Harry S. Miller, M.D. – Four Seasons Pediatrics, Clifton Park, NY – January 2009
Partners Healthcare Systems, MA
Jeffrey Lasker, MD – Hyde Park Pediatrics, Boston, MA
Practices Share BTE Experience in our MD Testimonials Brochure – November 2005
Margaret See and Louis Snitkoff, MD – Capital Care Medical Group, NY – December 2005
Mitch Selinger, MD – Bridgewater Goddard Park Medical Associates, MA – December 2004
Diabetes Care Recognition
Barry Bershow, MD – Fairview Health Services, Minneapolis, MN – May 2007
Practices Share BTE Experience in our MD Testimonials Brochure – November 2005
Jahangir Cyrus, MD – Practicing Physician, Louisville, KY – August 2005
A. O’tayo Lalude, MD – Practicing Physician, Louisville, KY – April 2005
Albany Medical College’s Goodman Diabetes Service, Upstate NY – December 2004
The Practice: Four Seasons Pediatrics, a three-physician practice in the Clifton Park, N.Y.
The Program: Physician Office Link
Implementation of Bridges to Excellence: Four Seasons Pediatrics had been receiving repeated letters from Bridges to Excellence (BTE), outlining the program and letting us know how many of our patients would figure into any rewards that were available. After the third letter, they called us to have lunch. That’s what made us say, ‘OK, let’s see what this is about.
P4P Activities: BTE’s Physician Office Link program encouraged the adoption of EHRs with incentive payments from employers. Myself and my wife and practice partner Kimberly Elmer, MD, ran some numbers. We would get a one-time incentive payment of $50 for each of the 220 patients in our practice who were insured by one of the participating companies, which included large area employers like General Electric and Verizon. That payment would cover a basic level of BTE certification (for effective use of registries to track care of chronically ill patients and for having systems in place for follow-up and patient education). If the practice went for advanced certification (an EHR system that provided decision support, the ability to order prescriptions and tests, and the ability to generate patient reminders), we would also get $50 per patient for another two years, which would add up to more than $30,000, or enough to cover the initial costs of hardware, software, upgrades, and maintenance. But that wasn’t all. Several insurers in the area, though not officially part of BTE, were adopting the program’s criteria as a basis for incentive payments. Just getting accredited by BTE allowed us to qualify for $90,000 in incentives in the first couple of years.
Practice Culture Transformation: The EHR system and the resulting improvements in information accessibility have started to have tangible impacts on the quality of patient care. For example, the practice can report its immunization information to New York State electronically. As a result of setting up that data feed, we saw that nurses were making little mistakes in filling out immunization forms. They have to enter a lot of data, and there are lots of opportunities to get something a little bit off. Probably one out of ten things was incorrect. When we were putting everything on paper, we had no idea that was happening. The practice began running monthly reports to show where the errors were occurring, and the error rate has dropped to 1 in 100. After we began a program to give optimal care to asthma patients (the right medications at the right time, making sure the patient’s environment is as free of triggers as possible, and getting patients in for regular assessments), one large insurer saw a 38-percent increase in inhaled-steroid treatment among its Four Seasons patients. “Initially their cost per patient went up as they used more meds, but ER visits and urgent visits dropped, which more than overtook the increase.
The Practice: Hyde park Pediatrics includes five pediatricians and a nurse practitioner who care for about 4500 patients in Boston, Massachusetts, and neighboring Milton. The practice is an affiliate of Partners Community Healthcare, Inc. (PCHI).
The Program: BTE Physician Office Link
The Motive: “I’ve always seen the flaw in health care as not having the right kind of systems and processes to help improve care,” says Lasker. “There isn’t any training in medical school or residency on how to make these kinds of improvements, especially in a small practice. This seemed to me to be a way to bring those skills into the private practice setting.”
The Systems: Dr. Lasker worked with PCHI to help facilitate the initial application process, and develop the policies and procedures needed to earn BTE rewards. Based on their findings, they created:
- An asthma registry that helps the practice manage many issues more effectively.
- A process to follow up with every patient who visits an emergency room.
- A system to reduce obesity through education materials and other interventions.
- A portable document for special needs children that contains all of his or her issues, medicines and specialists.
- A behavior survey for adolescents to identify problems before they become serious.
The Rewards: According to Dr. Lasker, “At the end of the day you feel much better about the care you’re providing. You’ll see examples on a pretty regular basis of patients whose care has been affected by what you do. Then it becomes part of the way you do business.” In addition, the practice has received approximately $12,000 to date, enough to cover the cost of implementing its new processes.
The Extra Edge: Hyde Park had previously worked with insurers on similar programs, but they only included patients covered by the insurer. This initiative allows the practice to develop programs for all patients. Plus, says Lasker, it puts practices into the mindset to create policies and procedures for all kinds of issues. “It makes you aware that systems help you care for your patients,” Lasker says. “I’m a believer in this stuff.”
The Practice: Fairview Health Services is the second largest physician group system in Minnesota, with sites located in 7 hospitals (including the University of Minnesota Hospital) and numerous independent physicians practicing in various site locations throughout the St. Paul/Minneapolis vicinity. Fairview employs more than 300 physicians throughout its care system, and 5 out of its 7 systems actively participate in pay-for-performance and transparency initiatives. The majority of physicians practicing in these sites have been recognized by the Minnesota Community Measurement for delivering quality care to diabetic patients.
The Program: BTE Diabetes Care Link
P4P Activities: In 2005, Fairview requested support from its Board to participate in pay-for-performance initiatives in order to advance quality care and encourage improvements in physician performance. The Board agreed to allocate a lump sum of money per physician into a P4P pool from which they could qualify for rewards. Additionally, Fairview allocated funds from several Minnesota health plans to this incentives pool. In 2006, Fairview decided to participate in Bridges to Excellence for national recognition of physicians’ excellent performance in diabetic care.
Implementation of Bridges to Excellence: In Minnesota, BTE’s Diabetes Care Link program was implemented statewide by the Buyer’s Health Care Action Group (BHCAG), an employer coalition aimed to promote value and optimal healthcare, in 2004. Through BCHAG, Minnesota physician groups are eligible to quality for financial rewards based on their performance in delivering safe, quality care to diabetic patients. Each group’s performance is evaluated using a year’s worth of claims data and medical records before becoming eligible to receive rewards through BTE.
Fairview’s performance displayed throughout the 2006 year permits the practice to quality for rewards in 2007. Through BTE’s Diabetes Care Link program, Minnesota Community Measurement evaluates and recognizes physician groups’ performance, and the top 9 physician groups receive financial rewards. Minnesota Community Measurement recently released performance results of MN physician groups measuring the percentage of delivering optimal diabetes care to patients, and Fairview was ranked 5th out of more than 50 groups for its performance in 2006 (http://www.mnhealthcare.org/~Display.cfm). Fairview anticipates that 21 out of its 28 clinical sites will be recognized by Minnesota Community Measurement for excellence in diabetic care.
Practice Culture Transformation: Because Fairview’s clinic sites have all fully adopted electronic medical record (EMR) systems, which occurred between 1999 and 2005, they have experienced overall process improvements, which has enabled them to continue performing at high levels. “Our EMR system, EPIC, was essential to our success in implementing Bridges to Excellence, because it provided alerts to physicians to check hemoglobin A1c levels, for example. It had a tremendous impact in transforming the culture within our practice and has ultimately helped improved our efficiency,” said Dr. Bershow. As a result, Fairview decided to take the next step and expand its level of transparency for consumers’ benefit. In April 2007, the practice published outcomes data for each of its clinical sites on its website (http://www.fairview.org/Patient_Safety/Effective/c_307097.asp). Consumers can use this information to determine the clinical sites that deliver optimal care to diabetic patients within Fairview’s system and seek care at those sites.
Over the years, Fairview has drastically improved its percentages of delivering optimal care to diabetic patients by becoming conscientious of the impact of quality care, which was the driver for Fairview’s participation in Bridges to Excellence and other P4P activities related to diabetes care. In 2003, Fairview delivered optimal care to diabetic patients approximately 4% of the time and increased its performance drastically throughout 2004-2006. In 2006, Fairview delivered optimal care 22.8% of the time and plans to achieve its goal of 38.8% for the 2007 year. It is evident that P4P programs like Bridges to Excellence truly impact practice culture and behavior, benefitting not only diabetic patients but physicians as well. In 2007, Fairview will be eligible for rewards that could potentially total $200,000, which will be dispersed among its physicians recognized by Minnesota Community Measurement for providing excellent care to diabetic patients.