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”
April 28, 2017

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
April 28, 2017

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
April 28, 2017

5. 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

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
April 28, 2017

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
April 28, 2017

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
April 28, 2017

10. Physician Query Workflow
Patient
Physician documents
CDI Specialist and Coder review
Code assigned
Quality Scores Reimbursement
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
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: Mortality In-Hospital figures. Mar

13. 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

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
April 28, 2017

16. 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