improvement 2. Quality improvement skills: Refresher Quality: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Institute of Medicine (IOM) Quality Improvement: Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Health Resources and Services Administration (HHS) Quality is increasingly important Who participates in Quality Payment Program? 1. Bill Medicare >$30,000 a year AND 2. See >100 Medicare patients a year Quality Payment Program Advanced APM MIPS 1

2 MIPS= Merit-based Incentive Payment System NOT FOR 2017 Start anytime between January 1, 2017 and October 2, 2017 Submit 2017 data by March 31, 2018 Improvement ivities In this new performance category for 2017, clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety. 2

3 What is Practice Improvement? Often more discrete Process analysis Essentially, Practice Improvement= Quality Improvement What are examples of Practice Improvement? Something you (probably) are already doing! Examples: Using telehealth services Collecting patient experience data Using reminders and outreach to contact patients regarding follow up Collecting patient information prior to the visit How do I participate in Improvement ivities? Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days. Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days. Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit. Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit. How do I participate in Improvement ivities? Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days. Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days. Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit. Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit. Points for Improvement ivities Medium: 10 points High: 20 points 15 or fewer MIPS providers: 20 points of practice improvement activities 16 or more MIPS providers: 40 points of practice improvement activities Improvement ivities: Categories Achieving Health Equity Behavioral and Mental Health Beneficiary Engagement Care Coordination Emergency Response & Preparedness Expanded Practice Access Patient Safety & Practice Assessment Population Management 3

4 What is a QCDR? QCDR Qualified Clinical Data Registry Previously used for PQRS reporting How to Report: All 92 practice improvement modules will be available in DataDerm for reporting Practice improvement is an attestation only 4

5 4 Parts of MOC I: Professionalism and Professional Standing II: Lifelong Learning and Self Assessment III: Assessment of Knowledge, Judgment, and Skills IV: Improvement in Medical Practice 4 Parts of MOC I: Professionalism and Professional Standing II: Lifelong Learning and Self Assessment III: Assessment of Knowledge, Judgment, and Skills IV: Improvement in Medical Practice ABD: Complete 2 practice improvement modules every 10 years Available PI Modules Appropriate timing of ophthalmologic screening for retinopathy in long-term hydroxychloroquine users Assessing for arterial disease and implementing compression for patients with venous leg ulcers Blood Thinner Management in Dermatologic Surgery Contraceptive education prior to starting isotretinoin Early assessment and intervention for infantile hemangiomas Importance of completing a delayed patch test reading Improved Melanoma Pathology Reporting Improving Adherence to Mohs Appropriate Use Criteria in Low-Risk Body Sites Improving genital lichen sclerosus detection in adult patients presenting with morphea Improving osteoporosis screening counseling and prevention for dermatology patients on chronic glucocorticoids More Modules Coming Soon! Improving pneumococcal vaccination counseling in dermatology patients prior to initiating biologic medications Improving smoking cessation efforts in patients with cutaneous squamous cell carcinoma Limiting oral antibiotic use to 3-6 months for treatment of acne Limiting use of topical and oral antibiotics in atopic dermatitis patients Reducing Potassium Monitoring in Healthy Young Women on Spironolactone Using Chemowraps for Chemoprevention of Nonmelanoma Skin Cancers in Solid Organ Transplant Recipients Using Retinoids for Chemoprevention of Nonmelanoma Skin Cancers in Solid Organ Transplant Recipients Utilization of imaging in melanoma (PQRS #224) Choosing a step in the Skin Biopsy Pathway to Assess in Your Office 5

6 3/2/17 Tools for Successful Practice Improvement How a typical QI Project begins... Patient presents for nbuvb Orders dose in computer Float nurse in clinic Software update Patient late to clinic Wrong dose given to patient New bulbs with dose adjustment 2 nbuvb machines Model for Improvement Choosing a Project Aim What are we trying to accomplish? Daily annoyances (often most satisfying) Measure Hospital metrics (multidisciplinary) How do we know that a change is an improvement? Sentinel events or error reporting system (Safety) Change What change can we make that will result in improvement? Dermatology quality measures Associates in Process Improvement Crafting an Aim Aim Writing an Aim What are we trying to accomplish? (specifically) How much? For whom? By when? Example: Schedule Mohs for 100% of patients with SCC on nose within 4 weeks by July 2017 Example: Decrease sun seeking behavior in our patients 6

7 n t confuse an Aim with your Mission Mission 1. Decrease biopsy follow up time Mission 2. Increase access to dermatology Aim 1. Results to patient within 10 days of biopsy for 90% of single lesions by July 2017 Aim 2. For changing pigmented lesion, see 90% of patients within 14 days by January 2017 Measurement How do we know we that a change is an improvement? Types of Measurements Outcome measures What are you trying to improve Process measures Variables that might affect your outcome measure Balance measures Change in one area of the system affecting another Outcome Measures Process Measures Balancing Measures Number of patients with biopsy site photo available at time of surgery Outcome Measures Process Measures Balancing Measures Outcome Measures Process Measures Balancing Measures Number of patients with biopsy site photo available at time of surgery Time of visit Extra time loading photos (electronic) Number of patients with biopsy site photo available at time of surgery Time of visit Extra time loading photos (electronic) Cost of camera Cost of camera 7

8 Outcome Measures Process Measures Balancing Measures Number of wrong site Number of patients with Time of visit surgeries biopsy site photo available at time of surgery Extra time loading photos (electronic) Cost of camera Changes How can we improve the system to achieve our aim? Change concepts Eliminate waste Improve work flow Optimize inventory Change environment Interface of customer/ producer Time management Minimize variation Limit error Change the product or service Model for Improvement Aim What are we trying to accomplish? Measure How do we know that a change is an improvement? Change What change can we make that will result in improvement? Associates in Process Improvement Team Who are the stakeholders? Examples: physicians, nurses, PAs, pharmacists, residents, medical students, schedulers, building maintenance PDSA cycle 8

9 AIM MEASURES CHANGES PDSA What question are we trying to answer? What are we trying to achieve? What happened? Measurements How did what happened compare with our plan? What is the next step? Think little: PDSA examples In reality. Aim: Biopsy site photo available for 95% of patients seen for NMSC surgery by June 2017 MD takes biopsy photos for 4 patients in a row before biopsy RN or MA in clinic takes biopsy photos for 4 patients in a row Delegate one RN to take photographs in clinic Test out new digital camera Maybe a secure iphone app? It s complicated. How can I learn more about QI/PI? Institute for Healthcare Improvement Open school Conferences AAD (here and online) Your institution 9

10 Take home points: Quality is increasingly part of the deal and there are resources to help you MACRA uses practice improvement for a portion of payment MACRA practice improvement requirements can be met with DataDerm or Part IV MOC Questions? Margo Reeder, MD mreeder@dermatology.wisc.edu 10