MESA COUNTY PHYSICIANS IPA 2017 INCENTIVE PROGRAM

Transcription

1 MESA COUNTY PHYSICIANS IPA 2017 INCENTIVE PROGRAM The 2017 Incentive Program for Mesa County Physician IPA (MCPIPA) is a crucial component of our Clinically Integrated Network. Participation in the Incentive Program is necessary for IPA members to contract through our Clinically Integrated Network. The active involvement of the IPA member physicians in the Incentive Program is essential and will contribute to successful contracting efforts for our Clinically Integrated Network. The 2017 MCPIPA Incentive Program is relevant to every specialty. The ongoing Incentive Program is designed to actively evaluate and modify the practice patterns of providers; to create a high degree of interdependence and collaboration; to help control costs; and, to ensure the quality of care provided to patients. There are three components to the Incentive Program: Quality Health Network (QHN) A fixed amount of $75,000 per quarter of the Incentive Pool will be paid to QHN to pay IPA physician monthly dues. The agreement with QHN has an annual cap of $300,000. The MCPIPA Board of directors will continue to determine whether to approve the payment to Quality Health Network (QHN) on a quarterly basis. Reward for Participation (R4P) A fixed amount of $75,000 of the Incentive Pool is allocated to fund the Quarterly R4P All Physician meetings. This includes covering the cost of the meeting, a flat rate payment of $350 to IPA Member Physicians for their attendance, and to help offset the cost of the $500 Minimum Threshold for the Incentive Measures (see page 4 for more details). Incentive Measures After funding QHN and the R4P meetings, the remaining dollars from the Incentive Pool are allocated and paid to those physicians who meet the requirements of the incentive measures. Three measures must be met to qualify for the 2017 incentive dollars. Funding The Incentive Program is funded in its entirety by IPA member physicians via a withhold from claims submitted for medical services provided to Rocky Mountain Health Plans (RMHP) Medicare, Commercial and CHP+ patients. Eight percent (8%) of the PAID amount of the claim is withheld and placed into the Incentive Pool. RMHP pays the withheld amount to MCPIPA on a quarterly basis. Disclaimer - Incentives are paid as indicated in the criteria described in this document and as determined by the Physician Incentive and Engagement Committee (PIE), in cooperation with the MCPIPA Board of Directors. The PIE Committee will determine the Incentive Program guidelines and the application of the guidelines to the particular situations. The PIE Committee, with approval of the MCPIPA Board of Directors, may make adjustments they deem necessary to reach the goals and objectives of the Incentive Program. The terms of the Incentive Program, can be changed or discontinued at the discretion of the MCPIPA Board of Directors. 1

2 INCENTIVE PROGRAM COMPONENTS QUARTERLY R4P ALL PHYSICIAN MEETINGS The R4P meetings are held quarterly at a local venue such as Two Rivers Convention Center or similar location. An agenda including discussion topics and meeting details will be sent to IPA member physicians in advance of each meeting. Meeting times: 5:30 6:00 Registration and Dinner 6:00 7:00 General Session 6:30 8:00 Breakout Sessions 2017 Schedule: Tuesday February 7, Q2017 R4P Quarterly Meeting Tuesday May 23, Q2017 R4P Quarterly Meeting Tuesday August 15, Q2017 R4P Quarterly Meeting Tuesday November 14, Q2017 R4P Quarterly Meeting Agenda Topics: We value your input and hope you will share ideas for discussion topics for the Quarterly R4P All Physician Meetings. The topic at each quarterly meeting may be a new subject or a further development of a prior topic if warranted based on interest expressed by the physicians. Please contact the IPA with your suggestions. Budget and Meeting Compensation The R4P budget is funded by allocating $75,000 of the total Incentive Pool each quarter. Under the R4P Program, MCPIPA member physicians will only be compensated for their attendance or presentation at the quarterly meeting. Attendance Compensation: MCPIPA member physicians who attend the R4P quarterly meetings will receive a flat rate of $350 per meeting. Policies and procedures for attendance have been developed by the IPA and are available to IPA members upon request. Presenter Compensation: MCPIPA member physicians who present a topic and lead the discussion will be compensated at the flat rate of $500. Physicians who are compensated as a Presenter will only receive the Presenter Compensation and they will not receive the Attendance Compensation. 2

3 INCENTIVE MEASURES The MCPIPA Incentive Design Team, composed of IPA member physicians from both primary and specialty care, worked with the IPA Executive Director and Clinical Program Coordinator to design the MCPIPA 2017 Incentive Program. Once the Incentive Measures were identified and developed, they were vetted through the Executive Committee and the Physician Incentive and Engagement Committee (PIE) and approved by the MCPIPA Board of Directors. The IPA Board, Executive Committee and PIE Committee are comprised entirely of IPA member physicians. IPA Member Physicians must complete three of the four required Incentive Measures each quarter to be eligible to receive Incentive payments for the completed Measures. IPA member physicians who meet the requirements of the Measures will receive the pre-determined value amount stipulated in the written detail of the Measure. For example, the Technology Measure is valued at 10% and, if the physician meets the requirements of this measure, he/she will receive 10% of his/her contribution to the Incentive Funds. Distribution of Incentive Funds IPA Member Physicians who complete the required Incentive Measures will be eligible to receive the Incentive Pool distributions for that measure. Conversely, physicians who do not complete the required Measures will not be eligible to receive the compensation for that Incentive Measures. The Incentive Measure payments will be distributed quarterly to those who meet the required benchmarks for each quarter. The amount each physician contributes to the Incentive Pool varies widely because it is eight percent (8%) of the physician s Paid Amount which is the amount paid to the physician by the health plan after patient responsibility is deducted. Effectiveness of the Incentive Measures This wide variability in the amount available for the physician to earn could impact the effectiveness of the general Incentive Measures. Because the individual physician contributions to the Incentive Pool vary each quarter that would mean that the earned value of the incentives measures also vary. For example: Physician A contributed $51.00 to the Incentive Pool. The Technology Measure is weighted at 10%, resulting in a payment to Physician A of $5.10 if the measure is met. The two Quality Measures, each weighted at 45%, would pay $22.95 per measure, if the measures are met. Physician B contributed $7, to the Incentive Pool. The Technology Measure, is weighted at 10%, resulting in a payment to Physician B of $ if the measure is met. The two Quality Measures, each weighted at 45%, would pay $3, per measure, if the measures are met. In November 2016, the IPA general membership approved the establishment of a $500 Minimum Threshold to more effectively incentivize all IPA members to participate in our incentive program. Effective with distribution of the 1Q2017 Incentive Program (estimated to be May of 2017), the methodology used will be a Modified Net Pro-Rated Basis. The Modified Net Pro-Rated Basis method allows for those physicians whose contribution to the Incentive Pool is less than $500 to be brought up to a minimum threshold of $500 before the payment of the quarterly incentive distribution is calculated. 3

4 Funding of the $500 Minimum Threshold The funding of the $500 Minimum Threshold will come from the following sources: 1. Funds from Non-IPA Physicians. The first source of funding for the $500 Minimum threshold is from physicians who are not members of MCPIPA. Each quarter when Rocky Mountain Health Plans collects the data and calculates the amount to be paid to MCPIPA for the 8% Incentive Plan Fund, the amount received includes dollars from physicians who are NOT members of MCPIPA. Typically, these physicians are those who provide coverage for MCPIPA member physicians. Though we have tried, it is too administratively burdensome for RMHP to reconfigure this allocation to MCPIPA. The dollars from Non-IPA physicians varies each quarter. 2. R4P Meeting Attendance. Another source of funding for the $500 Minimum Threshold is from the R4P allotment. Payment for attendance at the Quarterly R4P All Physician meetings will be capped at a flat rate of $350 per meeting per physician. Previously the R4P meeting attendance compensation was calculated by subtracting the cost of the facility, food, presentations (when done) and supplies from the $75,000 budget. The remaining balance was then shared equally with those physicians who attended the meeting. The $500 Minimum Threshold also subtracts the cost of the facility, food, presentations (when done) and supplies from the $75,000. Physicians who attend the Quarterly R4P meetings will receive a flat rate of $350 per meeting and the remaining balance will be used to help fund the $500 Minimum Threshold. If needed, an optional source of funding for the $500 Minimum Threshold is the Bonus Pool. Bonus Pool. The Bonus Pool is funded by those physicians who do not participate in or meet the incentive measures. Historically, this amount of dollars is shared on a pro-rated basis with those physicians who meet the incentive measures. In the event that the funds from Non-IPA Physicians and the change in R4P Meeting Attendance do not provide enough dollars to fund the $500 Minimum Threshold any additional monies needed would come from the Bonus Pool. The remaining funds in the Bonus Pool will be shared on a pro-rated basis with those physicians who met the incentive measures. Conversely, any overage from the Non-IPA Physicians and the funds available through the R4P Meeting Attendance will be included in the Bonus Pool and shared, on a pro-rated basis, with those physicians who met the incentive measures. Other Parameters for the $500 Minimum Threshold: In no event would the threshold be allowed to use more than 10% of the General Incentive Fund. The $500 threshold is the total amount paid, and it is only paid when the member meets the measures and would otherwise receive less than $500/quarter. The amount already contributed by the physician to the General Incentive Fund would be included in the $500 threshold and not in addition to it. For example, if a physician earned $53.00 for the quarter and if they meet the measures they would earn $500.00, and not $ The Physician Incentive and Engagement Committee, with direction from the Executive Committee and the Board of Directors, will oversee the distributions and make decisions on the details as needed. 4

5 2017 MCPIPA INCENTIVE MEASURES ADMINISTRATIVE MEASURE Technology Completed at Practice Level Goal: to capture data that could be used to identify improvement opportunities for our Clinically Integrated Network. The areas of focus are on clinical outcome and access measures. Outcome Measure: The outcome of the 2017 Technology Measure will be to assimilate data collected from practice which will be used to identify quality opportunities for the 2018 Incentive Program. Goals of the 2018 program will include population health management projects and improving access to care. Includes: All Primary Care and Specialty Practices Value: 10% of total o Benchmarks 1Q2017: Complete submission of practice dashboard for quality reporting as reported for PQRS, CPC or ACO programs for the calendar year This reporting will be at the practice level and will meet the benchmark for all physicians who report dashboard data o Submit attached Questionnaire to MCPIPA by April 30, Q2017: Complete attached Questionnaire to identify Third Next Available new patient appointments. o Submit attached Questionnaire to MCPIPA by July 31, Q2017: Complete attached Questionnaire to identify practice readiness on CMS Quality Payment Program options. o Submit attached Questionnaire to MCPIPA by October 31, Q2017: Complete PDSA cycle on opportunity identified from 3Q2017 Questionnaire. o Submit attached PDSA to MCPIPA by January 31,

6 1. YOUR CHOICE OF A. Shared Decision Making Tool OR B. Clinical Pearl AND 2. Collaborative Care Conference QUALITY MEASURES Must Be Completed By All Physicians SHARED DECISION MAKING OR CLINICAL PEARL Physicians can choose between: Implementation of Shared Decision Making OR Developing and Sharing a Clinical Pearl SHARED DECISION MAKING GOAL: To improve Patient Centered Management and engage patients in participating in management of their own health. Each practice will implement a Shared Decision Making tool of their choice. NOTE: This benchmark may help practices begin to work toward fulfilling one of the options available for the Improvement Activities performance category of the CMS Quality Payment Program(QPP) if the practice meets all of CMS requirements. NOTE: If your practice has difficulty identifying a shared decision making tool that fits your specialty, please contact MCPIPA ( ) to discuss options for your practice. OUTCOME MEASURE: Implementation of a Shared Decision Making tool that will be used to engage patients in making decisions regarding their own healthcare. CLINICAL PEARL Goal: To share clinical best practices with your colleagues. Shared Decision Making Includes: All IPA Member Physicians Value: 45% of total Benchmarks 1Q2017 Complete attached form identifying the clinical topic for implementation of a Shared Decision Making tool. o Submit attached form to MCPIPA by April 30, Q2017 Complete attached form identifying the Shared Decision Making tool. o Submit attached form to MCPIPA by July 31,

7 Clinical Pearl 3Q2017 Complete attached form for Implementation and Education of the Shared Decision Making Tool. o Submit attached form to MCPIPA by October 31, Q2017 Complete an assessment on patient satisfaction, physician satisfaction, or other measure of success of the Shared Decision Making Tool. o Submit attached form to MCPIPA by January 31, OR Includes: All IPA Member Physicians Value: 45% of total Benchmarks 1Q2017 Identify topic on a Clinical Pearl. Ideas for topics can come from Choosing Wisely specific to the physician s specialty or the physician may select a different topic. Choosing Wisely topics for any specialty can be found at under the Lists tab in the For Clinicians link. The Clinical Pearl should demonstrate standard of care for the specialty and represent an opportunity to improve quality and value for the IPA s Clinically Integrated Network. o Submit attached form to MCPIPA by April 30, Q2017 Physician writes the Clinical Pearl. The Clinical Pearl should include reference from peer-reviewed journal article. Pearls will be ed to infom@mcpipa.org. Once all Clinical Pearls are received they will be posted on the MCPIPA website along with the Physician s name and picture. Samples of Clinical Pearls received in 2016 are attached. o Submit with Clinical Pearl attached to MCPIPA by July 31, Q2017 Physician will provide a poster board to be shared with colleagues at the 3Q2017 Quarterly R4P All Physician Meeting scheduled for August 15, 2017 at Two Rivers Convention Center. Physician will be available during the cocktail hour to discuss the content of the Clinical Pearl with colleagues. o Submit attached form to MCPIPA by August 10, Q2017 Physician will read all the Clinical Pearls posted on the MCPIPA website and send attestation of Review of Clinical Pearls to MCPIPA. o Submit attestation form to MCPIPA by January 31,

8 COLLABORATIVE CARE CONFERENCE Goal: The purpose of the Collaborative Care Conferences is to identify process improvement opportunities for managing stipulated disease states, populations or episodes of care, and to design an appropriate outcome measure for each. NOTE: This benchmark helps practices work toward fulfilling a requirement of MIPS Improvement Activities. Outcome Measures: Outcomes from these Collaborative Care Conferences may include: a Care Compact, a practice Quality Improvement Program or Referral Guidelines from specialty practices. Includes: All IPA Member Physicians Value: 45% of total Benchmarks 1Q2017 and 2Q2017: Attend one of 26 Collaborative Care Conference education sessions scheduled February June 2017 (See following page for schedule). The Collaborative Care Conferences are based on relevance of the clinical topic and will help define the outcome measure and formulate an idea for a Process Improvement, Care Compact or Referral Guidelines. Facilitators will assist attendees in identifying opportunities for improvement including goals, potential opportunities or barriers, participants and their roles. Collaborative Care Conference Topics include: 1. Abnormal Liver Enzymes 2. Acute Joint Pain 3. Cancer Care and Management 4. Cancer Survivorship at conclusion of cancer treatments 5. Chronic Hip and Knee Pain 6. Chronic Sinusitis 7. Identifying a Surgical Candidate versus a Non-Surgical Candidate 8. Interoperative Management of Placenta Acreta 9. Management of the Complicated Diabetic Patient 10. Management of Headaches 11. Management of Hematopoietic Disorders (lab) 12. Management of Low Back Pain 13. Marijuana and Other Drug Use During the Perinatal Period 14. Nephrology and Creatinine Levels 15. Non-Accidental Trauma in Pediatrics 16. Pathologic Workup of Solid Tumors 17. Standard Opioid Prescribing Protocols 3Q2017: Complete attached form identifying outcome measure option from the Collaborative Care Conference. Options include: a Care Compact with another practice, a Quality Improvement Project within your own or with another practice, or creation of Referral Guidelines to be shared with other MCPIPA physicians o Submit attached form to MCPIPA by October 31, Q2017: Complete attached form or final outcome documentation of the finalized Care Compact; finalized QI Program; or finalized Referral Guidelines. o Submit attached form and completed document to MCPIPA by January 31, If you have any questions, or need additional information on the MCPIPA 2017 Incentive Program, please feel free to contact the MCPIPA office at

9 MCPIPA Collaborative Care Conferences 2017 TOPIC DATES IN 2017 MEETING TIME 6:30-8:00 am LOCATION SPECIALTIES SUGGESTED FOR TOPICS Facilitators SPC Facilitators PCP Abnormal Liver Enzymes Friday March 17 MCPIPA Gastro, FM, IM, Endo Shields Keel Acute Joint Pain Cancer Survivorship Chronic Hip/Knee Pain Chronic Sinusitis Contraindications and Mitigating Risk Factors For the Surgical Candidate Intraoperative Management of Placenta Acreta Friday March 10 Community Hospital Ortho, Infectious Disease, Rheumatology, Hospitalists, FM, Vance Wednesday May 31 St. Mary's Hospital IM Faber Klein Friday June 16 Community Hospital Preventative Medicine, Rad Onc, Oncology, Reconstructive Tarman/Marchionda Stroh Wednesday March 29 St. Mary's Hospital Plastics, Hospice, FM, IM Marchionda Friday June 2 Community Hospital Ortho,Pain Management, Anesthesia, Rheumatology, FM, Heil Taggart Wednesday. February 22 St. Mary's Hospital IM, Nakano Taggart Friday May 5 Community Hospital Merrell L. Campbell ENTs, Pediatrics, Allergy, FM, IM Wednesday April 12 St. Mary's Hospital - Annex A Scott J. Campbell Friday February 17 Community Hospital Surgeons, Neurosurgery, Ped Surgery, Derm, Ortho, Peds Morse Wednesday April 26 St. Mary's Hospital Ortho, CVT Surgery, Anesthesia, Ophthalmology, FM, IM Luker Tuesday April 18 St. Mary's Hospital - Annex A OB/Gyn,, Neonatology, Maternal Fetal, FM, Anesthesia, IR Simms Nelson Wednesday April 19 Fruita Community Center Neste Ellen Price Friday April 21 Community Hospital Ortho, Neurosurgery, Physiatry, Anesthesia, Pain Mgmt., Low Back Pain Chavda/Sohn Radiology, Sports Medicine, Psychiatry, FM, IM Friday February 10 St. Mary's Hospital Nederveld Wednesday May 10 St. Mary's Hospital Clifford Colwell Oncology, Rad Onc, Preventative Medicine, Derm, General Management of Cancer Friday June 23 Community Hospital Surgeons, Pulmonology, FM, IM Melancon Management of Headaches Management of Hematopoietic Disorder Managing the Complicated Diabetic Non-Accidental Trauma in Pediatrics Friday May 12 Community Hospital Neurology, Physiatry, pain Mgmt, FM, IM Dean/ Collier Wednesday June 14 St. Mary's Hospital Dean/McDaneld Wednesday June 28 Commuinity Hospital - Board Room Pathology, Hematology, FM Havlik Jahangiri Taggart Friday April 7 St. Mary's Hospital ER, Urgent Care, Psychiatry, FM, IM Greenlee Reicks Endocrinology, Ortho, Infectious Disease, wound Care, Peds, Friday March 31 Community Hospital FM, IM Deering Willy Marijuana/Other Drug During the Perinatal Period Friday May 19 St. Mary's Hospital OB/Gyn, Peds, Neonatology, Maternal Fetal, FM Bourkovski Hathaway Nephrology: Creatinine Levels Friday April 14 St. Mary's Hospital Nephrology, Radiology, Pathology, FM, IM Harawi Pathologic Workup of Solid Tumors Standard Opioid Prescribing Protocol Wednesday April 5 St. Mary's Hospital Oncology, Radiation Oncology, Pathology Mooney 12:00-1:30pm Friday February 3 Community Hospital Baldwin Gordon All surgeons, ER, Urgent Care, Hospitalists, OB/Gyn, Friday June 30 St. Mary's Hospital Pierce Morriseau Psychiatry, FM, IM Wednesday March 22 St. Mary's Hospital Harris Welsh

10 FORMS TO BE USED FOR 2017 INCENTIVE MEASURES 9

11 Administrative Measure Practice Technology Questionnaire Quality Program Reporting MCPIPA 2017 Incentive Program - 1Q2017 To be completed by Medical Practices Submit this form to MCPIPA by April 30, 2017 Practice Name: _ 1. Which program dashboard report(s) are you submitting for the calendar year 2016? Check all that apply. Physician Name Meaningful Use PQRS CPCI 2. If you did NOT report to any program, what barriers prevent your practice from reporting data for quality programs? Please an Excel spreadsheet of your practice quality reporting dashboard to: info@mcpipa.org Indicate date and spreadsheet sent: Office Manager Name Address 1

12 Administrative Measure Practice Technology Questionnaire Third Next Available New Patient Appointment MCPIPA 2017 Incentive Program - 2Q2017 To be completed by Medical Practices Submit this form to MCPIPA by July 30, 2017 Practice Name: Third Next Available Appointment Definition: Average length of time in days between the day a new patient requests an appointment with a physician and the third available appointment. Third next available appointment is used rather than next available as it is a more sensitive reflection of true appointment availability. For example, an appointment may be open at the time of a request because of a cancellation or other unexpected event. Using third next available appointment eliminates these chance occurrences from the measure of availability. Method: Sample all the physicians in the group on the same day. Sample one day in each of the three months of 2Q2017 Enter a dummy patient to schedule with a physician and identify the Third Next Available appointment for this new patient. Count the number of days between the request day and the Third Next Available date. Count ALL calendar days in your count, including weekends and days off. Do not use blocked or saved slots as these are not actually available. Compute the average of all physicians in the practice for each month by adding the number of days for each month for all physicians and dividing that total by the number of physicians. Physician Name(s) April Number of Days May Number of Days June Number of Days Practice Average: Office Manager Name Address 2

13 Administrative Measure Practice Technology Questionnaire MCPIPA 2017 Incentive Program - 3Q2017 To be completed by Medical Practices Submit this form to MCPIPA by October 31, 2017 Completion of this questionnaire will identify Process Improvement opportunities that, when completed, may help your practice meet certain QPP requirements in the areas of Improvement Activities and Advancing Care Information. Your responses to these questions will help identify process improvement activities to be implemented in 4Q2017 by your practice. Practice Name: Names of Physicians in practice: 3. Did you conduct Patient Satisfaction Surveys? (May count as a high weighting or medium weighted Improvement Activity for QPP if all CMS requirements are met) Yes No If No, what are the barriers? If Yes, what Patient Satisfaction Survey tool do you use? 4. Do the physicians in your practice consult the PDMP (Prescription Drug Monitoring Program) when prescribing narcotics? (May qualify as a high weighted Improvement Activity for QPP if all CMS requirements are met) Yes No 5. Does your practice EMR create, send and receive Summary of Care Documents electronically via DIRECT protocol when referring a patient to another setting of care or health provider? (Required for full scoring under Advancing Care Information performance category in QPP) Yes No Office Manager Name Address 3

14 Administrative Measure Practice Technology PDSA Cycle MCPIPA 2017 Incentive Program - 4Q2017 To be completed by Medical Practices Submit this form to MCPIPA by January 31, 2018 Practice Name: Names of Physicians in practice: Improvement Opportunity identified by questionnaire response in 3Q2017: (choose one) Patient Satisfaction Survey Consult PDMP Electronic Send/Receipt of Summary of Care Document 4Q2017: Create a PDSA cycle using the form below, or attach your own format to this form. P: PLAN the change, prediction(s) and data collection THE CHANGE: What are we testing? On whom are we testing the change? What time frame are we testing? FOLLOW UP DATA: What, who, when, where? D: Do: Carry out the change/test, collect data, and begin analysis Process change to be implemented. Include start date and process specifics Problems: S: STUDY: Complete analysis of data. Using back of form, summarize what was learned and resulting data A: ACT What adjustments to the change or method of test should we make before the next cycle? What will the next test cycle be? (use back of form to elaborate. 4

15 Quality Measure Shared Decision Making Identify Shared Decision Making Topic MCPIPA 2017 Incentive Program - 1Q2017 To be completed by Medical Practices Submit this form to MCPIPA by April 30, 2017 Practice Name: Physician Name(s): What is the clinical topic for your Shared Decision Making Tool? For example, mammography, total joint replacement, pharmacologic intervention, etc.? Office Manager Name Address 5

16 Quality Measure Shared Decision Making Identify Shared Decision Making Tool MCPIPA 2017 Incentive Program - 2Q2017 To be completed by Medical Practices Submit this form to MCPIPA by: July 31, 2017 Practice Name Names of Physicians in practice: What Shared Decision Making Tool are you using in your practice? Please provide a description of the tool? What is the source of this tool? For example, AAFP, National Institute of Health, etc. Note: to meet QPP requirement on Shared Decision Making as an Improvement Activity, the Shared Decision Making Tool must be evidence based and practices must complete all of the CMS requirements. NOTE: If you develop your own Shared Decision Making Tool it will likely NOT meet the QPP requirement. Office Manager Name Address 6

17 Quality Measure Shared Decision Making Implement and Educate on Shared Decision Making Tool MCPIPA 2017 Incentive Program - 3Q2017 Submit this form to MCPIPA by: October 31, 2017 Practice Name Names of Physicians in practice: 3Q2017: Implement and educate stakeholders (physicians, staff, and patients) on the need for the Shared Decision Making Tool and how it will be utilized. Examples to include with this form are staff meeting minutes, or an information letter shared with patients on the tool. Shared Decision Making Topic: Manner Education was delivered or performed: Please attach documentation of education. Office Manager Name Address 7

18 Quality Measure Shared Decision Making Assessment of the Shared Decision Making Tool MCPIPA 2017 Incentive Program - 4Q2017 Submit this form to MCPIPA by: January 31, 2018 Practice Name Names of Physicians in practice: 4Q2016: Complete assessment on patient satisfaction, physician satisfaction or other measure of success of the Shared Decision Making Tool. This can be done by a survey of the physicians, staff or patients who are using the Shared Decision Making Tool. Include a copy of the survey and the results Shared Decision Making Topic: Copy of Survey to Physician or staff attached? Yes No Number of Surveys given? Number of Survey Responses? Overall satisfaction of effectiveness of Tool? Copy of Survey to Patients attached? Yes No Number of Surveys given? Number of Survey Responses? Overall satisfaction of effectiveness of tool? Office Manager Name Address 8

19 Quality Measure Shared Decision Making Assessment of the Shared Decision Making Tool MCPIPA 2017 Incentive Program - 4Q2017 EXAMPLE OF ASSESSMENT SURVEY (Patient) Did you find this tool useful in making choices regarding your health care? Yes No Comments: Did this tool increase your knowledge about the medical decision you being asked to make? Yes No Comments: Would you recommend this decision making tool to a family member facing the same medical decision? Yes No Comments: 9

20 Quality Measure Shared Decision Making Assessment of the Shared Decision Making Tool MCPIPA 2017 Incentive Program - 4Q2017 EXAMPLE OF ASSESSMENT SURVEY (Physician) Did you find this tool useful in discussing patient options with them? Yes No Comments: Do you feel this tool increased your patients knowledge about the medical decision they are being asked to make? Yes No Comments: Do you agree clinically with the outcome of this clinical decision making tool? Yes No Comments: 10

21 Clinical Pearl Identify Clinical Pearl MCPIPA 2016 Incentive Program - 1Q2017 To be completed by Individual Physicians Submit this form to MCPIPA by April 30, 2017 Physician Name: Practice 1Q2016: Identify and submit detail on a Clinical Pearl. Ideas for topics can come from Choosing Wisely specific to the physician s specialty or the physician may develop a topic of his choosing. Choosing Wisely topics for any specialty can be found at under the Lists tab in the For Clinicians link. The Clinical Pearl should demonstrate standard of care for the specialty and represent an opportunity to improve quality and value for the clinically integrated network. Submit to MCPIPA by April 30, 2017 Topic: Details: who is the target audience? Options for the patient? Clinical alternatives? 11

22 Quality Measure Clinical Pearl Submission to MCPIPA MCPIPA 2017 Incentive Program - 2Q2017 To be completed by Individual Physicians Submit this form electronically to MCPIPA by July 31, 2017 Physician Name: Practice Name: Clinical Pearl Topic: 2Q2017: Physician writes a Clinical Pearl that will be posted on the MCPIPA website with Physician s name. o Physician sends an to info@mcpipa.org with Clinical Pearl attached to MCPIPA. o Pearl should include reference from peer-reviewed journal article o Samples of Clinical Pearl are attached. I have submitted a completed Clinical Pearl, including references, to Mesa County Physicain s IPA. Physician Signature 12

23 Quality Measure Clinical Pearl Education to Stakeholders MCPIPA 2017 Incentive Program - 3Q2017 To be completed by Individual Physicians Submit this form to MCPIPA prior to July 15, 2017 Physician Name: Practice Name: 3Q2017: Physician will provide a poster board to be shared with colleagues at the 3Q2017 Quarterly R4P All Physician Meeting scheduled for August 15, 2017 at Two Rivers Convention Center. Physician will be available during the cocktail hour to discuss the content of the Clinical Pearl with colleagues. Clinical Pearl Topic: I am planning to present my Clinical Pearl to my colleagues at the August 15, 2017 MCPIPA R4P meeting. Physician Signature: Date: 13

24 Clinical Pearl Attestation to Review MCPIPA 2016 Incentive Program - 4Q2017 To be completed by Individual Physicians Attestation can be completed at Submit electronic attestation to MCPIPA by January 31, 2017 Physician Name: Practice: 4Q2017: Read the Clinical Pearls posted on the IPA website and send attestation of Review of Clinical Pearls to MCPIPA. The Attestation below may be submitted via the MCPIPA website, or submit this form to MCPIPA. I have reviewed the Clinical Pearls posted by MCPIPA member physicians on the MCPIPA website. Physician printed name: Signature: Date: 14

25 Quality Measure Collaborative Care Conference Determine Outcome Option MCPIPA 2017 Incentive Program - 3Q2017 To be completed by Medical Practices or Individual Physicians Submit this form to MCPIPA by October 31, 2017 Practice Name: Names of Physician(s) in practice involved in this Collaborative Care Conference Outcome: Which Collaborative Care Conference did you attend? Which Outcome Option will you be completing for this incentive measure? Creation of Referral Guidelines Creation of a Care Compact with another practice Implementation of a Process Improvement Within my own practice In collaboration with another practice Practices involved Goals of the proposed Outcome Option: Office Manager Name Address 15

26 Quality Measure Collaborative Care Conference Outcome Measure: Process Improvement PDSA Cycle MCPIPA 2017 Incentive Program - 4Q2017 To be completed by Medical Practices or Individual Physicians Submit this form to MCPIPA by October 31, 2017 Practice Name (s): Names of Physician(s) in practice involved in this Clinical Quality Program: 3Q2017: Create a PDSA cycle for the quality improvement process using the form below, or attach your own format to this form. Submit to MCPIPA by January 31, 2018 P: PLAN the change, prediction(s) and data collection THE CHANGE: What are we testing? On whom are we testing the change? What time frame are we testing? FOLLOW UP DATA: What, who, when, where? D: Do: Carry out the change/test, collect data, and begin analysis Process change to be implemented. Include start date and process specifics Problems: S: STUDY: Complete analysis of data. Using back of form, summarize what was learned and resulting data A: ACT What adjustments to the change or method of test should we make before the next cycle? What will the next test cycle be? (use back of form to elaborate 16

27 Quality Measure Collaborative Care Conference Outcome Measure: Care Compact MCPIPA 2017 Incentive Program - 4Q2017 To be completed by Both Participating Medical Practices Submit this form to MCPIPA by January 31, 2018 Which Collaborative Care Conference did you attend? Practices involved in the Care Compact: Practice #1 Practice #2 Physicians involved in Care Compact: Practice #1 Physicians: Practice #2 Physicians: Intent of Care Compact: To set expectations for documented flow of information and practice expectations between practices when patients are referred between settings. To provide patients with information that sets their expectations consistently with the care coordination agreements and to track patients referred to specialists through the entire process. Please attach a copy of your completed Care Compact Office Manager Name Address 17

28 Collaborative Care Conference Outcome Measure: Referral Guidelines MCPIPA 2017 Incentive Program 4Q2017 To be completed by Medical Practices or Individual Physicians Submit to MCPIPA by January 31, 2018 Practice Name: Names of Physician(s) in practice involved in this Referral Guideline: Which Collaborative Care Conference did you attend? Scope of Referral Guideline to be created: Target Audience for Referral Guideline: Please attach a copy of completed Referral Guideline Office Manager Name Address 18

29 Samples of Clinical Pearls Sample One: Clinical Pearl: Diagnosis And Management Of Biphosphonate Related Hip Fractures Contributor: Steven Gammon, M.D. Rocky Mountain Orthopaedic Associates PC Target Audience: Primary Care; Emergency Department Physicians; and, Orthopedic Surgeons Osteoporotic or fragility fractures are any fracture that occurs from a simple fall, like a fall from standing height. People with weak bones are more likely to break bones with simple falls. The following are the most common types of osteoporotic fractures: Spine compression fractures Hip fractures Wrist fractures The following are the National Osteoporosis Foundation recommendations* for ANY female over 50 or male over 55: 1. Educate yourself about osteoporosis 2. Healthy diet a. Take adequate Vitamin D ( iu/day) and Calcium (1200 mg/day) in your diet and supplement as necessary. 3. Physical activity a. Weight-bearing activity, like walking, will stimulate bone production. 4. Avoid tobacco and excessive alcohol a. Tobacco nicotine slows circulation to bone and alcohol can impair your thinking and make you more likely to fall. 5. Practice fall prevention principles a. Clean clutter from house and be aware of throw rugs that can trip you. b. Make your bathroom a safe place with hand-rails to get in and out of bathtub and toilet. c. Be sure all stairs in and out of house have railings. d. Have good lighting and check your own sight too. 6. See your primary care doctor about being tested for osteoporosis and take osteoporosis medications if indicated. a. Bone mineral density (BMD) testing should be performed in women over 65 and men over

30 b. Initiate medical treatment for T-scores -2.5 OR in patients with hip or vertebral fractures. There is no uniform recommendation for duration of treatment. Monitor BMD every 2 years after initiating treatment. c. Look for and correct secondary causes of osteoporosis. References: *Cosman F, et al. Clinician s Guide to Prevention and Treatment of Osteoporosis: Position Paper. Osteoporos Int. 15 Aug

31 Sample Two: Clinical Pearl: Butalbital and Opioids in the Treatment of Migraine Headache Contributor: Joel Dean, D.O. Grand Valley Neurology Target Audience: Primary Care Physicians For many years, compounded butalbital and compounded narcotics were used frequently for the treatment of headache, especially migraine headache. In the early 1970s, evidence started to accumulate that butalbital could cause problems. By the late 1970s the concept of rebound was firmly established in the headache literature, and eventually gained acceptance among primary care providers. More recently, it is clear that compounded narcotics also cause rebound. Thus, it has been clear for a good while that these medications cannot be used frequently in headache patients. In the last 10 or 12 years studies have been published which suggest (primarily in the ER setting) that narcotics really have limited utility in the abortive treatment of migraine headache, even when used infrequently. Many physicians, however, have a different personal experience (that is, they have patients who report that narcotics are helpful for their headache). I believe a few historical features can be very helpful in the primary care clinic. Patients often talk to us about their significant headache, but don t mention all of their headaches. Whenever a patient is talking to me about migraine, I always ask them how many types of headache they have. It is quite common for patients with migraine to have sinus headache, muscle tension headache, or regular headaches. The other question I ask them is how many days in a month do they have no headache at all, versus small headaches or big headaches. It is common for a patient to say they have 2 or 3 migraine headaches a month. In some of these patients, that means they have 27 or 28 days with no headache at all. In other patients however, the story is completely different: They may have 2 or 3 migraines a month, each lasting 3 days. They may have 10, 12, 15 days a month with other headache types. These patients may be using Tylenol for some of their headache, Advil or Aleve for some of their headache, sinus preparations for some. If you add even a small number of Vicodin or Fiorinal tablets into this regimen, odds are you will see initial improvement followed by worsening. You will be the cause of their rebound headache. On the other hand, we all see patients who have 1 or 2 migraines a month, 6 or 8 migraine headaches a year, and very little migraine headache otherwise. In these patients the use of high-dose Aleve (600 to 1,000 mg), high-dose Advil (800 to 1,200 mg), or Fiorinal or Vicodin is probably fine. In some patients this may be highly preferable because of the cost of triptan agents. If these patients are taking pain medications on a very frequent basis for some other cause (back pain, shoulder 21

32 pain etc.) they may also be at risk of developing rebound. If not, then these affordable alternatives may be very appropriate. The key is to ask a couple of quick questions, so that you have an idea of the patient s overall headache history, and their overall use of OTC and prescription pain meds. Many headache specialists issue the blanket statement that Fiorinal and narcotics should never be used at all, for any headache type. This is because, especially in the case of butalbital, the development of rebound can occur so easily. References: AHS Annual Meeting syllabus, 2012, 2014,