Qualis Health – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Idaho and Washington – is working to improve quality reporting for clinicians, including those at physician practices and at larger health care facilities.
In December 2015, the Idaho Bureau of Rural Health conducted a collaborative needs assessment among Critical Access Hospitals (CAHs) that provided insight into their past reporting experiences, challenges and educational needs related to the Physician Quality Reporting System (PQRS), a precursor to the Medicare Access and CHIP Reauthorization Act (MACRA).
“CAHs are community hospitals that have close relationships with their local clinical providers,” says Qualis Health Idaho State Director Linda Rowe. “They have limited resources, so we approached our network of CAHs differently than other hospitals and focused on their unique areas of importance.”
Qualis Health used the information from the Bureau of Rural Health to develop a comprehensive education plan for 10 CAHs that has resulted in approximately 700 providers avoiding nearly $275,000 in penalties and a 43 percent relative improvement in participation of reporting 2016 PQRS data.
As part of its strategy, the QIN-QIO developed educational materials, held community lunch-and-learns at local hospitals across the state, and hosted webinars on aligning physician efforts between PQRS and other clinical goals like Medicare Beneficiary Quality Improvement Project measures and other incentive programs.
“It takes a team to make quality reporting happen.”
Qualis Health also developed the MIPS Minute, a 12-part video podcast series with more than 2,200 views as of December 2016, to help facilities and physicians understand the basics as the Quality Payment Program launches in 2017.
“Understanding the complexities of MACRA will be essential for physicians and practice staff that care for Medicare patients. The MIPS Minutes videos are an excellent vehicle for building that knowledge base,” a representative of the Washington State Medical Association says.
The QIN-QIO plans to release an updated MIPS Minute series on the final MACRA rules in early 2017.
Idaho is a primarily rural state, which in-and-of-itself can provide unique challenges. The QIN-QIO used a small team approach and leveraged the role of hospitals and providers, many of which are on their own, to foster team support in rural communities. “It takes a team to make quality reporting happen,” says Qualis Health’s Idaho Quality Improvement Consultant Deanna Graham.
“As conveners and collaborators, we are thankful that the relationships we have developed in Idaho are moving the needle on quality improvement. We’ve seen many more organizations and providers who now have experience in quality reporting that will be the foundation for their success with the new Quality Payment Program under MACRA,” Graham concludes.
In Washington in 2016, Qualis Health concentrated on ambulatory surgery centers (ASCs), which account for more than 60 percent of all surgical procedures performed in the United States. The QIN-QIO focused on infection prevention – a topic of great interest to ASCs – to engage them in how to use their data for quality improvement purposes and prepare them for pay-for-performance.
Unlike in hospitals, rates of surgical site infections (SSIs) in ASCs are not well known for a variety of reasons, including lack of standard infection definitions for most procedures performed, limited reporting of infections, and inconsistent coding for health care-associated infections in claims data.
However, preliminary analysis of ASC Medicare claims data for Washington shows a rate of 2.85 post-operative infections per 1,000 procedures, which, while low compared to hospital rates, represents a substantial number of adverse outcomes in aggregate, given the high volume of procedures performed in these settings.
"We...focused on building communication between various levels of staff with checklists, culture change tools and anything that improves teamwork."
To engage ASCs and support them in the transition from pay-for-reporting to pay-for-performance, Qualis Health provided half-day infection prevention trainings for approximately 40 ASCs, as well as on-site walkthroughs where possible. The four- to five-hour workshops were interactive and included detailed technical advice relating to care of environment, sequencing of processes, risk assessments and high-level disinfection and cleaning. They also received intensive training on how to use data for quality improvement.
“It’s important for facilities to have scientific tools to gather data they can demonstrate to surveyors and other stakeholders,” says Qualis Health Quality Improvement Consultant Jeff West. “Our focus was on engaging these types of providers on motivating infection control and accurate reporting.”
One day when the clinic was closed to surgery, Qualis Health provided an on-site walkthrough where the entire nursing, technical and administrative staff followed the typical path of patient flow, starting with the waiting room and moving through pre-op, operating room and post-op care.
“ASCs are known for being physician-owned and run with hierarchical structure, thus, we also focused on building communication between various levels of staff with checklists, culture change tools and anything that improves teamwork,” West said.
In 2017, Qualis Health plans to focus on expanding SSI control training with a long series of webinars that repurpose materials and include expert guest speakers as well as QIN-QIO staff.