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Quality Improvement

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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.

To satisfy the reporting requirements of the quality category for MIPS in 2018, 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. For more details, refer to the list of recommended measures here or the explore quality-measures tool. 

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 2016. The benchmarks are specific to the type of submission mechanism: claims, QCDRs/registries, EHRs, and CAHPS. Please see the 2018 Quality Benchmarks file to view and learn more about the benchmarks.

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 2018, IDSA recommends members to report on the following measures to reduce chances of payment penalties:

For Physicians Seeing Patients in Both the Inpatient and Outpatient Settings:

  • Measure #110: Preventive Care and Screening Influenza Immunization
  • Measure #111: Pneumococcal Vaccination Status for Older Adults
  • Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
  • *Measure #130: Documentation of Current Medications in the Medical Record 
  • Measure #226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
  • *Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia 
  • Measure #474:  Zoster (Shingles) Vaccination
  • Measure #475: HIV Screening

For Physicians Seeing Patients in Outpatient Setting Only:

  • Measure #110: Preventive Care and Screening Influenza Immunization
  • Measure #111: Pneumococcal Vaccination Status for Older Adults: 
  • Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
  • Measure #226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

*Indicates high-priority measures

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. Please see the MIPS quality measure specification requirements for each mentioned measure.

 

 

 

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Quality Improvement Measure Concepts

As publisher of clinical practice guidelines and other guidance, IDSA has taken a leadership role in generating concepts for quality improvement measures specific to the best practices associated with the treatment of infectious diseases.

Available measure concepts:

  1. 72 hour Review of Antibiotic Therapy for Sepsis
  2. Appropriate Use of Anti-MRSA Antibiotics

Please fill out the form below to download and view the measure concepts.

The measure concepts include numerator, denominator, exclusion statement, and supporting body of evidence for each measure. 

We are open to productive collaboration with hospital systems, payers, and other health care stakeholders.

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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.

As the healthcare payment system continues to shift towards value-based reimbursement, the IDSA Quality Improvement Committee (QIC) will continue to report and support the development of ID-specific measures that demonstrate the value of ID physicians in performing quality improvement activities. In 2018, the QIC published an article, reporting the current MIPS measures related to antibotic administration, vaccination and diagnosis of infections in adults. However, the MIPS measures lack metrics that guide payers on the value of ID specialty care. The article discusses the benefits of evaluating ID specific measures through a Qualified Clinical Data Registry to satisfy MIPS reporting; and the development of measures from guideline-based management of patients with infectious diseases. In order to accurately report quality improvement activites that demonstrate the value of ID specialty care to payers, we reccomend developing a mix of patient-level outcomes and process-level measures.

CID: How Do You Measure Up: Quality Measurement for Improving Patient Care and Establishing the Value of Infectious Disease Specialist

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