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  • Quality Improvement

     GRADE Determination of Strength of Recommendation - QI image

     

     

    Numerous publications have highlighted the need to measure and constantly improve quality in our healthcare system. Infectious Diseases (ID) physicians’ impact the quality of healthcare both at patients’ bedside but also through their infection prevention and antimicrobial stewardship activities that are focused on improving quality at the systems-level.

    The resources below are designed to help ID physicians understand the current state of quality improvement and the transition towards a value driven healthcare system that publicly reports providers performance and pays for high quality outcomes.

  • Provider-Level Measurement

  • ID-Specific MIPS Quality Resources

    To satisfy the reporting requirements of the quality category for MIPS in 2017, eligible clinicians or a group practice must report quality data on six measures. Of the six measures, one must be an outcome measure. In cases where an outcome measure is not available for a participating clinician, a high-priority measure can be reported as a substitute. A high-priority measure is defined as an outcome, appropriate use, patient experience, patient safety, efficiency, or care coordination measure.

    Please see the complete list of 2017 MIPS Quality Measures (.xls).

    To assess a clinician's quality performance, each measure is assessed against its benchmark to determine how many points a clinician has earned for the measures submitted. These benchmarks are based on performance data submitted to PQRS in 2015. The benchmarks are specific to the type of submission mechanism: claims, QCDRs/registries, EHRs, and CAHPS. Please see the 2017 Quality Benchmarks .zip file to view and learn more about the benchmarks.

    IDSA is aware of the lack of applicable quality measures to the ID physician and has voiced concerns to CMS regarding this troubling issue. IDSA is currently exploring initiatives to address the inappropriate evaluation of ID physicians by reviewing the feasibility of developing an IDSA-sponsored clinical data registry to promote the value of the ID physician. In the short term, as payment adjustments are increasing, -4% payment penalty for non-participation in MIPS for 2017, IDSA recommends members to report on the following measures to avoid the payment penalties, (Note: the measures indicated below assume that an ID physicians sees patients in the outpatient and inpatient setting. Those shown in bold below only apply to the outpatient setting).

    IDSA Recommendation for Reporting Six Quality Measures:

    • Measure #110: Preventive Care and Screening Influenza Immunization: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
    • Measure #111: Pneumococcal Vaccination Status for Older Adults: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
    • Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
    • *Measure #130: Documentation of Current Medications in the Medical Record -- High-Priority Measure; National Quality Strategy Domain: Patient Safety (Claims, Registry, EHR, GPRO Web Interface, Measure Groups)
    • Measure #226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
    • *Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- High-Priority Measure; National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
    *Indicates high-priority measures

    Inpatient Opportunities to Report

    There are a limited number of MIPS measures applicable to those clinicians who practice in the inpatient setting and rely largely on initial and subsequent hospital visit codes. Provided below is a list of these measures for 2017.

    Note: In order to ensure compliance in the Quality component of MIPS, ID physicians should report on #130 – Documentation of Current Medications in the Medical Record as a standard practice incorporated in a typical inpatient E&M encounter. The specification language for measure #130 indicates that this measure should be done at each visit, however, only the initial patient encounter CPT codes apply to this measure. As well, some ID physicians may feel that reporting measure #47 - Care Plan may be appropriate for some patient cases. Please be aware that once a provider starts reporting any quality measure, CMS will expect that the provider will report the measure for at least 50% of the cases. Therefore, should an ID physician report measure #47 for an initial or subsequent inpatient visit, then that physician will be expected to report measure #47 for at least 50% of the initial and subsequent patient visits for which they bill. Please see the MIPS quality measure specifications for the specific requirements for each mentioned measure (.zip – 249.3MB).

    Applicable Measures for 99221 - 99223:

    • Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
    • Measure #47 (NQF 0326): Care Plan -- National Quality Strategy Domain: Communication Care Coordination (Claims, Registry)
    • Measure #130: Documentation of Current Medications in the Medical Record -- National Quality Strategy Domain: Patient Safety (Claims, Registry, EHR, GPRO Web Interface, Measure Groups)
    • Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)

    For subsequent inpatient face-to-face encounters, CMS has identified three quality measures that are applicable, which are listed below. As stated above, there are times when an ID physician may discuss Advanced Care Planning with a patient. Should the ID physician want to report this as a quality measure, they should be aware that CMS will expect that they report it on at least 50% of the subsequent visit codes for which they bill.

    Applicable Measures for 99231 - 99233

    • Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
    • Measure #47 (NQF 0326): Care Plan -- National Quality Strategy Domain: Communication Care Coordination (Claims, Registry)
    • Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)

    CMS has developed a claims measures single source identifier tool. This can assist clinicians in identifying potentially applicable quality measures for reporting by searching for diagnosis and/or encounter code. Please see the 2017 MIPS Individual Claims Measure Single Source Tool (.xls).

    Key Resources
     
    Quality Improvement Measure Concepts
    IDSA has developed concepts for quality improvement measures specific to best practices associated with the treatment of infectious diseases. These concepts can be found here.
  • Registry Business Case

  • Exploration of an IDSA-Sponsored Registry
    In July 2016, IDSA’s Board of Directors (BOD) commissioned the Quality Improvement Committee (QIC) to develop a business case to highlight the benefits and possible solutions an IDSA-sponsored registry would provide an ID physician to increase their value within the changing health care payment system that is shifting from fee-for-service to performance-based payments. The business case proposed two strategic directions, 1) IDSA collects data from ID physicians in order to measure quality, report on their behalf when possible, and provide them bench-marking reports or 2) IDSA provides the “intellectual property” that enables hospitals to measure the care that ID physicians provide within the hospital’s electronic health record systems. The complete IDSA Registry Business Case is available for IDSA members.

    In October 2016, the BOD elected to pursue the strategic initiative of collecting data from ID physicians in order to measure ID quality of care. For next steps, the BOD directed the QIC to develop a business plan to highlight how to develop an IDSA-sponsored clinical data registry. The business plan will be presented to the BOD in March 2017 and will explore the financial and legal requirements to develop and operate an IDSA registry, the governance structure for management of an IDSA registry, the projected timelines for piloting testing and multi-phase implementation an IDSA registry, and the evaluation of potential registry vendor partners to develop an IDSA registry. In evaluating potential registry vendor partners, IDSA has solicited a Request for Information (RFI) proposal. The finalized business plan will be available for the IDSA membership upon completion.
  • IDSA Quality Improvement Committee

  • QIC Charge

    The charge of the IDSA Quality Improvement Committee (QIC) is as follows:

    • To promote valid performance measures that IDSA members can implement to improve patient care outcomes in infectious diseases;
    • To actively participate in and respond to:
      • The National Quality Forum (NQF) activities and policies as they relate to infectious diseases;
      • CMS Call for Measures  (and engage the CMS Quality Measurement and Health Assessment Group);
      • The American Medical Association (AMA) Physician Consortium for Performance Improvement measurement activity;
      • Other organizations involved in quality improvement and performance measurement (Agency for Healthcare Research and Quality, National Committee for Quality Assurance, etc.);
      • Commercial payer quality improvement initiatives (Bridges to Excellence).
    • To investigate the feasability of developing a registry for members to report and compare results on standard measures of patient care and outcomes;
    • To provide both online and in-person (via IDWeek) educational resources that will inform IDSA members about quality improvement in general and applicable performance measures;
    • To approache quality measurement of ID clinical care in a manner that promotes the value of ID specialists to the broader health care system.

     

    QIC Member List

    Ron Nahass, MD, FIDSA - Chair

    Lillian Abbo, MD, FIDSA

    Tamar Foster Barlam, MD, FIDSA

    Dale W. Bratzler, DO, MPH, FIDSA

    David Classen, MD

    Joshua Eby, MD

    Clare Gentry, MD, MS

    Amy Ray, MD, MPH

    Katherine Reyes, MD, MPH

    Kay Schwebke, MD, MPH

    Kathleen Sheridan, DO

    David Wheeler, MD, FACP, FIDSA

    Ann T. MacIntyre, DO - Clinical Affairs Committee Liaison

    Lawrence P. Martinelli, MD, FIDSA - Board Liaison

    Neil O. Fishman, MD - SHEA Liaison

    Michael A. Horberg, MD, FIDSA - HIVMA Liaison

    Andrés Rodríguez - Assigned IDSA Staff

    Thomas Kim - Assigned IDSA Staff

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