Scott S. Berman, MD, MHA, RVT, FACS, DFSVS Pima Heart and Vascular

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Presentation transcript:

Scott S. Berman, MD, MHA, RVT, FACS, DFSVS Pima Heart and Vascular Meaningful Use: Linking Physician Compensation to Vascular Quality Initiative Metrics Scott S. Berman, MD, MHA, RVT, FACS, DFSVS Megon L. Berman, BS Pima Heart and Vascular Tucson, Arizona

Disclosures: None

Challenges Improve provider engagement in VQI Incentivize vascular providers with meaningful metrics

Challenges

Challenges

Challenges

Challenges https://qpp.cms.gov/mips/quality-measures

Challenges

Challenges

Challenges

Opportunities

Opportunities

Objective To evaluate the impact of incorporating Vascular Quality Initiative (VQI) metrics into a vascular surgery compensation package.

Methods A retrospective review of VQI data was performed for a single group of vascular surgeons for 2 years beginning January 2017 through December 2018. Long-term follow-up data acquired in this interval was entered for cases performed from January 2016 through December 2017. In year 1, there was no financial incentive tied to the VQI metrics. In year 2, the providers’ end of year quality bonus was dependent upon and equally divided between 7 VQI metrics that the providers themselves chose to include in their employment agreement.

Methods Metric Performance Level Required for Bonus LTFU for all VQI procedures >86% Patient discharged on statin and antiplatelet >85% % of CEA LOS > 1 day ≤7% or below risk adjusted expected % of EVAR LOS > 2 day ≤3% or below risk adjusted expected EVAR Sac diameter reported on LTFU >71% Use of ultrasound guidance for PVI ≥99% Use of chlorhexidine 100% LTFU, long-term follow-up; CEA, carotid endarterectomy; LOS, length of stay; PVI, peripheral vascular intervention.

Background The group is a multi-specialty group consisting of: 90 primary care providers 10 cardiologists 2 general surgeons 1 cardiothoracic surgeon 2 urologists 4 vascular surgeons

Background Year 1 of the review, only primary care provider contracts had bonus compensation linked to quality measures through MIPS. Vascular surgery compensation was purely RVU-based. Year 2 of the review, vascular surgery was under a new contract which employer required to include quality-based compensation. The vascular providers were able to define the quality metrics and chose to use VQI data.

Background VQI participation The vascular group has been a VQI participant since 2010 The providers do a significant portion of the data input Data manager oversees completion and coordinates follow-ups Modules: CEA Open AAA CAS TEVAR PVI Infrainguinal EVAR Suprainguinal Hemodialysis

Results Year 1 2016 2016 2017 LTFU EVAR Sack CEA LOS >1 2016 2016 2017 LTFU EVAR Sack CEA LOS >1 EVAR LOS >2 Statin/Plt US Guid Skin prep #1 7 86 100 #2 6 95 #3 50 25 85 #4 79 78 overall 86% 61% meets the bonus threshold does not meet bonus threshold

Results Year 2 2017 2017 2018 LTFU EVAR Sack CEA LOS >1 2017 2017 2018 LTFU EVAR Sack CEA LOS >1 EVAR LOS >2 Statin/Plt US Guid Skin prep #1 18 67 90 100 #2 6 5 95 #3 9 74 #4 43 NA 73 overall 93% 95% meets the bonus threshold does not meet bonus threshold provider left during the contract year

Summary Year 1 16/22 (73%) metrics achieved outcomes that met bonus threshold 15/20 (75%) individual 0/2 group Year 2 13/17 (76%) metrics achieved outcomes that met bonus threshold 11/15 (73%) individual 2/2 (100%) group

Conclusion Physician engagement in meeting VQI metrics has remained a challenge since the inception of the registry. LTFU and EVAR sack size are recent national examples with values of 74% and 56%, respectively. Our data suggest that provider engagement in meeting VQI metrics may be influenced by financial incentives.

Discussion Alternative Scenarios Hospital is the PSO/VQI contracting entity-independent providers Can engage vascular providers through service line agreements and include VQI metrics as part of the shared savings incentives Hospital is the PSO/VQI contracting entity-employed providers VQI metrics can be included in physician employment agreements as bonus benchmarks or as part of shared savings programs for value-based insurance contracts

Discussion Alternative Scenarios Physician group is the contracted PSO/VQI entity and work at multiple independent hospitals Limits the use of the data to within the physicians’ practice group e.g. designated benchmarks for shared savings insurance contracts

Thank you scott.berman@pimaheart.com