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Physician Office Quality Award Criteria

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Three awards, choose only one to apply for:

  1. The HealthInsight Physician Office High Performance Award - This award recognizes high quality performance to clinics who have achieved above the 75th percentile benchmarks on at least six (6) quality measures.
  2. The HealthInsight Physician Office Exemplary Improvement Award - This award recognizes physician offices who can demonstrate a 15 percent absolute improvement on three (3) quality measures over two separate but recent time periods.
  3. The HealthInsight Physician Office Innovation Certificate - This certificate recognizes physician offices who have implemented an innovation that is measured and sustainable.

The HealthInsight Physician Office High Performance Award

Achievement of top level of performance (above the 75th percentile) on at least six (6) clinical quality and/or patient experience measures for primary care clinics or four total for pediatric clinics. (Note: Other specialty clinics can apply - they must have between four and eight total measures and benchmarks must be included):

Required Documentation: Please provide documentation of recent clinical outcome performance in any of the following formats: a report generated from an EHR, a third-party quality report, or claims-based data report.

Measures:

  • Measure scores must be greater than or equal to the benchmark.
  • Measures chosen do not need to conform exactly to the measures listed below but should be close (e.g. similar numerators and denominators).
  • Measures tracked by the clinic and not listed below can be included . The benchmark must be included. The measures will be subject to review panel verification/acceptance
  • Please round to the nearest whole number

Demoninator:

  • The denominators should include all patients who qualify for each measure, where possible.
  • The denominators should be a minimum of 25 patients - exceptions must be explained. (Note: higher denominators greater than 100 are preferred. The review committee reserves the right to deny the application if the majority of measures have very low denominators.)
  • All clinic providers must be included in the denominators for all measures.

Timeframe:

  • Timeframes for the measures are flexible but one year is preferred.
  • Timeframes should include data from 2016 or 2015. Please do not include a period prior to January 1, 2015 unless otherwise indicated by the measure.

Narrative: In addition to the measure section, the physician office is required to submit a short narrative (no more than 200 words) on how they have achieved great measure scores and/or notable recent clinic achievements, innovations, or initiatives.

Clinical Quality Measures

(Note: Currently, new benchmarks have not been released. HealthInsight will update this list with new benchmarks as soon as they are available. Typically there is little change year to year.)

  • Adolescent Well Care Visit (NCQA - 41%)
  • Antidepressant Medication Management (NQF 0105, numerator 1 - acute phase treatment - 70%; numerator 2 - continuation phase treatment - 54%)
  • Appropriate Imaging for Low Back Pain (NQF 0315 or NQF 0052 - 79%)
  • Appropriate Testing for Children with Pharyngitis (NQF 0002 - 88%)
  • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (NQF 0058 - 29%)
  • Body mass index Assessment in Children (NQF 0024 - 61%)
  • Breast Cancer Screening (NQF 0031 - 76%)
  • Cervical Cancer Screening (NQF 0032 - 79%)
  • Childhood Immunization Status (NQF 0038, Combo 2 - 85%)
  • Chlamydia Screening in Women (NQF 0033 - 51%)
  • Colorectal Cancer Screening (NQF 0034 - 66%)
  • Controlling High Blood Pressure (NQF 0018, BP<140/90 mmHg - 68%)
  • COPD: Spirometry Evaluation (NQF 0091 - 42%)
  • Diabetes: Blood Pressure Management (NQF 0061, BP<140/90 mmHg - 71%)
  • Diabetes: Eye Exam (NQF 0055 - 66%)
  • Diabetes: Hemoglobin A1c Poor Control (NQF 0059, HbA1c>9.0% - 23%; (lower is better)
  • Diabetes: Urine Protein Screening (NQF 0062 - 86%)
  • Influenza Immunization (NQF 0039 or NQF 0047, adults ages 50-64 - 54%)
  • Lipid Control (NQF 0074 LDL-C<100 mg="" dl="" or="">100 mg/dL with plan of care and statin - 50%)
  • Medical Assistance with Smoking and Tobacco Use Cessation (NQF 0027, component 2 or 3, cessation medications or strategies, or NQF 0028 - 81%)
  • Pneumonia Vaccination Status for Older Adults (NQF 0043, adults ages 65+ - 78%)
  • Screening for Clinical Depression and Follow-Up Plan (PQRS 134/NQF 0418 - 40%)
  • Unhealthy Alcohol Use - Screening (PQRS 173 - 96%)
  • Use of Appropriate Medications for Asthma (NQF 0036, ages 5-50 - 93%)
  • Well Child Visits in the First 15 Months of Life (NQF 1392, 6+ well child visits - 77%)

Patient Experience Measures

  • CG CAHPS Composite - Getting Timely Appointments, Care, and Information (NQF 0005, 67%)
  • CG CAHPS Composite - Helpful, Courteous, and Respectful Office Staff (NQF 0005, 93%)
  • CG CAHPS Composite - How Well Providers Communicate With Patients (NQF 0005, 92%)
  • CG CAHPS Follow up on Test Results (NQF 0005, 88%)
  • CG CAHPS Patients' Rating of the Provider (NQF 0005, 82%)
  • CG CAHPS Willingness to Recommend (NQF 0005, 91%)

Please complete this application by close of business Monday, July 31, 2017. If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for The HealthInsight Physician Office High Performance Award

HealthInsight Physician Office Exemplary Improvement Award

Demonstrated improvement by an absolute 15 percent on at least three (3) clinical quality and/or patient experience measures for primary care or pediatric clinics during the last two years. (Note: Other specialty clinics can apply -- they must show at least three (3) total quality measures that have an absolute improvement of 15 percent):

Required Documentation: Please provide documentation of recent clinical outcome absolute improvement in any of the following formats: a report generated from an EHR, a third-party quality report, or claims-based data report. Both reporting time periods (Time A and Time B) must be provided.

Measures:

  • Measure scores must demonstrate 15 percent absolute improvement in clinic rates from Time A to Time B.
  • Measures chosen do not need to conform exactly to the measures listed below but should be close (e.g. similar numerators and denominators).
  • Measures tracked by the clinic and not listed can be included. The benchmark must be included. The measures will be subject to review panel verification/acceptance.

Denominators and Numerators:

  • Improvement percentage is the result of your ending percentage minus starting percentage and must be 15% or greater.
  • The denominators should include all patients who qualify for each measure, where possible.
  • The denominators should be a minimum of 20 patients - any exceptions must be explained.
  • The denominators for all measures must include all providers as this is a clinic-wide award.

Timeframes:

  • Time periods must be comparable based on the measure. For example, with some seasonal based measures, such as influenza, a year later is appropriate (e.g. Q1 2015 as Time A would correspond to Q1 2016 for Time B). For many measures the subsequent quarter is appropriate (e.g. Q3 2015 as Time A would correspond to Q4 2015 for Time B).
  • Timeframes for the measures are flexible but one year is preferred.
  • Time A, the baseline period, must be above 20 percent.
  • Timeframes should include data from 2016 or 2015. Please do not include a period prior to January 1, 2015 unless otherwise indicated by the measure.

Narrative:

In addition to the measure improvement section, the physician office is required to submit a narrative and documentation about how improvement was achieved. Please attach supporting documentation. The narrative and documentation provided will be closely examined to ensure that the improvement reported is not due to improved documentation only or regular measure cycles. Please provided the quality steps undertaken to make these great strides in improvement.

Note: Please do not send protected health information (PHI) with your report. Please de-identify your reports of any patient identifiers.

Clinical Quality Measures: The national benchmarks are included as a reference point only. See measures listed above.

Patient Experience Measures: The national benchmarks are included as a reference point only. See measures listed above.

Please complete this application by close of business Monday, July 31, 2017. If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for The HealthInsight Physician Office Exemplary Improvement Award

The HealthInsight Physician Office Innovation Certificate

This certificate will be awarded to those who have shown substantial innovation based on the following five criteria . HealthInsight may change a clinic certificate to a clinic award if the effort is considered a full transformation in the clinic.

Criteria (See details below):

  1. Problem Identification
  2. Innovative or Transformational Activity
  3. Measurement
  4. Barriers
  5. Sustainability

Narrative: The physician office is required to submit a narrative and documentation discussing the transformation and/or innovation. Please attach supporting documentation.

The narrative must:

  1. Describe what problem was identified.
  2. Description of an innovative activity.
  3. How the practice measured the Innovation/transformation? (A simple tally sheet is acceptable but report/measurement must be uploaded - description box and upload required)
  4. Describe barriers encountered and mitigation strategies undertaken?
  5. Describe how did the practice incorporate this initiative (or sustain) the innovation into their processes?

Examples:

  • Patient portal innovation with high usage improvement
  • Innovative use of USIIS and gathered immunization data for quality improvement with measurement from EHR or USIIS report
  • Implementation of behavioural health screenings, measured by screening claims or process tally
  • Innovative quality improvement strategy
  • Formal policy and process to monitor and reduce disparities, measured disparate population improvement
  • Full practice transformation to an new payment model, ACO, or Medical Home

Please complete this application by close of business Monday, July 31, 2017. If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for The HealthInsight Physician Office Innovation Certificate