Primary Care Quality Reporting Prototype Questions & Answers 1. What additional information is available on this project and why it is important? Project overview information and the collaborative work sessions’ records that developed this project are available at http://accesshealthcolumbus.org/#/primary-care-quality-reporting/.
2. What does ‘transparent reporting’ mean for this project? How will these reports be shared? Who will see them?
The project will provide a 30 day window for practices to privately view their reports and work out any data anomalies. The reports will then be shared within the collaborative organizations under a Terms of Use agreement. Files will be shared over a secure server, not through a web portal. To see a list of the organizations and the Terms of Use agreement, click here.
3. What are the specific measures that will have data collected and be reported?
Measures reflect Central Ohio priorities and are from the National Quality Forum’s measures set. Adult practices can provide de-identified electronic medical record data for five measures: Diabetes (A1c, LDL, and Blood Pressure), Appropriate Medications for Asthma, Blood Pressure Control Pediatric practices can provide de-identified electronic medical record data for two measures: Appropriate Medications for Asthma and Influenza Immunization
To view summary descriptions of the measures, click here.
4. How frequently will data be collected and reports be available?
Initial 12 month data (summary values) will be collected in August and September. Reports will be privately available in November and shared with the collaborative organizations in December. A quarterly schedule will then apply. Click here for a timeline view. Measure Period
3rd Qtr 2012-2nd Qtr 2013 4th Qtr 2012-3rd Qtr 2013 1st Qtr 2013-4th Qtr 2013 2nd Qtr 2013-1st Qtr 2014 3rd Qtr 2013-2nd Qtr 2014
Data collected by 9/30/2013 11/30/2013 2/28/2014 5/31/2014 8/31/2014
Private Report Viewing 11/2013 2/2014 4/2014 7/2014 10/2014
Collaborative Sharing 12/2013 3/2014 5/2014 8/2014 11/2014
5. How does this quality reporting relate to other reporting practices do?
Practices are participating in a number of other public and private reporting initiatives. Most initiatives do not include all patients of a practice, so lack a comprehensive view. To see some initiatives (current and emerging) relevant to this project and its set of measures, click here.
April 2013
6. At what level will this reporting be captured?
The project will be collecting and reporting information at the practice level. Provider level data will not be collected or reported.
7. What are the data requirements?
Access HealthColumbus will be collecting de-identified (non-Protected Health Information) numerator and denominator measure values. This summary level allows for detail specification use and extract coding to occur at the practice rather than within a centralized data warehouse process. National standard data electronic measure coding files are available. Click here to see the data collection template.
8. How can I obtain more information? A. View a live 45 minute webinar, click or copy/paste link to register:
1. Friday 5/10, 7:00-7:45 am: http://www.anymeeting.com/PIID=E955DD84874E30 2. Friday 5/10, 12:15-1:00 pm: http://www.anymeeting.com/PIID=E955DD84874A31 3. Tuesday 5/14, 5:15-6:00 pm: http://www.anymeeting.com/PIID=E955DD8487483F
B. Click here to see additional project information (or copy/paste: http://accesshealthcolumbus.org/#/primary-care-quality-reporting/ ) C. Questions? Contact Carol Deibel at carol@accesshealthcolumbus.org
April 2013
Participant Terms of Use, Primary Care Quality Prototype Reports ..Central Ohio stakeholders collaborating to improve quality reporting of local patient-centered primary care in 2013 A multi-stakeholder collaborative formed in the fall of 2012. The collaborative will implement a transparent allpatient local prototype of Primary Care Quality Reporting in 2013. Local health care leadership sessions and a project design team have readied this project for Central Ohio. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. Participants are those organizations that provide data, view or review reports.
Participating Organizations Primary Care Practices
Terms of Use -provide timely, de-identified (no Protected Health Information) data from Electronic Medical Records for the selected measures -respond timely to data inquiry questions -share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to improve quality in your practice
Healthplans, Employers, & Other health care organizations
-share experiences of participating in local quality reporting
Access HealthColumbus & its Public-Private Partners
-facilitate the collaborative process in benefiting Central Ohio
-will not use report content to promote or publicize physician practices -use reports to work with practices to improve primary care
-maintain project support integrity and timeliness -provide technical services sufficient to support the prototype -manage report sharing with participating organizations
See below for organizations participating in the multi-stakeholder collaborative and eligible to view the quality reports.
April 2013
Organizations participating in the multi-stakeholder collaborative and eligible to view the quality reports. 1
All Participating Primary Care Practices
21
Mount Carmel Health System
2
Access HealthColumbus and Board
22
Mount Carmel Medical Group
3
Aetna
23
Nationwide Children's Hospital
4
American Health Network
24
Nationwide Insurance
5
Anthem
25
Ohio Academy of Family Physicians
6
Cardinal Health
26
Ohio Chapter, American Academy of Pediatrics
7
Central Ohio Primary Care
27
Ohio Osteopathic Association
8
Columbus Medical Association
28
Ohio Public Employees Retirement System
9
Columbus Metropolitan Library
29
OhioHealth
10
Columbus Neighborhood Health Centers
30
OSU Health System
11
Columbus Public Health
31
OSU Physicians, Inc., OSU Faculty Group Practice
12
Employers Health Coalition, Inc.
32
School Employees Retirement System of Ohio
13
Franklin County Cooperative Health Benefits Program
33
State Teachers Retirement System of Ohio
14
Franklin County Public Health
34
The Dispatch Printing Company
15
Health Action Council
35
The Medical Group of Ohio
16
Heart of Ohio Family Health Centers
36
The Ohio State University
17
Humana
37
The Ohio State University Health Plan
18
Lower Lights Christian Health Center
38
The Ohio State University Wexner Medical Center
19
Medical Mutual of Ohio
39
UnitedHealthcare of Ohio
20
MediGold
40
Village Family Medicine
April 2013
Primary Care Quality Reporting – 2013 Prototype EMR Measures Adult Practices Domain
NQF#
Quality Measure
Steward
Clinical Process/Effectiveness
0059
Diabetes: Hemoglobin A1c Poor Control. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 %. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent HbA1c level (performed during the measurement period) is > 9.0%
NCQA
Clinical Process/Effectiveness
0064
Diabetes: Low Density Lipoprotein (LDL) Management. Description: Percentage of patients 18â&#x20AC;&#x201C; 75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL.
NCQA
Clinical Process/Effectiveness
0061
NCQA
Clinical Process/Effectiveness
0036
Clinical Process/Effectiveness
0018
Diabetes: Blood Pressure Management. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or 2) who had a blood pressure < 140/90. Denominator: Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period. Numerator: The number of patients whose most recent BP reading during the measurement period was <140/90 mm Hg. Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Controlling High Blood Pressure. Description: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period. Denominator: Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period. Numerator: Patients whose blood pressure is adequately controlled ( systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mm Hg) during the measurement period.
NCQA
NCQA
April 2013
Primary Care Quality Reporting â&#x20AC;&#x201C; 2013 Prototype EMR Measures Summary Pediatric Practices Domain
NQF#
Clinical Process/Effectiveness
0036
Population/Public Health
0041
Quality Measure
Steward
Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Preventive Care and Screening: Influenza Immunization. Description: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. Denominator: All patients 6 months and older and seen for a visit between October 1 and March 31. Numerator: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization.
NCQA
AMA-PCPI
April 2013
Primary Care Quality Reporting, Practice Participation Timeline, 2013-2014
2013
Primary Care Practices
MAY
JUNE
Review Invitation and Questions & Answers, Enroll
JULY
AUG
NOV
DEC
1st Reports shared with the Collaborative
Data mine
Submit Summary Data
Submit Summary Data
1st Reports Compiled
MAR
APR
MAY
JUNE
JULY
AUG
3rd Reports shared with the Collaborative, 4th Data Submission
4th Report Private Viewing
4th Reports shared with the Collaborative, 5th Data Submission
FEB
Primary Care Practices
2nd Reports Compiled
2nd Report Private Viewing, 3rd Data Submission
3RD Reports Compiled
3rd Report Private Viewing
2014
SEP
OCT
NOV
DEC
5th Reports Compiled
5th Report Private Viewing
5th Reports shared with the Collaborative
Collaborative Reflections on Learning
Primary Care Practices
OCT
1st Report Private Viewing, 2nd Data Submission
JAN
2014
SEP
4th Reports Compiled
April 2013
Primary Care Quality Reporting Central Ohio 2013; Prototype Measures and their overlap with other relevant initiatives
Program:
Primary Care Quality Reporting Central Ohio (new in 2013) [1]
Comprehensiv Your Health e Primary Matters Care Initiative Greater SW Ohio [2] Cincinnati [3]
PatientCentered Medical Home Better Health Chronic Disease Greater Cleveland [4] Management [5]
Shared Savings Program Outpatient Accountable Prospective Care Payment Organizations System (in [6] discussion) [7]
4/2013
Physician Quality Reporting System [8]
Endorsed/ Developed by:
Measures:
٭
٭
٭
٭
٭
٭
x
٭
NQF/ NCQA
٭
٭
٭
٭
٭
٭
x
٭
NQF/ NCQA
٭
٭
٭
٭
٭
٭
x
٭
NQF/ NCQA
Asthma- Use of Appropriate Asthma Medications
٭
٭
Hypertension - Bp control
٭
٭
٭
٭
Diabetes HbA1c Poor Control Dibetes LDL Control Diabetes Blood pressure Control
Prevention- Influenza (Pediatric practices)
٭ ٭
٭
NQF/ NCQA
٭ ٭
٭
NQF/ NCQA NQF/AMA-PCPI
[1] http://accesshealthcolumbus.org/#/primary-care-quality-reporting/ [2] http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/Ohio-Kentucky.html [3] http://www.yourhealthmatters.org/for-health-care-professionals-health-care.php [4] http://www.betterhealthmembers.org/performance_achievement_reports_primary.asp [5] http://www.commonwealthfund.org/~/media/Files/Publications/Data%20Brief/2012/1601_Rosenthal_recommended_core_measures_PCMH_v2.pdf [6] http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.html [7] http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/hospitaloutpatientpps/ [8] http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqri
April 2013
Primary Care Quality Reporting
Practice Summary Data Reporting Template (contained on next 4 pages) Measure Reporting Period: 3rd Qtr 2012 - 2nd Qtr 2013
April 2013
Primary Care Quality Reporting Practice Summary Data Reporting
Date:
General Information Medical Group Medical Group Name Primary project contact Name
first
Primary data contact Name
last
first last
initials Title
initials Title
Phone
Phone
Practice Sites (data reporting level [1]) 1.
Practice Site Name
Percent of patients
Address 1
Adult over 18
Address 2
Children under 18
City
Total
0%
State Zip
Key site project contact Name
Number of Providers [2] Estimated Number of Unique Patients Percent of patients by payer (should add to 100%):
first
Medicare
last initials
Medicaid Commercial
Title Phone
Self Pay/Uninsured
Other Total
2.
0%
Practice Site Name
Percent of patients
Address 1
Adult over 18
Address 2
Children under 18
City
Total
0%
State Zip
Key site project contact Name
first last initials
Title
Number of Providers [2] Estimated Number of Unique Patients Percent of patients by payer (should add to 100%): Medicare Medicaid Commercial
Phone
Self Pay/Uninsured
Other Total
0%
[1] If unable to report data at the site level, complete one 'site' with the medical group information [2] Physicians, Nurse Practioners, Physician Assistants
April 2013
Primary Care Quality Reporting Practice Summary Data Reporting
Date:
General Information Practice Sites continued (data reporting level) 3.
Practice Site Name
Percent of patients
Address 1
Adult over 18
Address 2
Children under 18
City
Total
0%
State Zip
Key site project contact Name
Number of Providers [2] Estimated Number of Unique Patients Percent of patients by payer (should add to 100%):
first
Medicare
last initials
Medicaid Commercial
Title Phone
Self Pay/Uninsured
Other Total
4.
0%
Practice Site Name
Percent of patients
Address 1
Adult over 18
Address 2
Children under 18
City
Total
0%
State Zip
Key site project contact Name
Number of Providers [2] Estimated Number of Unique Patients Percent of patients by payer (should add to 100%):
first
Medicare
last initials
Medicaid Commercial
Title Phone
Self Pay/Uninsured
Other Total
5.
0%
Practice Site Name
Percent of patients
Address 1
Adult over 18
Address 2
Children under 18
City
Total
0%
State Zip
Key site project contact Name
Title
first
Number of Providers [2] Estimated Number of Unique Patients Percent of patients by payer (should add to 100%):
last
Medicare
initials
Medicaid Commercial
Phone
Self Pay/Uninsured
Other Total
0%
[1] If unable to report data at the site level, complete one 'site' with the medical group information [2] Physicians, Nurse Practioners, Physician Assistants
April 2013
Primary Care Quality Reporting
Practice Summary Data Reporting
Date:
Measures Data, Adult Practices Repeat for each Practice Site
Measure Reporting Period:
3rd Qtr 2012 - 2nd Qtr 2013
Practice Site Name: #
Measure #
1
0059 a.
Description Diabetes: Hemoglobin A1c Poor Control Numerator Patients qualified per the denominator with most recent (within the measure period) HbA1c >9%.
b.
Denominator Patients reaching 18-75 during measure reporting period, with diabetes within 2 years of the end date, with HbA1c tested within measure period, and NOT excluded. [1]
2
0064 a.
Diabetes: Low Density Lipoprotein (LDL) Management Numerator Patients qualified per the denominator with most recent (within the measure period) LDL-C<100 mg/dL.
b.
Denominator Patients reaching 18-75 during measure reporting period, with diabetes within 2 years of the end date, with LDL tested within measure period, and NOT excluded. [2]
3
0061 a.
Diabetes: Blood Pressure Management Numerator Patients qualified per the denominator with most recent (within the measure period) Blood Pressure <140/90 mg/dL (systolic <140 AND diastolic <90).
b.
Denominator Patients reaching 18-75 during measure reporting period, with diabetes within 2 years of the end date, with Blood Pressure tested within measure period, and NOT excluded. [3]
[1] 0059 see exclusion logic, includes patients with polycystic ovaries, gestational diabetes, and steroid induced diabetes. [2] 0064 see exclusion logic, includes patients with polycystic ovaries, gestational diabetes, and steroid induced diabetes. [3] 0061 see exclusion logic, includes patients with polycystic ovaries, gestational diabetes, and steroid induced diabetes. 4
0036
Use of Appropriate medications for Asthma Numerators (ages during the measurement period)
a.
Ages 5-11
b.
Ages 12-50
c.
Total Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Denominators (ages during the measurement period)
d.
Ages 5-11
e.
Ages 12-50 Total
f. Patients with persistent asthma and a visit during the measurement period. 5
0018 a.
Controlling High Blood Pressure Numerator Patients qualified per the denominator with most recent (within the measure period) Blood Pressure <140/90 mg/dL (systolic <140 AND diastolic <90).
b.
Denominator
Patients reaching 18-85 during measure reporting period, with and encounter during the measurement period, and NOT excluded. [4] [4] 0018 see NOT logic, includes End Stage Renal Disease and pregnancy
April 2013
Primary Care Quality Reporting
Practice Summary Data Reporting
Date:
Measures Data, Pediatric Practices Repeat for each Practice Site
Measure Reporting Period:
3rd Qtr 2012 - 2nd Qtr 2013
Practice Site Name: #
Measure #
1
0036
Description Use of Appropriate medications for Asthma Numerators (ages during the measurement period)
a.
Ages 5-11
b.
Ages 12-50
c.
Total Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Denominators (ages during the measurement period)
d.
Ages 5-11
e.
Ages 12-50
f.
Total Patients with persistent asthma and a visit during the measurement period.
2
0041 a.
Preventive Care and Screening: Influenza Immunization Numerator Patients qualified per the denominator who received OR reported previous receipt of an influenza immunization.
b.
Denominator All patients aged 6 months and older at start of measurement period and seen for a visit [1] between October 1 and March 31, NOT exceptions [2].
[1] 0041 Visits include varied office and other encounters, and occurrences of hemodialysis & peritoneal dialysis [2] 0041 See exceptions, includes documentation of medical, patient, and system reasons for not receiving influenza immuniation.
April 2013