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Physician Performance and Reporting Commentary

Physician Performance and Reporting Commentary. David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare Chief, Division of General Medicine, Brigham and Women’s Hospital. PQRI—One Perspective .

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Physician Performance and Reporting Commentary

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  1. Physician Performance and Reporting Commentary David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare Chief, Division of General Medicine, Brigham and Women’s Hospital

  2. PQRI—One Perspective • Think this will be a key lever (probably the key lever) for encouraging adoption • Unclear whether level of incentive will be sufficient to have desired impact • Will generate hot debate in physician community • Have to try and see • Should begin to engage consumers

  3. Pay-for-Performance Key Components • Individual vs. group incentives • Paying the right amount • Selecting high-impact performance measures • Making payment reward all high-quality care • Prioritizing quality improvement for underserved populations Rosenthal and Dudley, JAMA 2006

  4. Other sources Patients Providers Clinics Vital signs, weights Selected lab values Allergies Vital status LMRQualityDWH LMR Problems Meds Notes Health Maintenance Flow Sheets LMR Quality Data Warehouse • Externalize information from Partners ambulatory electronic health record • Make that information available in a variety of ways Ad hocqueries Reports Quality Dashboard PopulationMgmt Disease Registries

  5. Massachusetts eHealth Collaborative • Got $50 million from Blue Cross • Identified 3 communities in Massachusetts • Gave them EHRs • Made vendors agree to represent data in standard ways • Allow extraction of quality data • Setting up clinical data exchange • Setting up a data warehouse for quality data • All 3 communities will have a central store • Still hasn’t been easy—EHRs don’t include the necessary tools off-the-shelf

  6. Why EHRs are Better than Claims • MUCH more detailed data • Blood pressure • Full laboratories • Can record things like bilateral mastectomy, or patient with another inoperable cancer • Also refusals • Provider buy-in better • Covers ALL patients

  7. Key Pitfalls for Program • Could easily be set up in ways that would not make extraction easy or even possible • Having accurate links between patients and providers • Most commercial EHRs don’t currently facilitate either improvement or reporting • Need to try to avoid appearance of unfunded mandate (has to look like a carrot)

  8. Key Points to Emphasize • Providers need registry function, and reminders from EHRs • Eventually tools to enable team functions • Making reports available to providers • Allowing drilldown • Quality measures will be carefully scrutinized by physician community • Extraction has to be easy • Pull is best if feasible

  9. Regulatory Keys • At start should be easy to qualify • Gradually raise bar • Will need to follow whether amount has desired impact • Physicians need to be able to see how they are doing

  10. Conclusions • If pay sufficient attention to the 5 key elements should be possible to be successful • Paying right amount, selecting right measures, and using incremental payment are important • Using EHR data is much more accurate than claims and should be using that • There are many good EHRs on market and need to provide market incentives to use

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