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Physician Office Quality Award Criteria

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There are three categories for the 2017 Physician Office Quality Awards, and all outpatient medical practices and clinics are encouraged to apply. Please choose only one to apply for.

  1. The High Performance Award recognizes high quality performance in outpatient practices that have achieved above the 75th percentile benchmarks on at least six quality measures.
  2. The Exemplary Improvement Award recognizes outpatient practices that can demonstrate a 15 percent absolute improvement on three quality measures over two separate but recent time periods.
  3. The Innovation Certificate recognizes outpatient practices that have implemented an innovation that is measured and sustainable.

The High Performance Award

Achievement of top level of performance (above the 75th percentile) on at least six clinical quality and/or patient experience measures for outpatient primary care practices or four total for pediatric practices. (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 practice but 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.
  • Benchmarks are from Quality Compass (HEDIS) with the exception of PQRS 134/NQF 04 and PQRS 173 which are from CMS.

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 practice providers must be included in the denominators for all measures.

Timeframe:

  • Timeframes for the measures are flexible but one year is preferred.
  • Data from 2017 or 2016 is preferred. 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 practice is required to submit a short narrative (no more than 200 words) on how they have achieved great measure scores and/or notable recent practice-wide achievements, innovations or initiatives.

Clinical Quality Measures

Note: New benchmarks have not yet 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 (Nevada and Utah) or Friday, September 22, 2017 (New Mexico). If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for the High Performance Award

The Exemplary Improvement Award

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

Required Documentation: 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 practice 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 practice 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 practice-wide award.

Timeframes:

  • Time periods must be comparable based on the measure. For example, with some seasonal 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 practice 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 that were undertaken to make the strides in improvement.

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

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

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

Please complete this application by close of business Monday, July 31, 2017 (Nevada and Utah) or Friday, September 22, 2017 (New Mexico). If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for the Exemplary Improvement Award

The Innovation Certificate

This certificate will be awarded to outpatient practices that have shown substantial innovation based on the following five criteria. HealthInsight may change a certificate to an award if the effort is considered a full transformation in the practice.

Criteria (See details below):

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

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

The narrative must describe:

  1. A problem identified
  2. An innovative activity
  3. How the practice measured the innovation/transformation (both the application box must be completed and report/measurement must be uploaded - a simple tally sheet is acceptable)
  4. Barriers encountered and mitigation strategies undertaken
  5. How the practice incorporated or sustained the innovation into their processes

Examples:

  • Patient portal innovation with high usage improvement
  • Innovative use of statewide immunization information system (SIIS) and gathered immunization data for quality improvement with measurement from EHR or SIIS report
  • Implementation of behavioral 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, accountable care organization or medical home

Please complete this application by close of business Monday, July 31, 2017 (Nevada and Utah) or Friday, September 22, 2017 (New Mexico). If you have any questions, please contact HealthInsight at POawards@healthinsight.org.

Click here to complete the application for the Innovation Certificate