diabetes physician recognition program (dprp) may 2009
TRANSCRIPT
Diabetes Physician Recognition Program (DPRP)
May 2009
2DPRP Workshop
May 2009
• NCQA Overview
• NCQA Physician Recognition Programs
• DPRP Application & Survey Process
• P4P and Physician Recognition
Session Agenda
3DPRP Workshop
May 2009
• NCQA is a private, independent non-profit health care quality oversight organization founded in 1990
• NCQA is committed to measurement, transparency, and accountability
• NCQA unites diverse groups around a common goal: improving health care quality
MISSIONTo improve the quality of health care
VISIONTo transform health care through quality measurement, transparency, and accountability
A Brief Introduction
4DPRP Workshop
May 2009
NCQA Achieving the Mission
• Over 800 plans report HEDIS® data to NCQA (Commercial, Medicaid, Medicare, HMO/PPO)
• Over 250 commercial MCO plans are accredited by NCQA
• Over 75 Medicaid plans are accredited by NCQA
• Over 100 Medicare Advantage plans are accredited by NCQA (more than any other accrediting body)
• Over 85.9 million patients are impacted through the plans NCQA accredits
• Over 12,000 physicians are recognized nationally by NCQA programs
5DPRP Workshop
May 2009
• Current programs: DPRP, HSRP, BPRP, PPC, PCMH• What measures included: Structure, process and
outcomes of excellent care management• Where they come from: partnership with leading
national health organizations• Who rewards recognized physicians: many health plans
and coalitions of employers• Who is recognized: over 12,000 physicians nationally
NCQA Recognition ProgramsPhysician-Level Measurement
6DPRP Workshop
May 2009
Number of Recognitions by State(as of 1/31/09)
•ME
•VT
•RI
•NJ
•MD
•MA
•DE
•NY
•WA
•OR
•AZ
•NV
•WI
•NM
•NE
•MN
•KS
•FL
•CO
•IA
•NC
•MI
•PAOH
•VA
•MO
•HI
•OK
•GA
•SC
•TN
•MT
•KY
•WV
•AR
•LA
•MS •AL
•IN•IL
•SD
•ND
•TX
•ID•WY
•UT
•AK
•CA
•CT
•NH
•0 Recognitions
•1-25 Recognitions
•26-100 Recognitions
•101+ Recognitions
7DPRP Workshop
May 2009
What is the DPRP applicationand survey process?
8DPRP Workshop
May 2009
• Developed in partnership with American Diabetes Association (ADA); released in 1997
• Voluntary program; non punitive
• Report only physicians who earn Recognition
• Use nationally recognized reliable, valid measures
DPRP Basics…
3-year
recognition
periodOver 7,000 Physicians
Recognized Nationally
9DPRP Workshop
May 2009
2006 DPRP Adult Measures• Outcome Measures
– HbA1c Control <7.0%
– HbA1c Control >9.0%*
– Blood Pressure Control <130/80 mm Hg
– Blood Pressure Control ≥140/90 mm Hg*
– LDL Control <100 mg/dl
– LDL Control ≥130 mg/dl*
• Process Measures– Eye Examination
– Foot Examination
– Nephropathy Assessment
– Smoking Status and Cessation Advice or Treatment
* A measure of poor control ** Pediatric measures available
10DPRP Workshop
May 2009
Improvement In Key Clinical Measures
% of adult patients with
26.7
51.6
56.4
33.8
15.8
44.1
10.9
55.1
7.5
64.1
74.1
45.3
75.4
83.8
61.2
0 20 40 60 80 100
LDL Control (<100 mg dl)
LDL Control (<130 mg dl)
BP Control (< 140/90 mm Hg)
Good HbA1c Control (<7.0%)
Poor HbA1c Control* (>9.0%)
1999 2002 2005
``
* Lower is better for this measure.
11DPRP Workshop
May 2009
Who May Apply?
• An individual physician or a physician group
• To be eligible, applicants must:– have a current, non restricted license as a doctor of
medicine (MD) or doctor of osteopathy (DO)
– provide continuing care to patients with diabetes
– have had face-to-face contact with and submit data on a sample of patients with diabetes
12DPRP Workshop
May 2009
• Review program information - www.ncqa.org/dprp
• Purchase the “Diabetes Physician Recognition Package”- Package contains all the information needed to apply for Recognition
• Review materials & sign Agreement- Standards and Guidelines
- Agreement and BA Addendum
- Data Collection Tool (an Excel® workbook)
• Identify the patient sample- Patient sample must be identified using the DPRP patient selection methodology
or a random sample methodology approved in advance by NCQA
• Abstract medical record data• Enter data in Data Collection Tool• Submit completed materials to NCQA
What is the Process?
13DPRP Workshop
May 2009
Guidelines for Identifying Patient Sample
• The patient sample must:- be identified using the DPRP patient identification
methodology or a random sample methodology approved in advance by NCQA.
- be selected across the entire patient population regardless of the patient's method of payment (e.g., health plan, Medicare, Medicaid, employer, self-pay or other payment mechanism.)
- include all eligible patients (i.e., eligible patients must not be excluded from the sample).
14DPRP Workshop
May 2009
Sample Size Requirement - Individual
Individual Physician • 1 physician practicing in any
setting who provides continuing care to patients with diabetes
Sample Size• 25 patients per physician
Public reporting on Web Site• Listed by individual names
15DPRP Workshop
May 2009
Group A physicians • An entity of 2 or more physicians:
– that have used detailed protocols directly related to diabetes care for at least 1 year
– that apply and monitor the protocols across all physicians
– that provide feedback to physicians regarding performance against the protocols
• At time of application, must submit a letter that documents:
– diabetes management protocols– date protocols instituted– how physician compliance with
protocols is monitored– how feedback on performance is
provided to physicians
Sample Size *• A maximum of 200 patients as shown
in the table below:
* If group operates more than one site every site must
contribute patients to the total sample.
Public reporting on Web Site• Listed by group or site name only
Sample Size Requirement – Group A
Number of Physicians in
Group
Sample Size Requirement
2 50
3 75
4 100
5 125
6 150
7 175
8 200
9 or more 200
16DPRP Workshop
May 2009
Group B physicians • An entity of 2 or more physicians:
– who practice at the same site– who share responsibility for a
common panel of patients– who do not use detailed protocols
directly related to diabetes care.
Sample Size• A maximum of 200 patients as shown
in the table below:
Public reporting on Web Site• Listed by group or site name only
Sample Size Requirement – Group B
Number of Physicians in
Group
Sample Size Requirement
2 50
3 75
4 100
5 125
6 150
7 175
8 200
9 or more 200
17DPRP Workshop
May 2009
Identifying the Patient Sample
• Pick a “Start Date”– an arbitrary date within the last 12 months
• Choose to go forward or backward from the start date to identify eligible patients until the required sample size is met
• An eligible patient:- is 5 years of age or older
• pediatric patients 5 – 17 years
• adult patients 18 – 75 years
- has had a diagnosis of diabetes for at least 12 months- has been under the care of the applicant physician (or
physician group*) for at least 12 months
*Does not apply to physicians seeking individual recognition
18DPRP Workshop
May 2009
Abstracting Medical Record Data
After identifying the patient sample, abstract medical record data:
•for a12-month period going back from the last visit date that occurred prior to the start date
•from medical record documentation (electronic or paper), administrative data systems or registries to identify required data elements
19DPRP Workshop
May 2009
How to Identify Eligible PatientsMoving Backwards from Start Date - Step 1
Step 1• Establish a "Start Date"
within the past 12 months
• The start date is an arbitrary date set at your convenience
Example• You select May 1, 2009
20DPRP Workshop
May 2009
How to Identify Eligible PatientsMoving Backwards from Start Date – Step 2Step 2• Identify eligible patients
– On each day moving backward from the start date, consecutively evaluate each patient for eligibility who were seen at an office visit
– Select patients who meet the 3 eligibility requirements
– Identify eligible patients until the required sample size is met
Example• Moving consecutively backward
from 5/1/09, you identify 25 eligible patients who had office visits on the following dates:
Visit Date Identified as Eligible
Number of Patients
identified
4/30/09 3
4/29/09 6
4/22/09 5
3/26/09 7
3/04/09 4
21DPRP Workshop
May 2009
How to Determine the 12-month Abstraction PeriodMoving Backwards from Start Date – Step 3
Step 3• Determine 12-month Abstraction
Period – When moving backward from
the start date, the visit date that a patient is identified as eligible establishes that patient’s 12-month abstraction period
– After determining each patient’s 12-month abstraction period, abstract data for care completed for each patient in the sample.
Example• 12-month abstraction periods for
the 25 patients identified :
Visit Date
Identified as
Eligible
12-month Abstraction
Period
Number of
Patients
4/30/09 4/30/09 – 4/29/08
3
4/29/09 4/29/09 – 4/28/08
6
4/22/09 4/22/09 – 4/21/08
5
3/26/09 3/26/09 – 3/25/08
7
3/04/09 3/04/09 – 3/03/09
4
22DPRP Workshop
May 2009
How to Identify Eligible PatientsMoving Forward from Start Date – Step 1
Step 1• Establish a "Start Date"
within the past 12 months
• The start date is an arbitrary date set at your convenience
AttentionMoving forward is in “real-time”. Patients are identified as they present for an office visit.
Example• You select May 1, 2009
23DPRP Workshop
May 2009
How to Identify Eligible PatientsMoving Forward from Start Date – Step 2
Step 2• Identify eligible patients
– On each day moving forward from the start date, consecutively evaluate each patient for eligibility at the time the patient presents for an office visit
– Select patients who meet the 3 eligibility requirements
– Identify eligible patients until the required sample size is met
Example• Moving consecutively forward
from 5/1/09, you identified 25 eligible patients who had office visits on the following dates:
Visit Date Identified as Eligible
Number of Patients
identified
5/05/09 3
5/07/09 6
5/18/09 5
6/04/09 7
6/11/09 4
24DPRP Workshop
May 2009
How to Determine the 12-month Abstraction PeriodMoving Forward from Start Date – Step 3
Step 3• Determine 12-month Abstraction
Period – When moving forward from
the start date, the last office visit prior to the start date establishes the patient’s 12-month abstraction period
– After determining each patient’s 12-month abstraction period, abstract data for care completed for each patient in the sample.
Example• 12-month abstraction periods for
the 5 patients identified on 5/18/09.
Start Date: May 1, 2009 Patient Identification Direction: Forward
Visit Date Patients (5) Identified as
Eligible
Visit Date prior to
Start Date
12-month Abstraction Period
5/18/09 12/31/08
12/31/08 – 1/1/08
5/18/09 4/17/09 4/17/09 – 4/16/08
5/18/09 4/03/09 4/03/09 – 4/02/08
5/18/09 1/1/09 1/1/09 – 12/31/08
5/18/09 2/4/09 2/04/09 – 2/03/08
25DPRP Workshop
May 2009
Scoring of Measures
Scored Measures Threshold Weight (% of patients in sample)
HbA1c Control <7.0% 40% 10.0
HbA1c Control >9.0 %* 15% 15.0Blood Pressure Control <130/80 mm Hg 25% 10.0
Blood Pressure Control >140/90 mm Hg* 35% 15.0LDL Control <100 mg/dl 36% 10.0
LDL Control >130 mg/dl* 37% 10.0Eye Examination 60% 10.0Foot Examination 80% 5.0Nephropathy Assessment 80% 5.0Smoking Status and Cessation Advice or
Treatment 80% 10.0
Total Points = 100.0 Points to Achieve Recognition = 75.0
* A measure of poor control
26DPRP Workshop
May 2009
Data Abstraction
• Data elements– Date and value of most
recent HbA1c performed within the 12-month abstraction period
(2-month grace period allowed)
• Tips– To receive credit for the
measure of poor control, no more than 15% of patients can have HbA1c results >9.0%
– May use date drawn or date received
HbA1c Testing and ControlProportion w/HbA1c > 9.0%*Proportion w/HbA1c 7.0%
* A measure of poor control
27DPRP Workshop
May 2009
Data Abstraction
• Data elements– Record date and value of
most recent blood pressure measurement performed within the 12-month abstraction period
• Tips– To receive credit for the
measure of poor control, no more than 35% of patients can have B/P measurements >/= 140/90
Blood Pressure Measurement Proportion >/= 140/90 mm Hg*
Proportion < 130/80 mm Hg
* A measure of poor control
28DPRP Workshop
May 2009
Data Abstraction
• Data element– Record date and value
of most recent LDL within the 12-month abstraction period
(2-month grace period allowed)
• Tips– To receive credit for the
measure of poor control, no more than 37% of patients can have LDL results >/= 130 mg/dl
Lipid ControlProportion w/LDL >/=130mg/dl*
Proportion w/LDL <100mg/dl
* A measure of poor control
29DPRP Workshop
May 2009
Data Abstraction
• Data element– Record date of most recent
dilated retinal exam or retinal photograph performed within the 12-month abstraction period
• May use date within the past two years if patient showed no evidence of retinopathy in the 12 months prior to the abstraction period
• Tips– Patient self-report is not
acceptable– Use notes, reports, letters
or photographs from eye care professionals
– If exam performed by a non eye care professional documentation must state dilated exam
Eye Exam or Retinal Photographs
30DPRP Workshop
May 2009
Data Abstraction
• Data element– Record date of most
recent foot exam within the 12-month abstraction period
(2-month grace period allowed)
• Tips– May use notes, reports,
letters or assessments from podiatrists, PCP or your own examination
– Documentation must support that feet were examined with shoes and socks off
Foot Examination
31DPRP Workshop
May 2009
Data Abstraction
• Data Element– Record date of most
recent nephropathy assessment within the 12-month abstraction period
(2-month grace period allowed)
• Tips– Documentation must
include one of the following:
– Microalbuminuria test– Positive urinalysis for
protein– Medical attention for
nephropathy– Evidence of ACE/ARB
therapy
Nephropathy Assessment
32DPRP Workshop
May 2009
Data Abstraction
• Data Element– Document smoking
status
• Tips– If there is documentation
that the patient is a non-smoker, no further documentation is required
– Smokers: Record date that documents smoking cessation counseling or treatment within the abstraction period
Smoking Status
33DPRP Workshop
May 2009
Data Collection Tool
34DPRP Workshop
May 2009
Data Submission
Materials to submit:• Completed physician/physician group Application
Form• Signed DPRP Agreement (2 copies)
– Includes Business Associate Addendum
• Completed Data Collection Tool • Application fee
– Payable by check or credit card
35DPRP Workshop
May 2009
What Happens Next?
• Within 30 days of receiving all information needed to complete the application, NCQA reviews and makes recognition determinations– 5 percent of applications are randomly selected for
audit• Physicians or groups achieving Recognition receive:
– letter of recognition– posting to the Recognized Physician Directory– certificate of recognition– media kit/marketing and advertising guidelines
36DPRP Workshop
May 2009
RECOGNITION: REWARDED IN MANY WAYS
Provider Directories
Data CollectionAssistance
Active SteeringTo Recognized MDs
Network Entry
Financial Incentives
Specialty BoardMaintenance of Certification
37DPRP Workshop
May 2009
Pay rewards and/or applications fees
BCBS Alabama - Alabama Health Improvement Initiative
BCBS (SC)/ BlueChoice
BTE (KY, MA, NY, OH, GA, CO)
CareFirst (DC-MD-GA)
ConnectiCare
HealthAmerica (PA)
Oxford (NY)
Health First (FL)
Silicon Valley (CA)
(Examples of Current and Past Initiatives) Recognition Program Rewards
Distinction in Provider Directory
1. Aetna
2. BCBS Delaware
3. CareFirst
4. CIGNA
5. GeoAccess
6. HealthAmerica
7. Humana
8. Lumenos
9. Medical Mutual (OH)
10. MVP Healthcare
11. United
Actively steer patients to recognized MDs
BTE (KY, OH)
Help practices with data collection
BTE (KY, MA, OH, NY)
Oxford (NY)
United (4 areas)
Use for network entry
Aetna, CIGNA,
United
38DPRP Workshop
May 2009
Bridges to Excellence (BTE)
BTE Programs NCQA Measure Set Physician Activation
Cardiac Care Link (CCL)
Heart/Stroke Recognition Program (HSRP)
Up to $200 pcppy
Diabetes Care Link (DCL)
Diabetes Physician Recognition Program (DPRP)
Up to $100 pdppy
Physician Office Link (POL)
Physician Practice Connection
Up to $50 pmpy
Spine Care Link (SCL) Back Pain Recognition Program
Up to $50 pscppy
39DPRP Workshop
May 2009
• Mailing AddressNCQADiabetes Physician Recognition Program1100 13th Street, NW, Suite 1000Washington, DC 20005
• Customer Support (questions on DPRP in general, purchasing the workbook, etc.)
1-888-275-7585
• DPRP Staff (questions on sampling methodology, measures, etc.)
• Webwww.ncqa.org/dprp
DPRP Contact InformationDPRP Contact Information
40DPRP Workshop
May 2009
NCQA would like to thank our Diabetes Physician Recognition Program (DPRP) Sponsors
Founding Sponsor Champion Sponsor