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

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” April 28, 2017

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 April 28, 2017

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 April 28, 2017

OPPE Process Medical Board Credentials Committee 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

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 April 28, 2017

Sample OPPE Data

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 April 28, 2017

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 April 28, 2017

Physician Query Workflow Patient Physician documents CDI Specialist and Coder review Code assigned Quality Scores Reimbursement Query? Response 70% physician response rate

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

Queries Affect Quality Reporting Sepsis Mass General Hospital Mayo Clinic Johns Hopkins Hospital 5-Star Rating * * * * * * * * * Actual Mortality 24.04% 12.16% 26.32% Predicted Mortality 22.66% 21.84% 20.70% # of cases reported 1115 1587 323 Source: http://www.healthgrades.com Mortality In-Hospital figures. Mar. 2016.

Partnership with artifact health Admission Concurrent Review & 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 Query Response & Individual Education Discharge E M R Retrospective Review & Coding Final Bill/Hold Auto-Generated Addendum Second Level Review

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

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 April 28, 2017

Final Word: Key Physician Motivators Design IT solutions that: Improve patient care or clinical outcomes Lead to increased efficiency Enhance reputation / quality rankings April 28, 2017