Identifying and Measuring Quality Care Indicators

Most practices set out to provide high-quality medical care to their patients. However, while you and your staff set the bar high, do you have the data to measure that high level of quality care?

Quality indicators have been around in various forms for years. Private practices have participated in PQRS (Physician Quality Reporting System), private payers' pay-for-performance programs, the HITECH Act's meaningful use program, and HEDIS. Yet, many practices struggle with identifying the appropriate quality indicators in each program and how to measure them.

At first glance it seems that reporting the three core clinical quality measures and identifying three additional clinical quality measures to meet meaningful use should be fairly simple. After all, during intake, practice staff weigh every patient and record their vital signs, including blood pressure. Typically that information is recorded in discrete fields that can be easily reported. The next step to demonstrate quality is to link that action of recording a patient's weight to assessing his BMI, and if that BMI is outside parameters, documenting a follow-up plan. Is your follow-up plan a narrative that is typed into a template, or is it identified by a specific field that can be extracted, measured, and reported?

The question is: Does your practice act upon patient data gathered at intake and recorded in such a way that it can be tied to clinical quality indicators; measuring actions and demonstrating results? For example, if your practice interviews patients regarding their smoking status and then, if necessary, counsels them on smoking cessation programs and medications, have each of those options been documented in a field in your EHR that can be extracted to measure your level of activity? Or, are discussions like this recorded as a narrative in the physician's notes where they cannot be retrieved across all patients for reporting quality measures?

Another such measure is an annual LDL-C for patients with cardiovascular conditions with a defined control goal of perhaps <100mg/dl. Do you meet the criteria for annual measures for 80 percent of your patient population? Do you have the results entered in a discrete field to report those results?

Adult BMI assessment, Hb A1c control, breast cancer screening, use of spirometry testing in the assessment and diagnosis of COPD, osteoporosis management in women who have had a fracture, colorectal cancer screening, and cervical cancer screening are just a few examples of clinical quality indicators that can be readily measured and reported with the appropriate use of the EHR.

What may seem to just be additional work and cumbersome reporting requirements is really a way for your practice to maximize revenue. It is a certainty: Changing reimbursement models will impact your practice revenue adversely. Opportunities to increase revenue are already being realized by other practices that have demonstrated quality by reporting on measures such as preventive and chronic care. So don't let your practice miss out.

Start by building alerts and prompts so that when each patient is automatically screened by the EHR for the appropriate indicator you or your nurse are alerted when the patient meets the criteria. Screening for many of the quality indicators should be initiated by your rooming nurse, which will save you time and optimize the patient's visit.

Start with the end in mind as you develop or modify your EHR templates and tools. Enlist the vendor support team to be sure you can report on quality measures so that others can see just how good you are!

Rosemarie Nelson is a principal with the Medical Group Management Association healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.