|
Patient Condition |
Quality Standard |
Explanation |
|
Centers
for Medicare and Medicaid |
All |
Physician Group Practice Demonstration
(BIPA 2000) |
Mandated by the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA),
this demonstration is the first pay-for-performance initiative for physicians
under the Medicare program. The demonstration rewards physicians for improving
the quality and efficiency of health care services delivered to Medicare
fee-for-service beneficiaries. The demonstration seeks to encourage coordination
of Part A and Part B services, promote efficiency through investment in
administrative structure and process, and reward physicians for improving
health outcomes. |
| End-Stage Renal Disease Patients |
Physicians |
The End-Stage Renal Disease (ESRD) Disease Management Demonstration will
increase the opportunity for Medicare beneficiaries with ESRD to join integrated
care management systems. The demonstration is designed to test the effectiveness
of disease management models to increase quality of care for ESRD patients
while ensuring that this care is provided more effectively and efficiently.
|
| All |
Physicians |
Pilot program to award continuing medical education credits to physicians
who participate in quality improvement projects with Medicare's Quality
Improvement Organizations. The pilot project aims to boost the number of
physicians in outpatient and office settings participating in quality improvement
efforts. |
|
CMS/Medicare/Modernization
Act 2003/Grants to Physicians (electronic prescribing) |
All |
Physicians |
HHS is authorized to make grants to physicians to assist them in implementing
electronic prescription drug programs. Grants would help pay for the purchasing,
leasing and installing of software and hardware – including handheld computer
technology – making upgrades to existing systems; and training staff. |
|
National Quality Forum |
All |
30 NQF Endorsed Medical Practices |
The National Quality Forum (NQF) is a not-for-profit membership organization
created to develop and implement a national strategy for health care quality
measurement and reporting. |
|
American
College of Physicians |
All |
ACQA (Starter set only as of 9/2005) |
For physicians, it is no longer a question of whether they will be asked
to participate in such programs, but when and how many. In response to the
growing demand, a national consortium of large employers, public and private
payers, and physician groups began meeting last year to formulate a strategy
for nationwide ambulatory performance measurement and reporting. The goal
of this Ambulatory Care Quality Alliance (ACQA) is to provide evidence-based
guidelines vetted by leading medical organizations, quality groups, purchasers
and health plans for the many incentive programs already planned or in operation.
The idea behind the ACP pilot is to give CME credit to physicians for changing
their behavior and improving patient outcomes, not just answering questions
using PDAs. |
Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
|
All |
JCAHO is offering principles to guide the
development and refinement of current and future pay-for-performance programs.
|
Alignment
of payment program incentives to support the provision of safe, high quality
care is a complex undertaking, for it must simultaneously achieve fair
reimbursement for necessary services; promote desired behavior change;
and avoid unintended consequences. In the end, new payment policies and
programs must work to the advantage of the patient and support the provision
of patient-centered care. |
|
Agency for Healthcare
Research and Quality (AHRQ) |
All |
Physicians and Consumers |
The mission of this effort—named
the Ambulatory care Quality Alliance (AQA) is to:
Improve health care quality and patient safety through a collaborative process
in which key stakeholders agree on a strategy for measuring performance
at the physician level; collecting and aggregating data in the least burdensome
way; and reporting meaningful information to consumers, physicians and other
stakeholders to inform choices and improve outcomes. |
|
Aetna Healthcare |
All |
Focus is Physicians in multiple states |
In 2002, Aetna rejuvenated its physician incentive program, the Quality
Enhancement (QE) program. The quality measures employed by Aetna's QE program
reflect the nationwide and regional aspect of the insurer. The program rewards
primary care physicians for their scores on several measures intended to
evaluate the quality of care and service physicians provide to members.
|
|
American Academy of
Family Physicians |
All |
Physicians and EHRs |
The American Academy of Family Physicians has entered a deal with eight
companies, including General Electric and Siemens, to offer its members
discounts on systems to manage electronic medical records. |
| All |
ACP PDA Pilot |
The idea behind the ACP pilot is to give CME credit to physicians for
changing their behavior and improving patient outcomes, not just answering
questions using PDAs. |
|
Multi
State Initiatives |
All |
Physicians |
MA, VA, WI, IL, NM, NY, PA, NJ, CA, MN, HI, MO, MI, AL, KY, OH, NH. TX,
WA, FL all have pay for performance incentives applicable in their states. |
|
The
Leapfrog Group
It is anticipated that many
of the Leapfrog standards will become pay for performance standards. |
All |
The Leapfrog Hospital Rewards Program |
The Leapfrog Hospital Rewards
Program (LHRP) is a pay-for-performance program that recognizes and rewards
hospitals for their performance in both the quality and efficiency of
inpatient care.
The LHRP can be licensed and implemented
by private healthcare purchasers -- employers, healthcare coalitions,
and health plans -- to reward hospitals for performance. |
| Critical Care Patients |
ICU Physician Staffing |
Scientific
evidence suggests that quality of care in hospital ICUs is strongly influenced
by whether intensivists are providing care and the staff organization
in the ICU. Mortality rates are significantly lower in hospitals with
ICUs managed exclusively by board-certified intensivists. Research has
shown that in ICUs where intensivists manage or co-manage all patients
versus low intensity there is a 30% reduction in hospital mortality and
a 40% reduction in ICU mortality. The Leapfrog Group has implemented an
"IPS" staffing standard. |
| Computer Physician Order Entry (CPOE) |
Physicians |
The
potential benefits for patients, payers and providers led national experts
in health care quality and safety to recommend computer physician order
entry as one of Leapfrog's recommended practices. Recent research shows
that if this Leapfrog practice was implemented in all urban hospitals
in the U.S. we could prevent as many as 907,600 serious medication errors
each year . Studies have also shown that CPOE reduces length
of stay; reduces repeat tests; reduces turnaround times for laboratory,
pharmacy and radiology requests; as well as delivering cost savings. The
Leapfrog Group has implemented a standard for CPOE |
| All |
Physician Office Decision
Support
Physicians |
In
the outpatient setting, The Leapfrog Group has worked with the Centers
for Medicare and Medicaid and the Agency for Healthcare Research and Quality
to outline a "leap" for physician offices. The leap requires
doctors to use computers for prescriptions to avoid errors, to track laboratory
results electronically and to receive electronic patient care reminders
regarding nationally recognized medical guidelines when providing care
to patients with particular chronic conditions. This leap is being rewarded
today through another employer led initiative called Bridges to Excellence
an important partner of Leapfrog. |
| Diabetics and Cardiac Patients |
Bridges to Excellence Physicians |
The Bridges to Excellence
(BTE) initiative is comprised of three individual programs, each of which
is designed to promote and reward physicians for improving the quality
of patient care:
- Physician Office Link (POL): rewards office practices for the use
of systematic information to enhance the quality of patient care
- Diabetes Care Link (DCL): rewards physicians for demonstrating good
outcomes in diabetes care
- Cardiac Care Link (CCL): rewards physicians for demonstrating good
outcomes in cardiac care
Physicians who demonstrate high levels of performance in these program areas
are eligible for incentive bonuses paid by participating purchasers. Each
of the three programs has its own rewards and performance criteria. |
|
National Committee for
Quality Assurance (NCQA) |
All |
Physicians and others |
NCQA is an independent, 501(c)(3) non-profit organization whose mission
is to improve health care quality everywhere. Part of a consortium encouraging
pay for performance. |
|
Doc-IT |
ALL |
EHR Vendors |
Collects information about characteristics of vendors' systems. Vendors participate on a voluntary basis. Many vendors have now completed the Doc-it questionnaires. |
The are but a small sample of organizations and standards categories that have been cataloged. Be sure in any EHR you might consider, that as part of the selection process, you determine which of these is important in your practice and which EHR developers offer them in their systems.
