Acumentra Health is assisting 41 Oregon primary care practices in a Medicare-funded initiative aimed at helping the practices use their electronic health record (EHR) systems more effectively to increase delivery of essential preventive services. Many of the practices worked with us in a previous Medicare project that helped them select and implement an EHR.

In the current initiative, we have already provided training on population-based care and an assessment of how the practices use their EHRs. Future assistance will include webinars and on-site guidance in analyzing and improving workflows, tailored for the EHR system used at each practice.

Individual practices are working with our staff to articulate improvement goals and to identify baseline data (rates) for services ordered and received in four key areas of adult preventive care — mammography, colorectal cancer screening, pneumococcal immunization, and influenza immunization.

The aim of the project is to improve preventive service rates and to prepare participating practices for public reporting of EHR data, which may help them qualify for Medicare payment incentives. For example, the American Recovery and Reinvestment Act of 2009 provides for incentives, beginning in 2011, for “meaningful use of certified EHR technology,” with submission of data on clinical quality measures as one component. (See below for related updates on Medicare’s PQRI and E-Prescribing incentive programs.)

Participating practices are enthusiastic. “To realize the promise of an EHR, we need to modify internal processes to use the efficiencies—not just run inefficient processes faster,” says Jeff Stewart, clinic administrator for High Lakes Health Care practices in Bend and Sisters, Oregon. “The Acumentra Health team has seen what’s working and what’s not, with multiple practices and EHR platforms across the state. Their experience will help us redesign our workflows around best practices and plan how to capture data that demonstrate the quality and efficiency of our clinical care to patients, staff, and payers.”

For more information, contact Brad Hall at bhall@acumentra.org.

Children’s Health Foundation targets asthma care improvement

The Children’s Health Foundation has launched the Asthma Care Management Initiative to improve asthma care for children in Oregon. Funded by the Robert Wood Johnson Foundation, the initiative seeks to provide better care management for children with asthma, ultimately reducing asthma-related emergency department utilization and hospitalizations. The initiative will be implemented by the Foundation’s sister organization, the Children’s Health Alliance, an association of 110 primary care pediatricians.

Acumentra Health will provide project management consultation to help the Foundation conduct the pilot phase. In this phase, February–June 2009, the partners will

• Create a training curriculum to help Alliance pediatricians and nurses implement the National Heart, Lung, and Blood Institute (NHLBI) 2007 asthma care guidelines.
• Develop and implement a data collection and reporting plan for clinically relevant measures of asthma care. The reporting plan will include data obtained through the Partner for Quality Care initiative, led by the Oregon Health Care Quality Corporation (Quality Corp).
• Train 110 pediatricians and 15 nurses in the NHLBI guidelines. These pediatricians, according to the Alliance, represent 40 percent of all primary care pediatricians in the Portland/Vancouver/Yamhill County area.
• Set up a reliable, functional, and cost-effective registry with a web interface for reporting and data entry.

Susan Yates Miller, account manager with Acumentra Health, will provide project management services for the initiative. We are excited about this opportunity to contribute to hands-on quality improvement work in partnership with Alliance providers and the Quality Corp.

For more information, contact Susan Yates Miller at SYatesMiller@acumentra.org. For more about Partner for Quality Care, visit www.q-corp.org.

Acumentra Health to expand utilization review for Oregon Medicaid

Acumentra Health has renewed its contract with the Oregon Division of Medical Assistance Programs (DMAP) to provide quarterly utilization review of the medical services provided to beneficiaries of the state’s fee-for-service Medicaid program.

The new contract calls for Acumentra Health to provide post-payment review of almost three times the volume of cases currently reviewed each quarter. DMAP projects that increasing the review volume will result in significant cost savings and costs avoided in medical claims for services that are not covered benefits, not preauthorized as required by DMAP rules, or do not meet national or state medical necessity or level-of-care criteria. Healthcare providers and beneficiaries will continue to have access to processes to ensure that review decisions are valid. These include clinical peer review, second opinions, and administrative appeal.

“This program is as much about patient safety as it is about cost containment,” said Ruth Medak, MD, Acumentra Health’s associate medical director. “Unnecessary care exposes people to avoidable risks, such as infections, other complications, and medical errors. These not only have a human cost, which can sometimes be tragic, but they also drive up the cost of health care. Sometimes we recommend starting with a more conservative, equally effective treatment rather than the proposed surgical procedure.”

Acumentra Health’s utilization and quality review programs have received accreditation by URAC, an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification, and commendation. We have performed utilization review for DMAP and its predecessor agencies since 1984 and have performed similar services for Medicaid programs administered by Oregon’s Addictions and Mental Health Division over the past 10 years.

For more information on DMAP review, contact Michael Cooper at mcooper@acumentra.org.

Financial incentives for physician
data reporting

2009 PQRI information

The Physician Quality Reporting Initiative (PQRI) provides an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries. Now in its third year, the initiative is scheduled to pay an incentive bonus of 2% of allowable Physician Fee Schedule charges to EPs who participate during the 2009 and 2010 reporting periods.

Visit the CMS website for comprehensive PQRI information

2007 PQRI reporting update

CMS has published a detailed analysis of the 2007 program, including issues identified in 2007 reporting and plans for modifying the analytics for 2008 PQRI. In addition, CMS will apply these modifications to the 2007 PQRI data and re-run the data. CMS expects that additional EPs will qualify for an incentive payment for both 2007 and 2008 based on these efforts. CMS expects to complete these activities by fall 2009.

Download the 2007 PQRI Reporting Experience report from CMS (PDF, 2MB)

E-Prescribing Incentive Program

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new 2% incentive program for EPs who are successful electronic prescribers (E-Prescribers). The incentive decreases to 1% in 2011–2012 and to 0.5% in 2013. In addition, Medicare will reduce the fee schedule amounts paid to EPs who are not successful E-Prescribers beginning with the 2012 reporting period. EPs do not need to participate in PQRI to participate in the E-Prescribing Incentive Program.

CMS information about the E-Prescribing Incentive Program

March is Colorectal Cancer Awareness Month

Fewer than 50% of Oregonians with traditional Medicare are current with receiving recommended screening for colorectal cancer; the Medicare claims data show even lower rates for Hispanic, African American, Native American, and Asian beneficiaries. We encourage you to recommend colorectal cancer screening to all eligible patients and to help them address barriers to following through.

Acumentra Health is among 165 organizations engaged in the Stand for Quality coalition, formed to promote quality improvement as an essential component of healthcare reform. The coalition has put forward six key recommendations for a public–private partnership aimed at improving healthcare quality and affordability through performance measurement and reporting. Endorsing organizations span the healthcare spectrum, including patient and consumer groups, employers and public purchasers, medical associations, health plans, and hospitals.

View the Stand for Quality recommendations

Q-News, Issue 18
© 2009 Acumentra Health. All rights reserved.

This material was prepared by Acumentra Health, Oregon’s Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

9SOW-OR-GEN-09-02
03/25/09