Meaningful Practice: A VPMA Perspective

1. Meaningful Practice: A VPMA Perspective Medbiquitous Conference May 16, 2016 Redonda G. Miller, M.D., M.B.A. Senior Vice President, Medical Affairs

2. The Problem • So many competing priorities • Possibly over 1200 quality measures • More 15 educational mandates (internal, licensure CME, MOC, etc.) • Current technology solutions are well-intended • Try to be all things to all people (clinicians, compliance officers, billing personnel, etc.) • Prevailing mantra of “just add it on”

3. How Can We Win Over Physicians? • Align motives with truly trying to improve patient care • Develop meaningful measures (not just process measures) • Focus on data • Pay attention to workflow and unanticipated consequences • Engage physicians in the design from the ground up

4. Ongoing Professional Practice Evaluation (OPPE) • Joint Commission standard to monitor competency and performance of medical staff • Peer review of competency in an “ongoing” fashion (more frequent than annually) • Complex structure in place for over 3200 medical and allied health staff

5. OPPE Process Medical Board Approve measures and privileges Credentials Committee Process PPE data into files and recommend privileging decisions Central Steering PPE Committee Vet modifications to measures and determine remediation plans Departmental PPE Committee Chairman (Appointed by Dept. Chair) Quality Team Leader Department Committee

6. Ongoing Professional Practice Evaluation (OPPE), cont. • Global indicators • UHC data: LOS, mortality, readmissions • Process/professionalism measures: documentation completion • Department-specific indicators • Tend to be more clinical and more robust • Ex: antibiotic timing, blood transfusion, etc. • Based predominantly on administrative data with resultant limitations

7. Sample OPPE Data

8. Regulatory Demands • CMS Face-to-Face encounter • Requirement to document an encounter within 90 days prior to the start of home health services • Must forfeit payment if not done • Joint Commission annual education • Mandated topics • Need improved delivery modalities

9. Query Responses for Quality Rankings • Quality indicators often require clarification • Present on admission? • Known complication or accidental mishap? • Accurate documentation to reflect true level of patient morbidity • Impacts measures with O/E calculations • Coder and clinical documentation specialists generate queries to clinicians to resolve/clarify

10. Physician Query Workflow Query? Response 70% physician response rate

11. Queries Affect Reimbursement Hospital system with 115,000 admissions/yr. 95% response rate 70% response rate + $27 Million/yr.

12. Queries Affect Quality Reporting Sepsis Source: http://www.healthgrades.com Mortality In-Hospital figures. Mar. 2016.

13. Partnership with artifact health Admission Concurrent Review & Education Query Response & Individual Education • Query Template Library • Compliant • Customizable • Attach documentation • Query Management • Work lists • Review process • Query Activity Feed • Escalation process • Reassignment/Co-assignment • Education • Provider tips • CDS/Coder Guidelines • Analytics • Query tracking • Performance tracking • Comprehensive reporting Discharge E M R Retrospective Review & Coding Final Bill/Hold Auto-Generated Addendum Second Level Review

14. MAKE IT FASTER & Easier • Single platform • Consistent query format • Any device • ‘One-step’ workflow • Targeted education to reduce future queries • Scorecard with peer comparisons

15. Artifact: Anticipated Benefits • Create structure and accountability, no more chasing-down physicians • Provide automated query tracking and reporting • Foster collaboration between CDI & coding • Complement existing systems (3M, EMRs) • Handle the future increase in query volume

16. Final Word: Key Physician Motivators Design IT solutions that: • Improve patient care or clinical outcomes • Lead to increased efficiency • Enhance reputation / quality rankings