PHYSICIAN QUALITY
REPORTING INITIATIVE
You are listening to ReachMD XM 157, The Channel for
Medical Professionals. Welcome to GI Insights where we cover the latest
clinical issues, trends, and technologies in gastroenterological practice. GI
insight is brought to you by AGA Institute and sponsored by Takeda
Pharmaceuticals North America. Your host for GI insight is Professor of
Medicine and Director of Digestive Disease Center at the Medical University of
South Carolina Dr. Mark DeLegge.
The physician quality reporting initiative for PQRI may
seem like a massive investment of time and money, but its value to your
practice cannot be underestimated. Joining us to discuss the physician quality
reporting initiative its Ms. Mary Igo CEO of Minnesota Gastroenterology and an
MBA in Medical Group Management.
DR. DELEGGE:
Welcome Mary.
MS. MARY IGO:
Hi.
DR. DELEGGE:
Mary I have to ask first of all, what is PQRI?
MS. MARY IGO:
PQRI is sort of CMS attempted getting at reporting of data
to define what quality is. Unfortunately, I think there is mixed feelings
about what quality is, and if you go around the room you are going to end up
with 20 different viewpoints on it. There actually doing it in a way,
initially what these measures to get at health management and costing
utilization issues I believe, so that they can hopefully define what quality or
as I would like to refer value is some more down in the line.
DR. DELEGGE:
What for the gastroenterologist if we are looking at quality
reporting or initiative, from your perspective what will be the best measure
for us to you? I know there could be a lot of them, but what do you think?
MS. MARY IGO:
You really want to look out what are your top codes, what
are things you do all the time, things that you feel confident and that relate
to the measures. I believe there are hundred and some measures in 2008. The
measures you should pick are the once that you can get people to buy and to
sell for us really the once that was sort of safe and comfortable for
everybody, because we do a lot of patients were the GERD ones and how they
relate to patients care also seem to be the easiest. Selection of those was a
great discussion point with physician to really get them to understand PQRI.
To understand why we should go forward with it and really felt comfortable with
what the measures were.
DR. DELEGGE:
With regards to GERD measurement were the specific questions
or issues that you were looking at?
MS. MARY IGO:
Yes. A couple of the PQRI initiative one in particular was
assessment of GERD symptoms and really putting down what medications were they
taking or these particular things done for them for the patient. Fortunately,
CMS and the AMA both have a web site, but actual questions that need to be
asked for each one of those measures, so it would helps to understand where to
go with it and how to implement it.
DR. DELEGGE:
For my experience, I am a physician so I am in that pack. I
know that if you ask a physician to document anything else they are going to be
renascent, so how do you engage the gastroenterologist or the physician in your
practice to actually participate?
MS. MARY IGO:
First of all the understanding of what PQRI is and where its
going and I think in the market place and particularly where in Minnesota where
it is a very consumer-oriented market and very consolidated mature market we
are not going to be just doing PQRI. Performance based measurements are going
to be coming from all the payers sorted to find what you getting paid and your
credential for care and probably where you fit in the stratification as they
start to layer things if you are into 1, or 2 or 3. So it really is getting
all of you to understand that it is something that has to be done, will be
done, and either we get involved in it and test it and try it, they have some
input with the measures of their success or failure or they can be imposed up
on you. So that was part of it. I think the other part of it is with your
whole documentation thing. I understand completely when you ask for one more
thing to be sold out. I think it is very onerous and difficult if you do not
have an EMR. We are fortunate enough to have an EMR so we could
program it, so that the codes would signal when the doctors had to fill
something out that went along with that patient. We did not make that
capability when we first did it in 2006, and we had for two other measure, we
had less than 4% of our patients the data was filled out and so we didn’t get
the money, but it was a great learning experience. You know, if you can tell
me how to get people to fill out more papers than they already have, it would
be wonderful addition to my knowledge banks.
DR. DELEGGE:
It sounds like the pocket book is the way to go me in if it
impacts on what should actually be paid for the officer or procedure then you
can get compliant. Would you agree with that?
MS. MARY IGO:
Yes the pocket book and your referrals in the future are
going to be covering by some of these quality measure need to get involved at
the front line.
DR. DELEGGE:
Mary. If it is becoming publishable, may these be patients
being able to go and look up how their physician is appropriate for specific
disease?
MS. MARY IGO:
I do more from a cost perspective rate now and we actually
have that in Minnesota. Its www.mainstreetmedica.com is website that publishes
the cost differences between different facilities and different physician and
different system and that's going to be out there from the third party payers
and eventually from the employers, certainly is an issue with some of the
self-insured peoples, who are ready handing out their employees in our
particular area. Cards that say if you need a colonoscopy you go here because it's
less expensive and they have a great reputation.
DR. DELEGGE:
What certainly sounds like a means to pain what I could call
best practices?
MS. MARY IGO:
You know, yes, best practices as long as the questions are
meaningful.
DR. DELEGGE:
A lot of physician would tell me we listen, you know, sure
with GERD there are proven ways you should be taking care of patient, but what
about the patient with abdominal pain. Now how you are going to tell me what's
the right way to go about approaching that patient?
MS. MARY IGO:
You know, I was around in the air when there was “cookbook
medicine” and its really going to be to define protocol and processes in evaluating
and working that patient up to what diagnosis you should get. I think one of
the dangerous and abdominal pains; for example, is if you sent an abdominal
pain patient to gastroenterologist, you may get a whole different set of
diagnostic studies that are done than if the patient is with primary care and I
think that's going to be the hard part to sort of understand where are the
primary care roles where are the specialist roles, so patients don’t have to
get so sick and have much more expense before they get to specialist or to
actually the diagnosis. So I think that’s going to be tricky.
DR. DELEGGE:
If you are just tuning in, you are listening to GI
Insights on ReachMD XM 157, The Channel for Medical Professionals. I am your
host, Dr. Mark DeLegge and joining me to discuss PQRI is Ms. Mary Igo, CEO of
Minnesota Gastroenterology and MBA in Medical Group Management.
DR. DELEGGE:
Mary I have to ask you, it sounds to me like you are going
to have to have a physician buy in for this and therefore a champion at a
practice. First am I correct and secondly how would go about doing that?
MS. MARY IGO:
Oh, absolutely. You know this a physician-to-physician
discussion. I think we cannot as administrative people, although we can send up
and implement it, we can't deliver it. You lose credibility because we really
don’t understand what goes on in the exam room and the pressures around seeing
patients. I think physician champion again the first year we did not have a
physician champion in 2006. We put it out there. We put into the EMR. There
was box that came up that said, need to fill these questions out. Somebody
said, Oh, you can disregard that and pretty soon we only had, you know, 4.3% of
the papers filled out. You too really sat down with the doctors and said here
is what this means, here is where it to going, here is the dollar amount, here
is the report that you are going to get, and here is why you need to do it. We
have very physician-directed professionally managed organization. So it isn't
hard for me to find a champion, who will take the on and I think we have some
people that are very committed and defining-quality standard.
DR. DELEGGE:
You had mentioned earlier that having an electronic medical
record on EMR, it is easier because you have a screen pop up to ask you various
PQRI like questions, but what if say you have a paper chart or a practice that
just beginning to do this, how would they implement the process?
MS. MARY IGO:
As I said what the AMA and CMS they have what I would call
sheets just little forms look very much like kind of a survey, a Goggle-type
survey and they have this so it can be put in the physician area where you are
doing your charting. You would probably have to do one of two things. So it
is two different ways to submit data. You can submit in a more focused pool of
patients like 15 in a row, which will give you sort of the same thing as doing
80% and there is different methodology for some of the measures, but you would
have to have something on coding slip that if you check this CPT code and this
CPT code then you need to fill out that form. It would have be something that
tempt out. I think to help the physicians understand when to fill it out and
it would be important to do with all of the patients that fit into that
category not just the Medicare or Medicaid patients.
DR. DELEGGE:
I know there is number of advantage of the electronic
medical record with regards to data collection and accuracy of data, sounds to
me from what you just said that moving to an electronic medical record would
make this whole process a heck of a lot easier.
MS. MARY IGO:
It would and it really can start a simple as getting your
practice management system to be able to trigger electronic chart ticket for
you on outpatient that would give you a better idea when you need to submit
this data. There is so many advantages with an EMR if you implemented in the
right order that will help you with this and was quality data in general.
DR. DELEGGE:
I would like to thank my guest, CEO of Minnesota
Gastroenterology and MBA in Medical Group Management, Ms. Mary Igo.
Ms. Igo, thank you very much for being our guest this week
on GI Insight.
MS. MARY IGO:
Oh! My pleasure. Thank you.
DR. DELEGGE:
You have been listening to GI Insight on ReachMD XM 157,
The Channel For Medical Professionals. GI Insight is brought you by AGA
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