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Physician Performance Measures: The Massachusetts Experience Bruce Auerbach, MD, FACEP President Massachusetts Medical Society
The Massachusetts Environment ,[object Object],[object Object],[object Object]
Mass. Group Insurance Commission ,[object Object],[object Object],[object Object]
Cost & Quality: The GIC Approach “Clinical Performance Improvement initiative” ,[object Object],[object Object],[object Object],[object Object]
MMS-GIC Dialogue:  Timeline Highlights 2002-03: GIC begins work Aug. ’04 MMS, GIC  dialogues begin 2004 2005 2006 2007 2003 2008 …  more … ,[object Object],[object Object],[object Object],[object Object],[object Object]
. . . Early Decisions ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
RHI Quality Measures Assessment (Claim Years 2003-2005) Doctor's 08-ID: 401134   Doctor's Last Name: MAGEE   Doctor's First Name: BDALE   Doctor's Specialty:  OBSTETRICS & GYNECOLOGY Applicable RHI Measure Invoked Cases Compliance  Compliance Rate  HEDIS: CervCA_screen_PQP 111 107 96% HEDIS: BrCA_Screen_PQP 57 53 93% Preventive Care 26: High-risk_Pap Smear_PQP 13 12 92% HEDIS: Chlamydia_screen_PQP 13 8 62% Drug Safety 1: Pregnancy_Accutane_PQP 3 3 100% Breast Cancer 8: BrCA_mammogram_PQP 1 1 100% Osteoporosis 1: Women 66-67y_BMDTest_PQP 1 0 0% Prenatal Care 10: Pregnancy Screen_ Rubella_PQP 1 0 0% Prenatal Care 11: Pregnancy Screen_ Hep B_PQP 1 0 0% Prenatal Care 12: Pregnancy_HIV_PQP 3 0 0% Your Quality Assessment Results: 204 184 90%     Peer Specialty  Results: 171,145  139,393  81%     Your Final Quality Score (q-score): 1.11
 
Public Reports
Public Reports
MMS Principles and the CPI * Partial list ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Researcher Findings MMS Principles*
The GIC’s New Rules for 2008-11 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Net Result ,[object Object],[object Object],[object Object],[object Object]
What Physicians Are Saying ,[object Object],[object Object],[object Object],[object Object],[object Object]
MMS-GIC Dialogue:  Timeline Highlights 2002-03: GIC begins work Aug. ’04 MMS, GIC  dialogues begin April ’06:  Enrollment begins 2004 2005 2006 2007 July ’07: Year 2  begins 2003 2008 April ’08: Patient Charter July ’06: Year 1  begins Nov. ’07: NY & MMS Principles July ’08: Year 3 begins May ’08:  MMS files litigation
The Litigation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Health Plan  Incentive Programs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Doing It the Right Way … (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Doing It the Right Way … (2) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Doing It the Right Way . . . (3) Hill Physicians Group
 
 
 
Another “Right Way”
Another “Right Way”
Where we are today ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Quality And Performamce Measurement: The Massachusetts Experience

  • 1. Physician Performance Measures: The Massachusetts Experience Bruce Auerbach, MD, FACEP President Massachusetts Medical Society
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  • 9. RHI Quality Measures Assessment (Claim Years 2003-2005) Doctor's 08-ID: 401134   Doctor's Last Name: MAGEE   Doctor's First Name: BDALE   Doctor's Specialty: OBSTETRICS & GYNECOLOGY Applicable RHI Measure Invoked Cases Compliance Compliance Rate HEDIS: CervCA_screen_PQP 111 107 96% HEDIS: BrCA_Screen_PQP 57 53 93% Preventive Care 26: High-risk_Pap Smear_PQP 13 12 92% HEDIS: Chlamydia_screen_PQP 13 8 62% Drug Safety 1: Pregnancy_Accutane_PQP 3 3 100% Breast Cancer 8: BrCA_mammogram_PQP 1 1 100% Osteoporosis 1: Women 66-67y_BMDTest_PQP 1 0 0% Prenatal Care 10: Pregnancy Screen_ Rubella_PQP 1 0 0% Prenatal Care 11: Pregnancy Screen_ Hep B_PQP 1 0 0% Prenatal Care 12: Pregnancy_HIV_PQP 3 0 0% Your Quality Assessment Results: 204 184 90%     Peer Specialty Results: 171,145 139,393 81%     Your Final Quality Score (q-score): 1.11
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  • 17. MMS-GIC Dialogue: Timeline Highlights 2002-03: GIC begins work Aug. ’04 MMS, GIC dialogues begin April ’06: Enrollment begins 2004 2005 2006 2007 July ’07: Year 2 begins 2003 2008 April ’08: Patient Charter July ’06: Year 1 begins Nov. ’07: NY & MMS Principles July ’08: Year 3 begins May ’08: MMS files litigation
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  • 22. Doing It the Right Way . . . (3) Hill Physicians Group
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