slide 1 - american health quality association
TRANSCRIPT
QIOSC UpdateAHQA Technical Conference
February 23 - 26, 2009 Tampa, FL
Today’s Agenda
• Background• QIOSC Team•Major Tasks• Current & Future Activities
Background
• Prevention QIOSC contractawarded 9/30/08• Start-up activities:–Clarify CMS’ expectations for QIOSC work–Develop QIOSC comprehensive work plan–Define roles of Prevention and
Health Disparities QIOSCs• QIO support defined:
Core Prevention tasks (53 QIOs)and CKD tasks (11 QIOs)
Unique QIOSC Structure
Meet the QIOSC Team
Prevention QIOSC Team – 7.68 FTEs• Robin Weil, Director• Erica Morrison, Community of Practice Manager• Sandra Atkins, Project Assistant• Sallie Cook, MD, Medical Director• Linda Xu, Analytics• Susan Brittman, QSource Lead & Disparities Subject Matter Expert and
Analytics• Monet Carnahan, CKD Subject Matter Expert• Carol Stowell, Communications• Anthony Culver, Communications • Robert Canada, MD, Nephrologist• Robin Kaiser, SoftDev Lead & Senior Applications Engineer• Rich Kaiser, User Services Specialist• Nancy Carlson, Data and Analytics Manager
Core Prevention Clinical Measures
• Breast Cancer screening (mammography)• Colorectal Cancer screening:–Fecal occult blood test (FOBT)–Flexible sigmoidoscopy–Double contrast barium enema–Colonoscopy• Influenza immunization• Pneumococcal immunization
National Core Prevention Activities
• Recruit participating and non-participating practices (PPs and NPs); • Provide post-recruitment care
management training to PPs;• Complete Assessment of Care
processes for PPs and NPs;
National Core Prevention Activities
• Provide technical assistance to PPs for care management:–Workflow analysis and redesign– Interventions to increase patient self-
management• Provide technical assistance to PPs
and NPs for data reporting:–Retrieving data from EHR–Reporting aggregate data
(numerators and denominators)
National Core Prevention Activities
• Report activities to CMS:–PP and NP progress with data reporting–Monitoring of statewide rates
and disparities–Plan for optimization of performance–Annual report
How We Are Helping QIOs
QIOSC Role - How We Support QIOs
• Engage expert stakeholders andpartners such as:– American Academy of Family Physicians– American College of Physicians– American Board of Internal Medicine– American Medical Association– Healthcare Information and Management
Systems Society– Medical Group Management Association– Infectious Diseases Society of America– American Cancer Society
How We Support QIOs
• Conduct an inventory ofavailable interventions• Develop and/or disseminate tools• Provide educational information and
resources• Facilitate monthly Community of Practice
sharing calls• Identify QIO barriers, lessons learned and
success stories• Synthesize and disseminate “what works”
information
How We Support QIOs
• Facilitate monthly EHR reporting workgroup calls• Liaison with EHR vendors as needed• Provide comprehensive Quest Index•Monitor and evaluate to provide
special assistance when needed•Make the “business case”
QIO Issues and Concerns
Core prevention recruitment was a challenge due to:– Limited pool of practices with CCHIT certified EHRs– Practice workflow issues preventing optimal use of EHR
for care management– Practices feared that data could not be retrieved from
EHRs– Practices saw data reporting as a burden– Practices uneasy about how their data would be used– Lack of buy in from EHR vendors– Negative experiences with PQRI created resistance
from some practices– No perceived benefit for participation by NPs
QIO Issues and Concerns
• Logistical/technical issuesrelated to PATRIOT• Lack of specifications for
EHR reported measures• Lack of clarity regarding definitions related to data
reporting - “active patient”• Evaluation criteria not finalized• Limited national support for vendor relations
Persistence and Ingenuity Pays Off!
• 98% of QIOs recruited their target number of PPs (target numbers range from 4 to 125)• 94% of QIOs recruited their target number of
NPs • 94% of QIOs provided required post-
recruitment training to PPs• 29% of QIOs have reported some practice level
data
Core - Next Steps
• Focus of QIOSC support will switch from recruitment to:–Care management interventions–Support for practice data reporting
• Updated MedQIC coming very soon• Launch of national campaign focused
on stakeholder/partner engagement
CMS’ CKD Quality Initiative
• Focus on three clinical areas:– early detection of CKD in
beneficiaries with diabetes; – appropriate medication treatment
(angiotensin converting enzyme inhibitors/angiotensin receptor blockers) to slow the progression of kidney failure; and
– adequate counseling prior to initiation of dialysis which leads to placement of an arteriovenous fistula for hemodialysis patients.
CMS’ CKD Quality Initiative
• Collaborate to achieve sustainable CKD system-level changes• Partners
– community health centers – community representatives, – ESRD Network Organizations, – health department diabetes grantees– local chapters of kidney organizations– patient representatives, provider groups,
state and county– government representatives, and others
CKD States• Florida• Georgia• Missouri• Montana• Nevada• New York• Rhode Island• Tennessee• Texas• Utah• U.S. Virgin
Islands
Recruitment Phase Successful!
• CKD recruitment–Previous work made
recruitment less difficult–All now at 100% of goals
QIOSC Role - How We Support QIOs
• Engage expert stakeholdersand partners• Conduct an inventory of
available interventions• Develop and/or disseminate tools• Provide educational information
and resources
QIOSC Role - How We Support QIOs
• Facilitate bi-weekly sharing/educational calls with CKD QIOs• Identify QIO barriers, lessons learned
and success stories• Synthesize and disseminate
“what works” information• Provide comprehensive Quest Index• Monitor and evaluate to provide
special assistance when needed• Make the “business case”
CKD Prevention Issues & Concerns
• PATRIOT Issues• $4 Generic Prescriptions
Effect on Measures• AV Fistula Placement Reimbursement
CKD - Next Steps
• Focus of QIOSC support will switch from recruitment to interventions• Updated MEDQIC coming very soon• CKD Community Tool Kit
– Under Discussion with CMS• National Kidney Month Activities
– “March Madness” CKD News Release
Summary
• Physician office HITassistance is welcomed by practices• Prevention topics are extremely
important–quality perspective–business case perspective• QIOSC welcomes ideas to optimize
support to QIOs
Contact InformationPrevention QIOSCVirginia Health Quality Center (VHQC)9830 Mayland Drive, Suite JRichmond, VA 23233(804) 289-5320 (Main)
Robin [email protected] QIOSC DirectorErica [email protected] Community of Practice Manager
Thank You!QIOSC Update
AHQA Technical ConferenceFebruary 23 - 26, 2009
Tampa, FL This material was prepared by the Prevention Quality Improvement Organization Support Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.QSOURCE-TN-450-2009-03