National Committee for Quality Assurance NCQA Physician Recognition Programs

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National Committee for Quality Assurance (NCQA)
Physician Recognition Programs

A Powerful Change Agent to Improve Quality and
Affordability

• Colette Rush
• Quality Improvement Specialist
• In collaboration with the Washington State
  Department of Health

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Three Physician Recognition Programs
Recognition is for 3 years

• Diabetes Physician Recognition Program (DPRP)
• Heart/Stroke Physician Recognition Program (HSRP)
  
• Physician Practice Connections (PPC)

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Why the NCQA Recognition Programs are Important
to the Alliance and DOH

• Advances and/or endorses tools and approaches
  that improve quality in the health care system
• Use of performance reporting to drive quality and
  affordability
• Use of evidence-based measures and care
• Use of the Chronic Care Model (CCM), a systems
  approach
• Use of registries and electronic medical records
  (EMRs)
• Support of the work of the Washington State
  Collaborative
• Use of recognition as an aligned incentive

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Recognition Encourages Practices to Transition by
Adding a Population-based Focus and a Systems
Approach to Improve Quality
Infrastructure in place for continuous and
consistent quality improvement
Evolution of Readiness
Apply for NCQA Recognition
Use a systems approach to care, to improve
quality based on clinical outcomes for
populations of patients
Use of registries to care for individuals and
populations of patients
Focus on individual patients only
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Measurement with Systems Change Leads to
Sustained Quality Improvement
of adult patients with
Diabetes Physician Recognition Program, average
performance of applicants, 1999-2005 data
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Why These Programs are Important for Physicians
and Practice Groups

• Provides distinction
• Enables practice against nationwide benchmarks
• Encourages creation of ongoing systems- driven
  quality improvement activities
• Promotes excellence in patient care across all
  payer networks
• Creates infrastructure for financial incentives
  (P4P), such as BTE
• Supports what is important to patients (quality
  and affordability)

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Why NCQA Recognition is Important to Payers and
Purchasers

• Drives quality and improved health, decreasing
  health care costs, increasing employee
  productivity and decreasing sick days
• Identifies best practices (best value)
• Recognize them
• Reward them
• Encourage members to choose them
• Provides infrastructure for P4P to drive practice
  change through aligned incentives

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NCQA Physician Recognition Program Features
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NCQA Physician Recognition General Features

• Uses nationally recognized reliable, valid
  measures
• Requires that the data is self-reported resulting
  in physician confidence in the results
• Defines excellence in care through having to
  meet robust performance thresholds
• Publicly recognizes physicians who meet criteria
• Creates an infrastructure to reward recognized
  providers (financial and non-financial)

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Who May Apply

• Individual primary care physicians OR physician
  groups
• Specialists including
• Endocrinology for Diabetes Program
• Cardiology for Heart in the Heart/Stroke Program
• Neurology for Stroke in the Heart/Stroke Program
• Applicants must have
• MD or DO license
• Provided 12 months of continuing care to patients
  with ischemic vascular disease or diabetes
• 25 eligible patients

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Patient Eligibility
DPRP
HSRP
See Standards and Guidelines for ICD-9 Codes for
Diabetes and IVD
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Sample Size Requirements
Data from medical records (electronic or paper),
registries or administrative systems
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Diabetes Physician Recognition Program

• Scored Measures
  Threshold Weight
• ( of patients in sample)
• HbA1c Control lt7.0 40
  10.0
• HbA1c Poor Control gt9.0
  ?15 15.0
• Blood Pressure Control gt140/90 mm Hg
  ?35 15.0
• Blood Pressure Control lt130/80 mm Hg
  25 10.0
• LDL Control gt130 mg/dl
  ?37 10.0
• LDL Control lt100 mg/dl
  36 10.0
• Eye Examination 60
  10.0
• Foot Examination 80
  5.0
• Nephropathy Assessment 80
  5.0
• Smoking Status and Cessation Advice 80
  10.0
• or Treatment
• Total weight 100.0
• Percent to Achieve Recognition
  75.0

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Heart/Stroke Physician Recognition Program

• Scored Measures
  Threshold Weight
• ( of patients in sample)
• Blood Pressure Control lt140/90 mm Hg
  75 10.0
• Complete Lipid Profile
  80 10.0
• LDL Control lt100 mg/dl
  50 10.0
• Use of aspirin or another anti-thrombotic 80
  10.0
• Smoking Status and Cessation Advice or
  80 10.0 Treatment
  
• Total weight 50.0
• Points to Achieve Recognition
  40.0

Partial points available for this condition
only
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Cost
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Estimated Time Required for Recognition
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Materials to Purchase and Download

• Access the DPRP or HSRP website at
  www.ncqa.org/hsrp or www.ncqa.org/dprp
• Purchase application package
• Purchase the HSRP or DPRP workbook
• Download and print Quick Start instructions
• Download training calendar

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Enter Data Into Workbook

• Workbook is purchased from NCQA, by phone or at
  www.ncqa.org/publication for 60
• Requires Microsoft Excel (Office2000 version or
  later)
• Enables user to collect and submit data for
  evaluation for recognition
• Is non-refundable

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Support From the Department of Health

• Grants are available for some group and
  individual practices for application fees
• 50 of funds will be awarded to apply for DPRP,
  50 awarded to apply for HSRP
• Grant process extends through June 30, 2007
• Support is available to assist practices in
  pulling patient data from CDEMS (for practices
  who use CDEMS)

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Contacts for Next Steps

• DOH To apply for a scholarship to assist with
  application fees
• Miriam Patanian, MPH
• Heart Disease and Stroke Prevention Program
  Manager
• Washington State Department of Health
• 360-236-3792 Miriam.Patanian_at_doh.wa.gov
• NCQA For detailed information and training
  schedule www.ncqa.org/hsrp www.ncqa.org/dprp
  
• Alliance For interested providers to receive
  detailed presentation on what it takes to apply
  for recognition
• Colette Rush, RN, BSN,CCM
• Quality Improvement Specialist
• 206.448.2570, ext. 122 crush_at_pugetsoundhealtha
  lliance.org