Physician Consortium for Performance Improvement Excellence in health

Physician Consortium for ® Performance Improvement Excellence in health care delivery and Fairness in provider accountability

Quality of Health Care in US • Adults do not receive almost half of the clinical services from which they would likely benefit 1 • Other countries achieve better performance on many measures despite higher per capita health care spending in US vs. other industrialized countries 2 • Spending levels vary widely among U. S. regions 3 – No evidence that more expensive regions have either better quality or improved health outcomes Ø From IOM, Pathways to Quality Health Care (Dec. 2006) 1. 2. 3. Mc. Glynn et al, 2003 Hussey et al. , 2004; Reinhardt et al. , 2004 Baicker and Chandra, 2004; Fisher et al. , 2003 a, b

“The full potential of current [quality improvement] initiatives cannot be realized without a coherent, robust, integrated performance measurement system that is purposeful, comprehensive, efficient, and transparent. ” ØFrom IOM Pathways to Quality Health Care (Dec. 2006)

Landscape: Who Does What Measure Development National Selection and Endorsement Measure Implementation AMA-convened Physician Consortium for Performance Improvement® (Consortium), National Committee for Quality Assurance (NCQA), JCAHO, specialty societies, others National Quality Forum™ Ambulatory Care Quality Alliance Centers for Medicare and Medicaid Services (CMS), private plans, NCQA, medical specialty boards, continuing medical education (CME), electronic health record vendors, physicians/practices, private sector regional measurement initiatives

PCPI Mission • Improve patient health and safety by – Identifying and developing evidence-based clinical performance measures – Promoting the implementation of clinical performance improvement activities – Advancing the science of clinical performance measurement and improvement

PCPI Membership (1) • PCPI Membership is open to – National medical specialty societies and state medical societies in the AMA House of Delegates who wish to participate – ABMS and its member boards – Health care professional organizations – Individuals/organizations committed to health care quality improvement and/or patient safety, and participants in the development, review, dissemination or implementation of performance measures and measurement resources.

Current PCPI Membership (2) • More than 100 national medical specialty and state medical society representatives • Council of Medical Specialty Societies • American Board of Medical Specialties and its member boards • Experts in methodology and data collection • Agency for Healthcare Research and Quality • Centers for Medicare and Medicaid Services • Convened and staffed by AMA

PCPI Governance • Governance – In October 2006, formal PCPI governance and structure (Bylaws and Rules and Procedures) was adopted by its members, the AMA, and the Council of Medical Specialty Societies (CMSS) • PCPI Executive Committee – Expanded to include representatives from the AMA, CMSS, and the six largest national medical societies, as well as others from the Consortium membership.

Measure Development (1) • Identifying opportunities for improvement • Involving representatives from all medical specialties and other relevant health care disciplines in the process • Linking measures to an evidence base • Supporting clinical judgment and patient preferences • Testing measures • Promoting a single set of measures for widespread use

Measure Development (2) • The Consortium does not develop clinical guidelines. • It relies on available guidelines to identify aspects of care for measure development • Work groups prefer to base measures on guideline principles that have the highest level of evidence and the strongest recommendations. • Measures leave room for valid medical and patient reasons for deviating from recommendations

Notable PCPI Achievements (1) • To date, the AMA/PCPI has developed performance measures for more than 40 areas of clinical care, comprising more than 250 individual, physician-level clinical performance measures (all completed and approved measures can be accessed from the Consortium web site – www. physicianconsortium. org) • 112 of the 153 total measures in the CMS Physician Quality Reporting Initiative (PQRI) for 2009 were developed by the PCPI with medical specialty societies, and in conjunction with the National Committee for Quality Assurance (NCQA) *updates can be accessed from the PCPI web site

Notable PCPI Achievements (2) • Focused on quality • Measures derived from best available evidence • Cross-specialty representation & consensus • Driven by physicians • Consideration of exclusions, patient preferences, system issues • Harmonization of measures with other groups • Measures being implemented by many types of groups

Ongoing PCPI Activities • Review of all PCPI measurement sets - incorporate testing and implementation results, bundling or grouping of measures, new measures of intermediate and longterm outcomes and care coordination where feasible • Adopt new format for measurement sets which document key components of measurement • Develop measures on appropriateness (including overuse) • Develop measures on patient safety • Increase involvement with key stakeholders (consumers, purchasers, ABMS and member boards)

Who are using PCPI measures? (1) • Physicians – internal quality improvement; fulfill requests from outside stakeholders • Medical Boards - Maintenance of Certification programs • Medical Specialty Societies and other CME providers - CME programs • Electronic Health Record Vendors – in discussion

Who are using PCPI measures? (2) • Private/Public Health Plans - recognition, pay for reporting, pay for performance programs • Employers –to ensure healthcare purchased is high quality • Local and national quality improvement initiatives and CMS demonstration projects

Use of measures in CMS demonstration projects QI initiative PCPI measures used* Data Source Physician Quality Reporting Initiative Of the proposed 153 measures designated by the CMS for the 2009 PQRI, 112 measures were developed by the PCPI with medical specialty societies, and often in conjunction with the NCQA. Claims or Registry (EHR Pilot in 2009) Physician Group Practice demonstration Coronary artery disease Diabetes Heart failure Preventive care and screening EHR Medicare Care Management Performance demo Coronary artery disease Diabetes Heart failure Preventive care and screening EHR Medicare Acute Care Episode demonstration Perioperative care Combo of claims and registry

Measures Feasibility/ Validity Testing • Testing protocol developed - are we really measuring what we think we’re measuring? – recommends studies of feasibility, reliability, validity, and unintended consequences that should be undertaken to evaluate all AMA/PCPI measures. – encourages measures testing in varying types of physician practices and multiple data sources (electronic, paper, administrative). – Recommends cataloging of testing projects that have been completed to date, as well as opportunities for future testing. • Continually seeking opportunities/partners to test measures • Testing Needed: – All PCPI measures – Different sized practices – Different data sources (paper, EHRS, administrative claims)

Examples of Current PCPI testing projects (as of January 2009*) PCPI measures Collaborator(s) End-stage renal disease Renal Physicians Association and Iowa Foundation for Medical Care Chronic kidney disease Same as above Chronic stable coronary artery disease heart failure Cardio-HIT Emergency medicine Community-acquired bacterial pneumonia University of Chicago Heart failure Northwestern Memorial Hospital HIV/AIDS Alliance of Chicago Community Health Centers Acute otitis extera/ Otitis media with effusion American Academy of Pediatrics and Qu. IIN (Quality Improvement Innovation Network) Eye care Wisconsin Medical Society, University of Wisconsin Medical Foundation, and Metastar

Future Strategic Priorities • Identify coordination of care measures • Move PCPI measure development beyond the current focus on measures for the individual physician • Foster quality improvement collaboratives • Foster quality measurement registries

Contact Information www. physicianconsortium. org 312/464 -4956 Karen Kmetik, Ph. D Karen. Kmetik@ama-assn. org Heidi Bossley, MSN, MBA Heidi. Bossley@ama-assn. org