1. PRE-CONFERENCE WORKSHOP PPRNet 101

2. introductions
Who you are
Why you are here
What you hope to learn

3. Workshop Goals
To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”
Introduce (or reintroduce) PPRNet and its mission
Provide an overview of PPRNet reports
Share examples of how practices use PPRNet reports to achieve recognition and/or incentives
Allow time for participants to use reports and network with one another

4. agenda 1:00pm-1:15pm Introductions Vanessa Congdon Andrea Wessell
What is PPRNet?
1:30pm-2:00pm
PPRNet Performance Reports and FAQs
2:00pm-2:30pm
Using PPRNet Tools for Recognition and Incentive Programs
2:30pm-2:45pm
Break
2:45pm-3:00pm
Recognition/Incentive Programs, continued
3:00pm-3:15pm
PPRNet Top 10 List for Quality Improvement
3:15pm-4:00pm
Open Session
Demonstrations, Follow-up Discussions
All Participants

5. Revise agenda? 1:00pm-1:15pm Introductions Vanessa Congdon
Andrea Wessell
1:15pm-1:30pm
What is PPRNet?
1:30pm-2:00pm
PPRNet Performance Reports and FAQs
2:00pm-2:30pm
Using PPRNet Tools for Recognition and Incentive Programs
2:30pm-2:45pm
Break
2:45pm-3:00pm
Recognition/Incentive Programs, continued
3:00pm-3:15pm
PPRNet Top 10 List for Quality Improvement
3:15pm-4:00pm
Open Session
Demonstrations, Follow-up Discussions
All Participants

6. What is pprnet?
“A practice-based learning and research organization designed to improve health care in its member practices and elsewhere in the United States.”

7. What is pprnet? Primary (care) Practices Research Network
A virtual network of primary care practice teams and researchers that aims to:
Turn EHR data into actionable information for clinicians and practice staff
Empirically test theoretically sound primary care quality improvement interventions
Disseminate interventions that improve primary health care

8. “Blur the distinction between quality improvement and research”
PPRNet Aims to…
“Blur the distinction between quality improvement and research”
3 aims

9. PPRNet: Primary Care Practice-Based Research and learning Network

10. PPRNet
Agency for Healthcare Research and Quality Center for Primary Care Practice-Based Research and Learning
Answer questions relevant to practice
Disseminate findings

11. Pprnet research Primary Care-Relevant Questions
“Preventive Services Delivery in Patients With Chronic Ilnesses: Parallel Opportunities Rather Than Competing Obligations”
“Learning from Primary Care Meaningful Use Exemplars”
Translating Research into Practice (TRIP) Interventions
Impact studied across a variety of clinical areas
Prevention, chronic disease management, acute care and medication safety
A-TRIP, C-TRIP, SO-TRIP, MS-TRIP, AM-TRIP, CKD-TRIP…

12. Practice spotlight: NEW London Family Medicine

13. Disseminating “lessons learned”
Ongoing PPRNet Activities
Annual meetings
Monthly webinars
Listserv
Social media
Publications
Presentations

14. PPRNET PERFORMANCE REPORTS
Patient & Provider- Level Report
Practice-Level Performance Report

15. Clinical Practice Quality Measures
MEASURE CONDITION #
Diabetes Mellitus 12
Cardiovascular Disease 17
Women’s Health Care 2
Cancer Screening 3
Immunizations 8
Mental Health & Substance Abuse 6
Respiratory Disease 4
Medication Safety 15
TOTAL: 67

16. Practice Performance Report
67 Quality Indicators
3 Summary Measures
SPC Methodology
Time trends – Monthly over 2 years
Comparison with PPRNet benchmark (ABC)
Comparison with national benchmarks (when available)

17. Patient-Level Report (PLR)
Excel Spreadsheet with 78 tabs:
PPRNet Switchboard
Practice Performance on Individual Measures
Provider Performance on Individual Measures
Patient Registry
PPRNet Measure Groupings (8 tabs)
Patient Lists of those not meeting criteria for each of 67 Individual Measures
Same indicator criteria as practice report
All “active” patients ≥ 3 months age

18. PPRNet Switchboard

19. PRACTICE PERFORMANCE ON Individual Measures

20. Provider Performance on Individual Measures

21. Patient Registry

22. CMS MU CQM

23. CMS ACO CQM

24. USPSTF Recommendations (Grade A and B)

25. CDC Advisory Committee on Immunization Practices Recommendations

26. NIAAA Alcohol Screening and Intervention Recommendations

27. CDC Get Smart Treatment Guidelines for URI’s

28. CMS PQRS CQM Groupings

29. PQRS DM TAB
All Pts with DM

30. PQRS DM LIST

31. ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction

32. ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction Hierarchical Statin Benefit Groups
ADULTS >=21 years old
Diagnosis of ASCVD (CHD or Atherosclerosis)
Highest LDL-C >=190 mg/dL
Diagnosis of Diabetes Mellitus; age yr
Estimated 10-yr ASCVD Risk >=7.5% age yrs

33. ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction Estimated 10-yr ASCVD Risk Equations
Age
Sex
Race
Total Cholesterol
HDL-CSystolic BP
Hypertension Dx
Diabetes Mellitus
Dx Smoking Status
Systolic BP
Hypertension Dx
Diabetes Mellitus Dx
Smoking Status

34. Q: What data are used for calculating performance?

35. A (part 1): Report guide details data source for each measure
Highlight other things in appendix

36. Identifiers (ie, CMS id, NQF # or PQRS id) cited in reports
A (part 2): PPRNet measures are now aligned with Meaningful Use Clinical Quality Measures
Applies to some new measures (ie, eye exam in patients with diabetes) and new categories (ie, ACO CQMs)
Identifiers (ie, CMS id, NQF # or PQRS id) cited in reports

37. How do I UPLOAD MY DATA EXRACT AND access my reports?

38. New DATA Extract
PP users will be migrating to a new extract process for October reports
McKesson support for prxtract ends in October
The MUSC OCIO has worked with us to develop a “vendor neutral” extraction process
New reports will include patient identifiers!

39. Summary: PPRNet Reports in Practice
Evaluate performance over time
Identify patients overdue for care
Engage, motivate, and incentivize practice team
Demonstrate quality of care for quality recognition and incentive programs

40. questions
To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”
Introduce (or reintroduce) PPRNet and its mission
Provide an overview of PPRNet reports
Share examples of how practices use PPRNet reports to achieve recognition and/or incentives
Allow time for participants to use reports and network with one another

41. USING REPORTS FOR RECOGNITION AND INCENTIVE PROGRAMS

42. Recognition and incentive programs
PPRNet practices use reports for a variety of local and national quality recognition and pay for performance programs
During this session, we will highlight:
NCQA Patient-Centered Medical Home
CMS Physician Quality Reporting System

43. Pprnet 101: glossary NCQA PCMH CMS PQRS ABFM PLR SQUID
What is your experience with these recognition programs?
How has your practice benefited from recognition?

44. NCQA PCMH 2014 Standards
Published in March 2014 (must be used by March 2015)
Revisions to align with MU Stage 2, reflect PCMH evidence base and from stakeholder input
Major edits in the areas of:
Care management of high-need populations
Team-based care
Focus on triple aim domains (patient experience, cost, clinical quality)
Sustaining transformation
Integration of behavioral health
NCQA = national co for quality assurance

45. NCQA PCMH 2014 Content and Scoring (6 standards/27 elements)
1: Enhance Access and Continuity
*Patient-Centered Appointment Access
24/7 Access to Clinical Advice
Electronic Access
Pts
4.5
3.5 2 10
2: Team-Based Care
Continuity
Medical Home Responsibilities
Culturally and Linguistically Appropriate Services (CLAS)
*The Practice Team 3
2.5 4 12
3: Population Health Management
Patient Information
Clinical Data
Comprehensive Health Assessment
*Use Data for Population Management
Implement Evidence-Based Decision- Support 5 20
4: Plan and Manage Care
Identify Patients for Care Management
*Care Planning and Self-Care Support
Medication Management
Use Electronic Prescribing
Support Self-Care and Shared Decision-Making
Pts 4 3 5 20
5: Track and Coordinate Care
Test Tracking and Follow-Up
*Referral Tracking and Follow-Up
Coordinate Care Transitions 6 18
6: Measure and Improve Performance
Measure Clinical Quality Performance
Measure Resource Use and Care Coordination
Measure Patient/Family Experience
*Implement Continuous Quality Improvement
Demonstrate Continuous Quality Improvement
Report Performance
Use Certified EHR Technology
Practice Team is new
Care Management was must pass – now combined with “care planning and self-care support”
All other must pass are the same
Same total points
Scoring Levels
Level 1: points.
Level 2: points.
Level 3: points.
*Must Pass Elements 45

46. PCMH 2: Team-based care Element 2D: The Practice Team
The practice uses a team to provide a range of patient care services by:
Defining roles for clinical and nonclinical team members
Identifying practice organizational structure and staff leading and sustaining team based care
Having regular patient care team meetings or a structured communication process focused on individual patient care*
Using standing orders for services
Training and assigning members of the care team to coordinate care for individual patients
(continued)
2 and 8 are new
3 is critical factor
Other factors were a part of 2011 Standard 1 “Enhance Access and Continuity”
Documentation for Factor 3 – description of communication and at least 3 examples
Factor 2: The practice delineates responsibilities for sustaining team-based care, and specifies how care teams align to provide patient-centered care. Specific team units may focus on providing care coordination across and beyond the practice (factor 5). An organizational chart may be used to illustrate how a care team fits in the practice.
8 (regular team mtngs) Factor 8: Description of staff communication processes and sample

47. PCMH 2: Team-based care
Training and assigning members of the care team to support patients/families/caregivers in self-management, self-efficacy and behavior change
Training and assigning members of the care team to manage the patient population
Holding regular team meetings addressing practice functioning
Involving care team staff in the practice’s performance evaluation and quality improvement activities
Involving patients/families/caregivers in quality improvement activities or on the practice’s advisory council
2 and 8 are new
3 is critical factor
Other factors were a part of 2011 Standard 1 “Enhance Access and Continuity”
Documentation for Factor 3 – description of communication and at least 3 examples
Factor 2: The practice delineates responsibilities for sustaining team-based care, and specifies how care teams align to provide patient-centered care. Specific team units may focus on providing care coordination across and beyond the practice (factor 5). An organizational chart may be used to illustrate how a care team fits in the practice.
8 (regular team mtngs) Factor 8: Description of staff communication processes and sample

48. PPRNet Tools PPRNet Improvement Model as background
Build team meeting agendas based on PPRNet reports, webinars or network meeting topics
Use plans for Element 3D (Population Management) or 4A (Care Management and Support) to document responsibilities for team-based care

49. PCMH 3: Plan and Manage Care
Element 3D: Use Data for Population Management (MUST PASS)
At least two different preventive care services
At least two different immunizations
At least three different chronic or acute care services
Patients not recently seen by the practice
Medication monitoring or alert
Documentation:
Factors 1-5: Lists or summary reports of patients who need services within past 12 mo. (Health plan data okay if 75% of patient population) and
Factors 1-5: Documented process demonstrating staff responsibilities and desired timing of reminders and materials showing how patients were notified for each service.
The practice must perform these functions at least annually and make documentation of each reminder available to NCQA upon request.

50. PCMH 3: PLAN AND MANAGE CARE
PPRNet Patient-level Report (PLR) includes lists of patients:
With specific diagnoses
Needing preventive services, including immunizations
Requiring clinician review
or action
Taking specific medications
Factor 1- Pts who need preventive screening or immunizations (at least 3 different immunizations or screenings)
Factor 2-Pts who need acute or chronic care services (at least 3 different services)
Factor 3-Pts who have not had recent appointment (practice may use own criteria)
Factor 4-Pts on specific medications

51. PPRNet Tools Add narrative describing who does what
Save examples of letters or chart flags
Pick 2-3 areas to work on every quarter to “complete” all in 12 months

52. PCMH 4: Care Management and Support
Element 4A: Identify Patients for Care Management
Systematic process and criteria for identifying patients who may benefit from care management The process includes consideration of the following:
1. Behavioral health conditions
2. High cost/high utilization
3. Poorly controlled or complex conditions
4. Social determinants of health
5. Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver
6. The practice monitors the percentage of the total patient population identified through its process and criteria*
Factors 1-6 are new, previously you could define it on your own.
Documentation
Factors 1-5: Criteria and process for identifying patients.
Factor 6: Report showing number and percentage of patients identified as likely to benefit from care management through one or any combination of the other five factors or other criteria determined by the practice.
Must meet #6 to get any points

53. PCMH 4: Care Management and Support
Performance Reports
Use Summary Quality Index (SQUID) as marker of “poorly controlled or complex conditions”
Define your practice’s target SQUID
Patients that fall below this = patients that may benefit from care management
Use a screen shot of PLR to document the number of patients that fall into this category
Track this number (and % of total patients)
Design and implement care management plan for Element 4B (MUST PASS)

54. PCMH 6: measure and improve performance
“The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.”
Measure Clinical Quality Performance
Measure Resource Use and Care Coordination
Measure Patient/Family Experience
*Implement Continuous Quality Improvement
Demonstrate Continuous Quality Improvement
Report Performance
Use Certified EHR Technology

55. PCMH 6: measure and improve performance
Element 6A: Measure Clinical Quality Performance
At least annually, the practice measures or receives data on:
At least 2 immunization measures
At least 2 other preventive care measures
At least 3 chronic or acute care clinical measures
Performance data stratified for vulnerable populations (to assess disparities in care)
Vulnerable populations are “those who are made vulnerable by their financial circumstances or place of residence, health, age, personal characteristics, functional or developmental status, ability to communicate effectively, and presence of chronic illness or disability,” (AHRQ) and include people with multiple comorbid conditions or who are at high risk for frequent hospitalization or ER visits.

56. PCMH 6: measure and improve performance
Element 6D: Implement Continuous Quality Improvement (MUST PASS)
Ongoing QI process that includes regular review of performance data and evaluation of performance against goals or benchmarks to:
Set goals and analyze at least 3 CQM from A
Act to improve at least 3 CQM from A
Set goals and analyze at least 1 measure from B
Act to improve at least one measure from B
Set goals/analyze at least 1 patient experience measure from C
Act to improve at least one patient experience measure from C
Set goals and address at least one identified disparity in care/service for identified vulnerable populations
Vulnerable populations are “those who are made vulnerable by their financial circumstances or place of residence, health, age, personal characteristics, functional or developmental status, ability to communicate effectively, and presence of chronic illness or disability,” (AHRQ) and include people with multiple comorbid conditions or who are at high risk for frequent hospitalization or ER visits.

57. PCMH 6: measure and improve performance
Element 6E: Demonstrate Continuous Quality Improvement
Ongoing effort of assessing, improving and reassessing
Emphasis on ongoing QI to demonstrate that practice has gone beyond setting goals
Measuring effectiveness of actions it takes to improve measures selected in D
Achieving improved performance on at least 2 CQM
Achieving improved performance on one utilization or care coordination measure
Achieving improved performance on at least one patient experience measure

58. PCMH 6: measure and improve performance
Element 6F: Report Performance
Results reflect care provided to all patients in the practice, not only patients covered by a specific payer and shares:
Individual clinician performance results with the practice
Practice-level performance results with the practice
Individual clinician or practice-level performance results publicly
Individual clinician or practice-level performance results with patients

59. PCMH 6: measure and improve performance
Use PPRNet reports to show how your practice measures clinical quality performance, implements QI, demonstrates QI and reports performance across:
Clinical processes
Clinical outcomes

60. More on PPRNet research and PCMH saturday…
Engaging patients in upcoming and planned projects as part of the “Practice Team” element

61. Other pcmh examples
What other ways have you applied PPRNet tools to PCMH work?
How has your practice benefited from PCMH recognition?

62. BREAK

63. CMS Physician Quality Reporting System (PQRS)
“A reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).”
Evolved from the Physician Quality Reporting Initiative (PQRI)
Aims to reach 50% of EPs by 2015
Regulations made permanent in 2008

64. PQRS
Is this “old news”?
Have you used PPRNet reports for this program in the past?

65. PQRS incentives/adjustments
2014: % of total estimated allowed charges for Medicare Part B Physician Fee Schedule during reporting period
2015: % based on 2013 participation
2016-: -2% based on 2014 participation
Additional +0.5% incentive with Maintenance of Certification Program participation
Regulations made permanent in 2008
2009 avg payment (2% incentive) ~$1100
MOC with practice assessment

66. PQRS Reporting Mechanisms
Claims
Registry
Qualified Clinical Data Registry (QCDR)
Certified EHR Technology
Group Practice Reporting Options
Stay tuned – PPRNet will apply for 2015!
CMS recognized Registry or EHR – not the same as MU
30 pts seen Jan – Dec 2011
Registry options:
NCQA DRP for ex
Clinicians Applying for Recognition and Submitting Data for PQRS:
For clinicians who achieve Recognition in 2011 or who apply for Recognition in 2011 with the appropriate fee, the PQRS application fee is $50.00 per clinician in addition to the Recognition application fee of $500.
Clinicians Already Recognized and Submitting Data for PQRS Only:
For clinicians who have a current Recognition with a start date prior to 2011, i.e., 2008, 2009, 2010, the application fee is $150 per clinician.

67. All Pts with DM
tab in pprnet plr

69. PQRS is pay for reporting
See note regarding > 0% requirement for full sample

72. Using pprnet reports for pqrs
For 2014, use October 2014 PLR to fill out ABFM registry/report to CMS
ABIM diplomates, check PQRS page for other registry options ($)
For 2015, look for news of PPRNet becoming a Qualified Clinical Data Registry
More tomorrow!

73. Physician compare

74. PPRNet’s “Top 10” List for Quality Improvement

75. 1. Identify a Clinician Leader

76. 2.Use PPRNet reports to identify opportunities for improvement and monitor progress.

77. 3. Select a limited number of priorities for improvement and build on incremental successes

78. 4. Adopt standing orders and have all staff function at the top of their licenses

79. 5. Educate staff members as needed for their expanded roles

80. 6. Hold regular practice “PPRNet meetings”

81. 7. Use HM broadly and establish a practice goal to “get the red out”

82. 8. Use PPRNet patient-level reports (PLRs) for patient case management and/or outreach.

83. 9. Provide staff incentives for achieving improvement goals.

84. 10. Participate in PPRNet projects and attend PPRNet meetings.

85. Open Session “Making the Most” of PPRNet

86. recap
First time attendees, how many new acronyms have you learned today?
“Refresher” attendees, what new thing(s) did you learn?

87. recap
To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?”
Introduce (or reintroduce) PPRNet and its mission
Provide an overview of PPRNet reports
Share examples of how practices use PPRNet reports to achieve recognition and/or incentives
Allow time for participants to use reports and network with one another

88. Use your reports! Talk to each other!
Open session
Use your reports! Talk to each other!
Identify patients for NCQA PCMH population management or care management standards
Identify 1 or 2 areas for improvement from your practice report

89. agenda 5:30 pm Happy Hour Rooftop at Vendue Inn, 19 Vendue Range
Presenters Dinner (Invitation only)
Blossom, 171 East Bay Street
Friday, August 22, 2014
7:15 am
Breakfast & Registration 
8:00 am
Welcome 
8:15 am
Plenary: Improving the Quality of Primary Care Through "Meaningful" EHR Use  

90. Follow-up needs assessment
Webinar topic suggestions