1. Alphabet Soup-The Latest Flavor AQI QCDR CMS SCIP VBP MU HCAHPS NACOR RGG-17 Dec, 2014

3. The Federal Government-Come a Little Closer Provide us with metrics-we don’t care how you do! We’ll give you money We’ll give you less money We’ll give you NO money Provide us with metrics-we will measure and compare your performance! We might take away money(payment adjustment) And BTW, how you do this year affects your payments two years from now Stop providing us this metric-everyone is doing well and we don’t care about it anymore Current state?

4. PQRS-Current Four measures Antibiotic timing-#30 Beta Blocker use in patients having CABG procedures-#44 Central line insertion sterile barrier technique-#76 Temperature management-#193 Recorded by us Submitted by Plexus Claims based reporting Graded by CMS Additional CMS reimbursement up through 12/31/2014

5. Problems with the old PQRS paradigm CMS holds all the power and makes up the rules We must submit exactly what CMS dictates Some measures may be meaningless i.e. there is no EBM behind the measure Measures can be difficult to collect

6. From Old to New

7. PQRS reborn: QCDR-what’s the big deal Specialty driven-Qualified Clinical Data Registry Over 35 specialty specific QCDRs Combine CMS PQRS measures with specialty specific measures the specialty deems important In theory measures are more relevant since they are primarily specialty driven Moves responsibility for measure development, data collection and reporting from CMS to the specialty society registry-measures must still be “approved” NACOR (AQI/ASA) is one of the first registries certified under this program 19 measures were approved for the first year, 2014

8. So Where’s the Good News Of the 19, we only have to report on 9 We get to choose the ones to report We have a place and a face with whom to communicate (AQI/ASA) QCDR (aka ASA) is somewhat sympathetic to our cause and has tried to make this as easy as possible

9. Anesthesia Measures in the QCDR 4 existing PQRS measures (antibiotic timing, central line sterile placement, PACU normo-thermia, beta blockade for CABG patients) Also from PQRS: Medication reconciliation (#130) Smoking cessation screening (#226) Acute pain management (#342) Preoperative risk assessment (#358)

10. Anesthesia Measures (ASA) in the QCDR Post-op transfer of care protocol OR to PACU Post-op transfer of care protocol OR to ICU Prevention of PONV, adults Prevention of PONV, pediatrics OR/PACU cardiac arrest rate OR/PACU all-cause mortality Successful completion of planned procedure (composite anesthesia safety) PACU Re-intubation rate Short-term pain management CVL composite procedural safety Composite patient experience

11. PAI and QCDR-going forward Continue to provide excellent clinical care Collect and report measures with clinical relevance to our practice Leverage existing data collection mechanisms to minimize additional workload by clinicians and staff (Paula), and our billing company Favor measures that are “easily” reportable using those mechanisms Act on measures’ information to further improve care

12. PAI and QCDR-WHO

13. The Importance of YOU QCDR changes our AQI paradigm Real attestations Real penalties Real consequences Real data required

14. Time to Commit

15. PAI and QCDR-WHAT PQRS 30-Antibiotic prophylaxis-retired, pending CMS approval as ASA measure PQRS 44-Administration of Beta blocker within 24 hours prior to isolated CABG procedure PQRS 76-Central Line Sterile Barrier Technique PQRS 193-Perioperative Temperature, Active Warming ASA 6-Use of a checklist upon transferring care-to the ICU ASA 9-Use of a checklist upon transferring care-to the PACU ASA 10-Composite Anesthesia Safety ASA 11-Perioperative Cardiac Arrest Rate ASA 12 Immediate Perioperative Mortality Rate ASA 13 PACU Reintubation Rate ASA 15 Composite Procedural Safety for Central Line Placement

16. PAI and QCDR-WHERE Epic (paper records)-primary data source for process measures Green sheet-primary data source for outcome measures Eventually this will move to Epic (protected server) Plexus data extraction (out billing company) Green sheet extraction (Paula) Upload combined data file (AQI)

17. PAI and QCDR-WHEN Starting 2015 Another piece of good news We will start in earnest at Epic go-live Three months to work out the bugs

18. PAI and QCDR-HOW Epic Measures button CVL procedure note Post procedure use of Transfer of Care checklist

19. Measures-PQRS 30, PQRS 193, PQRS 44

20. Measures-PQRS 44, ASA 11, ASA 12

21. PQRS 76

22. ASA 6/9 Transfer of Care Checklist Use

25. End of Case Checks

27. In Summary

28. We Don’t Want to Think Like This

29. So We Can Avoid This

30. Thank you!