Page 1

Mount Carmel Health Partners Report on Clinical Integration

Commitment to Quality Report

2010


In memory of TAMMY L. WEIDNER January 19, 1960 — February 16, 2011 Vice President Patient Care Services and Chief Nursing Officer Mount Carmel St. Ann’s Board of Directors Mount Carmel Health Partners, Inc.

We shall remember you and your dedication to the care of others.


3

Table of Contents Welcome to the 2010 Commitment to Quality Report ........................................................... 4 Letter from the Medical Director ............................................................................................. 5 Mount Carmel Health Partners Organizational Information .................................................. 6 Clinical Integration ................................................................................................................... 8 Clinical Integration Committee Structure .............................................................................. 10 Clinical Integration Program Summary ................................................................................. 11 Patient Registry ....................................................................................................................... 12 Clinical Guidelines ................................................................................................................. 14 Generic Prescribing ................................................................................................................ 16 Diabetes Care.......................................................................................................................... 17 Primary Care Physician HEDIS Improvement ....................................................................... 18 Female Preventive Screenings by OB/GYN Physicians ....................................................... 20 Optimal Prenatal and Postpartum Care ................................................................................. 21 Perinatal Electronic Fetal Monitoring Certification ............................................................... 22 Reduction in Emergency Room Medically Treated and Released Visits .............................. 23 Patient-Centered Medical Home ............................................................................................ 24 NCQA Diabetes Physician Recognition Program .................................................................. 26 NCQA Heart-Stroke Physician Recognition Program ........................................................... 30 Cardiology and Vascular Service Outcomes ......................................................................... 34 Orthopedics Service Outcomes ............................................................................................. 38 Post-Fracture Osteoporosis Management .............................................................................. 41 Oncology Outcomes .............................................................................................................. 42 Physician Credentialing and Board Certification .................................................................. 44 Genesis Information ............................................................................................................... 45 Physician-Led Quality Improvement in the Hospital Setting ............................................... 46 References ............................................................................................................................... 51


4

Welcome to the 2010 Commitment to Quality Report

I

t is with great pride and pleasure that the Board of Directors of Mount Carmel Health Partners, our Medical Director and I share with you the work and progress that have taken place during 2010. At the same time, we are certain you will agree that 2010 was a pivotal year in healthcare nationally. The Patient Protection and Affordable Care Act (Healthcare Reform) and political influence will continue to drive change in healthcare and leave us with some uncertainty. One thing that is certain, however, is that maintaining the status quo will result in many being left behind. Knowing this, we continue to build on the concept that physician and hospital collaboration, herein referred to as Clinical Integration, is not only beneficial and rewarding but also timely in a rapidly changing healthcare delivery system with a focus on quality and value. At Mount Carmel Health Partners, we feel a sense of responsibility to our physician and hospital members and to the community to deliver the appropriate care, at the appropriate time and in the appropriate setting. Achieving this through physician-led initiatives is a driving force behind our actions. This is evidenced by a number of initiatives described in this publication, which range from the development of nine new clinical pathways designed to aid physicians in patient care, to new quality programs that will reward physicians for their efforts. The latter includes the introduction of our first specialist pay-for-performance program directed at OB/GYN physicians, as well as an emergency room avoidance program with the goal of redirecting patients to their primary care physicians when appropriate and a program focused on generic drug utilization. In 2011 it is our highest priority to take the next steps essential to becoming a truly clinically integrated healthcare delivery system. In order to achieve this, a patient registry will be adopted by mid-year. This new technology will measure quality and aid physicians in meeting quality goals established by the government and our physician leaders to ensure that as a network we can demonstrate quality care. We believe it is the right thing for our patients and the right thing for the communities we serve. We invite you to read through this 2010 Commitment to Quality Report to better understand Mount Carmel Health Partners’ vision for Clinical Integration, the programs we have put into place to improve patient care and the successful outcomes that were achieved. We wish you the best in 2011 as we look forward to a year filled with efforts that make a difference in this ever-changing healthcare environment. Michele Helbig Executive Director, Mount Carmel Health Partners


5

Letter from the Medical Director

I am proud and excited to share with you Health Partners’ third annual Commitment to Quality Report. In the pages that follow, you will see documentation of the exciting progress our physician-hospital organization has made in 2010 and our plans for the future. Not only does the Commitment to Quality Report detail the ongoing efforts to improve quality and reduce the cost of healthcare provided by our member physicians, but it also outlines the exciting movement we have made toward achieving our strategic goal of having a Clinically Integrated network in place in 2011. You will notice that the quality programs displayed go well beyond the primary care focus of the past and include hospital initiatives and specialist programs. This true collaboration is essential as we move forward. Health Partners will soon be utilizing a new information technology platform to allow seamless data gathering and intra-network communication. This platform, coupled with the outstanding quality programs outlined in this publication, will prepare member physicians and Health Partners to step into the future with a fully integrated network that includes primary care and specialist physicians working in concert with the hospital system to provide the finest care in central Ohio. If you are reading this as a physician or hospital member of Health Partners, I would ask that you take appropriate pride in the good work you have done, which is documented here. If you are reading this as a consumer, payer or important stakeholder, I think it will be clear to you how proud we are of the work of all 1,400 Health Partners member physicians and the over 5,000 Mount Carmel Health System associates. These efforts allow change to take place and the quality of patient care in central Ohio to improve. Daniel Wendorff, MD Medical Director, Mount Carmel Health Partners


6

Mount Carmel Health Partners Organizational Information Mount Carmel Health Partners

Contact Information

Mount Carmel Health Partners (Health Partners) is a physician-hospital organization (PHO) composed of more than 1,400 individual physician members and Mount Carmel Health System. Mount Carmel Health System serves more than a half-million patients each year and is the second-largest healthcare system in central Ohio. The system includes four acute care hospitals as well as outpatient facilities, a free-standing emergency room, physicians’ offices, surgery centers, urgent care centers and community outreach sites. Physician members of Health Partners represent all specialty disciplines and practice sizes.

Main telephone number Fax number Website Address

Each physician who joins Health Partners is credentialed to ensure that he or she is boardcertified and meets the organization’s standards for education and quality. The organization follows the National Committee on Quality Assurance (NCQA) credentialing standards to ensure that the credentialing process is comprehensive and complete. All physician members are reviewed by the Credentialing Committee, which is composed of practicing physicians, and by the Health Partners Board of Directors. A benefit of participation in Health Partners is access to numerous health plan and payer contracts. Health plan contracts and terms are analyzed thoroughly to be certain that the contract can be administered and that terms cover key provisions such as prompt payment and clear billing requirements. Member physicians enjoy reduced administrative costs as a result of a comprehensive credentialing process. Payer contracts have delegated the credentialing function to Health Partners, creating ease of participation for physicians who do not have to complete paperwork for each individual payer. Health Partners also has an experienced Provider Relations team that can assist practices in understanding specific managed care contract offerings, aid in resolving payer issues and provide education related to new payer contract offerings and requirements.

(614) 546-3000 (614) 546-4261 www.mchp.com 6150 East Broad Street Columbus, Ohio 43213

Mount Carmel Health Partners Board of Directors Health Partners is a partnership between member physicians and Mount Carmel Health System. Physician Directors are elected by physician shareholders, and Mount Carmel Health System Directors are appointed by Mount Carmel Health System leadership. 2010 Board of Directors Michael J. Cooney, MD, Co-Chair Cooney, M.D., Ricaurte, M.D. & Associates, Inc. INTERNAL MEDICINE George Ho, MD, Co-Chair Scioto Valley Urology, Inc. UROLOGY James J. Barr, MD Dublin Family Care FAMILY PRACTICE Franklin Bressler, MD Bressler & Schaeffer, Inc. OBSTETRICS AND GYNECOLOGY John Tyznik, MD Family Physicians of Gahanna FAMILY PRACTICE Paula Autry Mount Carmel Health System CHIEF OPERATING OFFICER, MOUNT CARMEL EAST Jackie Primeau,Vice Chair Mount Carmel Health System SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER Cindy Sheets Mount Carmel Health System SENIOR VICE PRESIDENT, AMBULATORY SERVICES AND CHIEF INFORMATION OFFICER Richard Streck, MD Mount Carmel Health System SENIOR VICE PRESIDENT AND CHIEF MEDICAL OFFICER Tammy Weidner Mount Carmel St. Ann’s VICE PRESIDENT, PATIENT CARE SERVICES AND CHIEF NURSING OFFICER


8

Clinical Integration Clinical Integration is the coordination of patient care across conditions, providers and settings. It is characterized by a high degree of interdependence among hospitals and physicians, and it involves the establishment of agreed-upon clinical protocols across a broad spectrum of diagnosis and procedures, the development of sophisticated revenue compensation methodologies to align incentives, and the integration of information technology and reporting capabilities among healthcare organization and physicians.1

Commitment to Quality Report

Clinical Integration Vision

The third edition of Health Partners’ Commitment to Quality Report is an opportunity to share the organization’s Clinical Integration program achievements, explain the quality projects that have taken place in 2010, and demonstrate physician and hospital collaboration in improving healthcare quality in central Ohio. The report is written for a variety of audiences: Health Partners physician members, physician practice administrators, employers, health plans, hospitals, coalitions, pharmaceutical companies and, of course, patients and the community.

Clinical Integration is primary care physicians, physician specialists and hospitals working together, using proven protocols and measures, to improve patient care. Health Partners physicians, along with Mount Carmel Health System, will engage in physician-directed quality improvement with the focus on improving patient and clinical outcomes along with reducing the cost of healthcare. These efforts and their outcomes will be shared with health plans, employers and the community, allowing Health Partners physicians and hospitals to demonstrate and be rewarded for exceptional patient care.

Mount Carmel Health Partners’ Mission The mission of Health Partners is for physicians and Mount Carmel Health System to venture collaboratively to provide high-quality, costeffective, coordinated and innovative patient care in all healthcare settings and to be the premier healthcare provider network in central Ohio.

Clinical Integration is important because it: • Improves clinical outcomes and care for patients and their families • Improves patient, physician and employee satisfaction • Reduces healthcare costs for patients, employers and health plans • Increases the coordination of care between physicians, hospitals and other care providers • Improves a health plan’s quality performance and Healthcare Effectiveness Data and Information Set (HEDIS) performance • Facilitates the delivery of the right care at the right time in the right setting • Improves physician reimbursement through quality improvement • Aids in establishing the healthcare quality standard in central Ohio


9

Clinical Integration

continued

Traditional healthcare can often be described as being fragmented and uncoordinated. Patients are expected to navigate through a series of unaligned resources and services. Physicians are often expected to manage the care for a patient without adequate communication between providers. This can lead to unnecessary delays in care, causing patients to leave a market or network in search of more coordinated services and immediate attention. Once the defined treatment plan is complete, the complex network of healthcare professionals may have lost a valued patient, or may continue to work in a manner that fails to meet the expectations of the patient.

Clinically integrated healthcare helps the network improve the quality of care while also improving the coordination of care. This approach is centered on managing the patient more proactively through data and processes designed to avoid the traps associated with the traditional healthcare environment. Clinical Integration provides the resources and infrastructure necessary to coordinate patient care across the continuum of services and demonstrates the results associated with improved patient care.


10

Clinical Integration Committee Structure The success of Health Partners’ Clinical Integration strategy is reliant on a foundation of physicians who are leaders in quality in their practices and among their peers, and a partnership with Mount Carmel Health System leaders. The following are the physician-led committees that form the infrastructure for a successful Clinical Integration program. As Health Partners’ Clinical Integration program matures, additional physicians and hospital personnel will be added to serve as a resource in developing and implementing new Clinical Integration programs. Health Partners always welcomes interested physicians and hospital leaders who would like to contribute to these important endeavors.

Credentialing Committee Committee Focus: Ascertains that physician applicants and existing Health Partners physician members meet established criteria for network membership, ensuring Health Partners physicians meet the highest professional and ethical standards. The committee reviews the credentials of new physician applicants, recredentials existing members every two years and ensures that the organization adheres to the National Committee on Quality Assurance (NCQA) credentialing policies and procedures. Additional committee responsibilities include recommending physician applicants to the Board of Directors. The committee also serves as the nominating committee to fill seats on the Board of Directors. 2010 Committee Members

Quality and Clinical Integration Committee Committee Focus: Researches and develops the clinical measures, clinical guidelines and quality improvement programs that form the foundation of the Clinical Integration strategy. The committee has been actively involved in the development, implementation and monitoring of the programs that are outlined in this publication. This involvement will continue during the development of additional metrics, quality programs and Clinical Integration educational materials that will be shared with member physicians, payers and others. 2010 Committee Members Daniel Wendorff, MD Chairperson and Medical Director, Internal Medicine Augustus Parker, MD Obstetrics and Gynecology Jay Bombach, MD Orthopedic Surgery Dennis Ruppel, MD Family Practice Maria Courser, MD Internal Medicine and Pediatrics Greg Wise, MD Family Practice Paul Grandinetti, MD Internal Medicine Gayle O’Brien, RN Vice President, Mount Carmel Quality and Safety Anantha Padmanabhan, MD Colon and Rectal Surgery Melissa Caust-Ellenbogen Director, Mount Carmel Finance

Phillip Shubert, MD, Chairman Obstetrics and Gynecology

Anita Steinbergh, DO Family Practice

Charles Vonder Embse, DO Family Practice

Terri Latourelle Director, Mount Carmel Provider Relations

Elena Christofides, MD Endocrinology Daniel Wendorff, MD Medical Director, Internal Medicine

Linda Yonker Chief Nursing Officer Mount Carmel New Albany

David Drees, MD Radiology

Information Technology Committee Committee Focus: In 2010, the Information Technology Committee led the review and selection of a clinical information technology solution that will support the organization’s Clinical Integration strategy. This included a comprehensive review and development of a formal request for information, vendor presentations, identifying which systems met the organization’s needs, and interviewing current users. The committee will also serve as a resource going forward relative to Clinical Integration information technology and needs. 2010 Committee Members Daniel Wendorff, MD Chairperson and Medical Director, Internal Medicine Paul Grandinetti, MD Internal Medicine Thomas Brady, MD Internal Medicine Douglas VanFossen, MD Cardiology David McMahon, MD Internal Medicine

Dennis Ruppel, MD Family Practice Kristine Slam, MD General Surgery Anita Jordan Director, Mount Carmel Information Technology Sherri Stagg Manager, Mount Carmel Information Technology


11

Clinical Integration Program Summary The U.S. healthcare environment will continue to move to a system that rewards physicians, hospitals and other providers based on quality performance and the value they provide to purchasers of healthcare services. Under this new and evolving model, healthcare providers must focus on developing care processes, using proven methods to aid in care management, developing measurement tools that evaluate their ability to improve the health of a given population, improving a patient’s experience

and reducing healthcare costs through improved efficiency. Health Partners and its member physicians have and are developing the clinical competencies under the Clinical Integration model to enable members physicians to succeed in this new environment. The following table outlines key programs that Health Partners and its member physicians have implemented and monitored in 2010. These programs are detailed in the proceeding sections of this document.

Health Partners’ Current Quality Programs Current Quality Programs

Population Health

Experience of Care

Cost of Care Reduction

Patient Registry

x

x

x

Clinical Guidelines

x

x

x

Diabetes Care

x

x

Primary Care HEDIS Improvement

x

x

Female Preventive Screenings by OB/GYN Physicians

x

Appropriate Prenatal and Postpartum Care

x

Perinatal Electronic Fetal Monitoring Certification

x x

x

x

x

Reduction in ER Medically Treated and Released Visits

x

x

x

Patient-Centered Medical Home

x

x

x

NCQA Diabetes Physician Recognition Program

x

x

NCQA Heart-Stroke Physician Recognition Program

x

x

Cardiovascular and Vascular Service Line

x

x

x

Orthopedic Service Outcomes

x

x

x

Post-Fracture Osteoporosis Management

x

x

x

Oncology Outcomes

x

x

Physician Credentialing and Board Certification

x

x

x

Genesis Implementation and Preparation

x

x

x

Physician-Led Quality Improvement in the Hospital Setting

x

x

x


12

Patient Registry Successful Clinical Integration is heavily reliant on collaboration between each provider of care and between the providers and their patients. In order to accomplish this, systems have been developed to aid in this process of patient or population management. These systems, called patient or disease registries, collect patient information and match this information to evidence-based medicine and metrics that have been decided upon in advance using standards from various physician specialty organizations and input from local physician committees. The registries manage this information and report back to the physician to aid in supporting clinical care and to identify patients who need clinical engagement. They also generate patient communications. Using these tools, physicians, hospitals, Health Partners’ Medical Director and quality staff, as well as health insurance plans can identify areas of opportunity where collaboration directed at improving care can take place. The quality programs included and outlined in this publication were all developed using various forms of this type of quality-related clinical information to achieve the targets. Health Partners is developing a more robust and comprehensive process of utilizing quality and clinical information for Clinical Integration through the adoption of a patient registry. Physician-hospital organizations throughout the nation have utilized patient registries to support successful Clinical Integration programs. Patient information will be collected from physicians, hospitals, laboratories, pharmacies and other healthcare providers. Once analyzed, care management protocols will be reported back to physicians. This information will make it easier to determine how best to serve a patient or a population of patients. A patient registry provides unique benefits to all vested parties: Patients: • Provides patients with the ability to participate in their healthcare and make better-informed healthcare decisions. • Gives their physician(s) the most up-to-date information on their clinical care. • Reduces out-of-pocket costs and time by avoiding unnecessary or duplicative testing and procedures. • Offers patients comprehensive review of their total clinical care.

Physicians and healthcare providers: • Delivers timely reminders and care guidance for optimal clinical decision-making during each patient encounter. • Includes comprehensive population management tools. • Increases access to patient-specific information from laboratories and pharmacies. • Provides clinical performance measurement tools. • Offers patient outreach tools such as patient letters and patient compliance reports. • Delivers access to clinical best practices. • Assists in meeting pay-for-performance goals. Hospitals • Provides the information that allows hospitals and other providers to work with their medical staff on quality initiatives. • Delivers the framework to develop pay-forquality programs with payers and physicians. • Supplements hospital quality data to provide a complete picture of patient care. • Reduces unnecessary tests by allowing hospitals to have a record of care delivered by patients in the ambulatory setting. Employers and health plans: • Reduces healthcare costs for health plan members or employees by avoiding unnecessary or duplicative testing and procedures. • Reduces healthcare spending through preventive care. • Increases worker productivity by avoiding or mitigating chronic diseases. • Provides health plan members or employees access to high-quality physicians and hospitals. Future editions of Health Partners’ Commitment to Quality Report will describe additional programs that have been developed using the patient registry.


14

Clinical Guidelines Clinical Integration Clinical Guidelines

Program Summary Clinical Guidelines are an important element of Clinical Integration. They contain treatment recommendations that are based on evidence from a rigorous systematic review of published medical literature regarding best practices for the diagnosis and treatment of specific clinical diseases. The guidelines have been reviewed by the Health Partners Quality Committee and by other member practicing primary care and specialty physicians. They have also been reviewed and approved by the Health Partners Board of Directors to be a key part of the Clinical Integration program. The purpose of these guidelines is to assist physicians in the care of specific illnesses and thereby improve the overall health of specific patient populations. These Clinical Guidelines support a variety of Health Partners Quality and Clinical Integration programs. Five Clinical Guidelines were developed as part of Health Partners emergency room (ER) utilization reduction projects. They were developed based upon discharge diagnosis codes that are common in the ER. The guidelines are intended to be used by all Health Partners physicians for any patient with the identified conditions. Additional guidelines have been developed for the Patient-Centered Medical Home, Diabetic Care program, and ambulatorycare-sensitive admissions initiative. Ambulatorycare-sensitive admissions are admissions where high-quality outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.1 Ambulatory-caresensitive admissions are a key focus area of Health Partners as the organization attempts to reduce healthcare costs and unnecessary hospitalizations. Health Partners Clinical Guidelines can be found at www.mchp.com.

Acute Bronchitis: Acute bronchitis is a disorder affecting approximately 5% of adults annually. It is a clinical term implying a self-limited inflammation of the large airways of the lung characterized by cough without pneumonia. Acute bronchitis and other respiratory conditions account for a high percentage of outpatient, urgent care and ER visits. The clinical guideline provides treatment recommendations for complicated and uncomplicated acute bronchitis. Diabetes Type 2: Diabetes is a multifactorial metabolic disease influenced by environmental and genetic factors characterized by impairment of insulin secretion from pancreatic Ă&#x;-cells and insulin resistance in peripheral tissues. Recent studies estimate that by 2050, 33% of the U.S. population will have diabetes.2 The guideline provides recommendations regarding the proper management of individuals with diabetes as well as referral recommendations. Chronic Obstructive Pulmonary Disease (COPD): COPD exacerbation accounts for a significant number of physician and ER visits. COPD is an incurable condition in which lung function progressively decreases over time. The clinical guideline provides the treating physician with a consolidation of best practice recommendations in order to decrease the number of exacerbations and therefore decrease patient morbidity and medical resource utilization. Cystitis/Urinary Tract Infection in Adult Women: Recurrent urinary tract infections, an inflammation of the urinary bladder and ureters, are common among women, even though they have anatomically and physiologically normal urinary tracts. Prevention and management of urinary tract infections can reduce the likelihood of recurrent episodes and decrease severity of symptoms. Heart Failure: Heart failure is a condition in which the heart cannot pump enough blood to meet the needs of body tissues. The diagnosis of heart failure is a clinical diagnosis based upon patient history, the physical examination and diagnostic studies. The clinical guideline provides information on the clinical management of heart failure in order to reduce unnecessary healthcare utilization and poor clinical outcomes associated with heart failure.


15

Clinical Guidelines Hyperlipidemia: Hyperlipidemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood and can contribute to severe cardiovascular diseases. This clinical guideline outlines the treatment protocol for hyperlipidemia with therapeutic lifestyle changes and pharmacologic management. Hypertension: Hypertension, or high blood pressure, is a chronic medical condition in which the systemic arterial blood pressure is elevated and can progress to severe cardiovascular diseases. This clinical guideline outlines the treatment protocol for hypertension, including therapeutic lifestyle changes and pharmacologic management. Kidney Stones: Kidney stones are a mineral buildup (stone) in the kidney that accounts for considerable morbidity and discomfort and ER utilization. Many or most of these ER visits are appropriate due to the significant symptom complex (especially pain) and the potential for complications that could require hospitalization and urgent urologic consultation. The goal of this guideline is to decrease the rate of recurrent kidney stones and thereby reduce ER utilization and the cost associated with it. Osteoporosis: Osteoporosis is a multifactorial skeletal disease characterized by low bone mineral density with micro-architectural disruption and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. The clinical guideline outlines treatment protocols including lifestyle and pharmacologic management.

continued


16

Generic Prescribing Program Summary Health plans, employers and patients can realize substantial cost savings from generic prescriptions. It is estimated that every percentage point increase in generic utilization reduces overall drug spending by nearly a percentage point.1 Extensive research demonstrates the effectiveness of generic medications in treating patients. In addition, all generics have long-term safety data often not available with newer, branded medications. This combination of long-term efficacy, safety data and lower cost makes generic pharmaceuticals a cost-effective option for physicians and their patients.2

Pharmacy Cost Savings

Program Goals Health Partners, in partnership with an employersponsored health plan, launched a Generic Prescribing Initiative in 2009. The health plan spent $2.5 million on 13 brand-name drugs with generic alternatives in calendar year 2008. Spending on these 13 brand-name drugs represented 23.8% of the health plan’s pharmacy costs. Over 13,000 scripts were written for these 13 drugs in 2008. These drugs were chosen because they have a generic alternative and/ or alternatives that can be purchased over the counter. The goals of the initiative were to: • Maximize medication compliance to improve health outcomes by ensuring patients are provided with affordable medications. • Reduce the health plan’s costs for 13 selected brand-name pharmaceuticals by 20% through appropriate use of generic alternatives.

Program Results Physicians participating in this program were able to reduce the costs of 13 brand-name drugs with generic alternatives by 22% during the measurement period. This represented a total savings to the health plan of more than $150,000. The health plan savings is the difference between the cost of the brand-name drugs and the costs of the generic alternatives that were prescribed in place of the brand-name pharmaceuticals.

$150,000

Cost Savings


17

Diabetes Care Program Summary

Measure

Health Partners, in partnership with an employersponsored health plan, launched a Diabetes Quality Improvement program in 2009 and 2010. The health plan spent approximately $6 million on the cost of diabetic care of more than 725 diabetes members in the prior year. This cost was double the cost incurred by a typical health plan member. It was also recognized that many diabetic members did not receive the appropriate testing as recommended by the National Committee for Quality Assurance (NCQA) and the American Diabetes Association.

Percent of patients who had an office visit for diabetes care in the last 6 months

90%

Percent of patients who had an HbA1c test performed in the last 12 months

90%

Percent of patients whose HbA1c test was less than 7.0% (good diabetic control)

40%

Percent of patients whose HbA1c test was not greater than 9.0% (poor diabetic control)

15%

Percent of patients who had an LDL test in the last 12 months

90%

Percent of patients whose most recent LDL was less than 100 mg/dL

36%

Percent of patients who had an annual screening for nephropathy

80%

Percent of patients who had an annual screening for retinopathy

60%

Program Goals The goals were to improve outcomes, continuity and quality of care for the health plan’s members with diabetes by encouraging them to have a diabetes care visit every 6 months (more if appropriate) and to have testing as recommended by NCQA and the American Diabetes Association. Another goal was to track and report the cost of diabetes to better understand the financial impact of controlled versus non-controlled diabetic patients.

Program Results The measures of HbA1C less than 7.0% and LDL less than 100 mg/dL, indicators of excellent diabetic control, both met the goals that were set based upon recommendations by the NCQA. While other measures remained relatively the same from baseline, together with our physicians we continue to develop tools to enable achievement in all program objectives.

Goal


18

Primary Care Physician HEDIS Improvement 2009 Program Program Summary Health Partners primary care physicians partnered with a Medicare Advantage plan and an employer-sponsored health plan to impact and improve six HEDIS plan measures. These measures are of particular importance to the health plan, Health Partners physicians and plan members, since high HEDIS performance results represent effective preventive care delivery. Recommended preventive care can prevent the development of acute and chronic disease and can help mitigate the costs associated with them.

Program Goal The program measured individual physician performance across six HEDIS measures. A total of 356 primary care physicians participated in the program. Physicians were successful in the program if they met the goal of three out of six HEDIS measures.

Program Results Overall, Health Partners physicians met the program goal on five out of six measures. One hundred and seventy of the 356 participating physicians (48%) met three out of six measures. Twenty-five participating physicians met five out of six program measures. Over 13,000 health plan members received care from the physicians who met three out of six HEDIS measures.

2009 Measure Breast cancer screening

2009 Goal

2009 Health Partners Performance

69.50%

69.10%

LDL-C screening

88.00%

89.44%

Colorectal cancer screening

53.20%

58.17%

Comprehensive diabetes care: HbA1c less than 7%

45.80%

51.18%

Osteoporosis management in women with a fracture

21.80%

30.57%

Persistence of beta-blocker treatment

69.60%

83.12%

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.1


19

Primary Care Physician HEDIS Improvement continued

2010 Program

2010 Measure Breast cancer screening

70.0%

Program Summary

Spirometry testing to confirm the diagnosis of chronic obstructive pulmonary disease (COPD)

32.2%

Colorectal cancer screening

53.2%

Diabetic patients who had at least one hemoglobin A1c in the last 12 months

90.0%

Health Partners continued the HEDIS program in 2010 with a focus on preventive care with a specific emphasis on preventing the development and severity of chronic diseases in the health plan’s members.

Program Goal The program measured individual physician performance across four HEDIS measures. Physicians will receive a report on their performance in early 2011. Results will be shared in the 2011 Commitment to Quality Report.

2010 Goal


20

Female Preventive Screenings by OB/GYN Physicians Program Summary Health Partners launched an obstetrics and gynecology (OB/GYN) quality care project with an employer-sponsored health plan in 2010. The OB/GYN project focuses on ensuring that women in the health plan receive appropriate preventive screenings and osteoporosis management based on national standards of quality utilizing the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. The preventive measures selected for the project have proven to identify illness early in the disease state and reduce the severity of illness in this population.

Program Goal The goal of the program is for participating OB/GYN physicians to meet or exceed three out of five project goals. The goal seeks to exceed the 90th percentile for the HEDIS national benchmark for breast cancer, cervical cancer and colorectal cancer screening measures. The project will end in 2011.

Project Measure

2010 Health Partners Performance

2011 Goal

Breast cancer screening

90%

90%

Cervical cancer screening

95%

90%

Colorectal cancer screening

61%

90%

Osteoporosis management

65%

72%

Not available

80%

Body mass index screening

Negative Changes in U.S. Mammography Screening Rates 68.3%

2000 2005

66.4%

Additional Measures The Health Partners Quality and Clinical Integration Committee has recommended four additional measures that are in need of attention in female populations. These measures are HIV testing for pregnant women, influenza immunization for pregnant women, a postpartum visit between 21 and 56 days after delivery, and postpartum diabetes screening for women with a history of gestational diabetes.

U.S. Mammography Screening Rates 3


21

Optimal Prenatal and Postpartum Care Program Summary Health Partners, in partnership with a managed care plan, launched an obstetrics and gynecology (OB/GYN) quality of care project in 2010. The OB/GYN project focuses on ensuring that pregnant health plan members receive appropriate prenatal and postpartum care based on national standards of quality. The Healthcare Effectiveness Data and Information Set (HEDIS) was utilized to provide measurement guidelines and benchmarking standards for the project. Appropriate prenatal care provides mothers and infants with optimal opportunity for a healthy delivery by reducing high-risk behaviors and involving a physician early in the pregnancy. Communication to pregnant health plan members reminding them of the recommended prenatal and postpartum care services was also provided.

Program Goal Individual participating physicians will be successful in the program if they meet the following goals. Project Measure

Individual Physician Goal

Initiation of prenatal care

Care provided at the 90th HEDIS national percentile

Frequency of ongoing prenatal care

Care provided at the 75th HEDIS national percentile

Postpartum care

Care provided at the 75th HEDIS national percentile

Perinatal risk assessment

90% of health plan members have a completed risk assessment

Program Result The program will end on December 31, 2011, and results will be shared in the 2011 Commitment to Quality Report.


22

Perinatal Electronic Fetal Monitoring Certification Program Summary OB/GYN physicians, Mount Carmel and Trinity Health (parent organization of Mount Carmel) have developed a collaborative Perinatal Electronic Fetal Monitoring Certification program. This program focuses on implementing a uniform electronic fetal monitoring interpretation program at Mount Carmel hospitals that is consistent with best practices. This initiative will ensure that all members of the medical team caring for a patient in labor have been certified by the National Certification Corporation which certifies perinatal electronic fetal monitoring. All physicians and clinical caregivers who participate in the delivery process at Mount Carmel hospitals will be participating in this program. This initiative will provide system-wide standardization for electronic fetal monitoring interpretation. The program is being adopted in order to improve patient safety and reduce the risk of medical errors during deliveries. Significant medical errors and patient harm can take place if physicians and caregivers interpret perinatal electronic fetal monitoring results differently. The Perinatal Electronic Fetal Monitoring Program consists of a number of key elements: 1. Physicians and Mount Carmel Health System Associates will have the opportunity to participate in perinatal electronic fetal monitoring education to assist caregivers in the adoption and implementation of electronic fetal monitoring standards. 2. The Perinatal Electronic Fetal Monitoring Program will positively impact the obstetrics care delivery processes at Mount Carmel Health System through the adoption of national best practices. 3. Participating physicians will be provided the opportunity to obtain financial rewards when they are credentialed by National Certification Corporation. The project will take place in 2011, and results will be shared in the 2011 Commitment to Quality Report.


23

Reduction in Emergency Room Medically Treated and Released Visits Program Summary Health Partners has developed programs with two payers focusing on the reduction in emergency room (ER) utilization of treated and released, non-emergent visits. Overutilization of the ER for non-emergency conditions is a common and major concern for most health plans. Patients often utilize the ER for treatment and routine care that could be delivered in a primary care physician office or urgent care setting. The health plan statistics show that 50% of their ER visits were for patients who were classified as treated and released. This occurs when the visit is non-emergent and the patient is not admitted to observation or as an inpatient. These patients were released from the ER within 24 hours.

Costs by Treatment Location $1,111 Patient Cost Plan Cost

Clinical care guidelines, community resource guides, patient education and physician communication regarding specific patient ER utilization were developed and utilized to support this initiative.

$100 $81 $61 $15

Program Goal

$25

The goals of both programs are to:

Physician Office Visit

• Encourage plan members to establish a relationship with a primary care physician.

Health Plan ER Cost Example1

• Encourage members to contact their primary care physician before utilizing the ER. • Increase the use of a patient’s primary care physician in lieu of going directly to the ER for non-emergent care. • Reduce the number of treated and released patient visits by 5%. Both programs will end in 2011. Results will be shared upon conclusion of the programs and in the 2011 Commitment to Quality Report.

Urgent Care

Emergency Room


24

Patient-Centered Medical Home Program Summary Seventeen Health Partners physicians and their practices have been recognized by the National Committee for Quality Assurance (NCQA) for obtaining Patient-Centered Medical Home recognition at the time of this document’s publication. The initiative was led and supported by Access HealthColumbus and Health Partners. Access HealthColumbus is a non-profit group working to improve access to healthcare by coordinating collaborative improvement projects in central Ohio. Physicians who obtain Patient-Centered Medical Home status were involved in a comprehensive medical home audit, along with the implementation of systematic practice changes to meet the objectives and goals of the medical home. The Patient-Centered Medical Home is a healthcare setting that facilitates partnerships between individual patients, their personal physicians and, when appropriate, the patient’s family. Care is facilitated by patient registries, information technology, health information exchanges and other means to ensure that patients receive the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.1 Practices can achieve three levels of Medical Home recognition based on nine key standards: • Level 1: 35-39 (NCQA medical home audit points awarded, and the practice must pass six essential elements). • Level 2: 50-84 (NCQA medical home audit points awarded, and the practice must pass six essential elements). • Level 3: 85-100 (NCQA medical home audit points awarded, and the practice must pass six essential elements). The core principles of the Patient-Centered Medical Home include: 1. Personal physician — Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. 2. Physician-directed medical practice — The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients and follow-up.

3. Whole person orientation — The personal physician is responsible for providing for all the patient’s healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes acute care; chronic care; preventive services; and end-of-life care. 4. Care is coordinated or integrated across all elements of the complex healthcare system and the patient’s community. Care is facilitated by patient registries, information technology, health information exchange and other means to ensure that patients get the necessary care when and where they need it in a culturally and linguistically appropriate manner. 5. Quality and safety are hallmarks of the medical home. • Practices advocate for their patients to support the attainment of optimal, patientcentered outcomes that are defined by a care-planning process driven by a compassionate, robust partnership between physicians, patients and the patients’ families. • Evidence-based medicine and clinical decision-support tools guide decision making. • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement. • Patients actively participate in decision making, and feedback is sought to ensure that patients’ expectations are being met. • Information technology (IT) is utilized appropriately to support optimal patient care, performance measurement, patient education and enhanced communication.


25

Patient-Centered Medical Home 6. Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician and practice staff. 7. Payment appropriately recognizes the added value provided to patients who have a patient centered medical home.1 Electronic capabilities and electronic medical records are not required for the practice to achieve recognition. The NCQA recognition lasts for three years. At the end of 2010, almost 7,700 clinicians in the nation have received PatientCentered Medical Home recognition.1

Outcomes The Patient-Centered Medical Home has been adopted throughout the nation with great success. Outcomes data from patients who participated in Patient-Centered Medical Home programs include: • 15%-50% reduction in emergency room visits2 • 11%-40% reduction in hospitalizations2 • Annual healthcare cost savings per patient ranging from $640 to $1,364 per patient, a return on investment greater than 2 to 1.3 As a result of these outcomes and at the time of this document’s publication, there are six health plans in central Ohio that plan to provide financial incentives to physicians who have received Patient-Centered Medical Home recognition by mid-2011.

continued

Health Partners physicians who have received NCQA’s Patient-Centered Medical Home recognition include: Pickerington Family Practice 641 Hill Road N. Pickerington, OH 43147 Level 2 Recognition Stephanie Benedict, MD David Kageorge, MD Stephen Koch, MD Jennifer Silver, MD Joseph Winchell, MD Central Ohio Primary Care 4030 West Henderson Road Columbus, OH 43220 Level 3 Recognition Sean Barnes, MD Amanda Gordon, MD Lisa Horn, MD Julie Hundley, MD Mihai Jipa, MD John Moffa, MD Alan Steginsky, MD Robert Stone, MD Maria Varveris, MD Lower Lights Christian Health Center 1251 West Broad Street Columbus, OH 43222 Level 2 Recognition Dana Vallangeon, MD Lindsay Rerko, DO American Health Network Hilliard 3823 Trueman Court Hilliard, OH 43026 Level 3 Recognition Daniel Bloch, MD


26

NCQA Diabetes Physician Recognition Program Program Summary The National Committee for Quality Assurance (NCQA) and the American Diabetes Association developed the Physician Diabetes Recognition Program to distinguish physicians who provide high-quality diabetic patient care. The program also provides physicians with tools to support the delivery and recognition of consistent, highquality care. This is a voluntary program to help physicians use evidence-based measures and provide excellent care to their patients with diabetes. Health Partners, in collaboration with Employers Health Coalition of Ohio, Inc., facilitates the process necessary to achieve NCQA diabetes certification for member physicians. Physicians who participate in the program enhance their delivery of diabetic care through the use of a physician and practice evaluation tool and strive to achieve individual physician benchmarking to national diabetic performance standards. Additional resources are provided to participating physicians to help them manage and control diabetes in their patients.2 The program focuses on preventing diabetic complications by concentrating on four main areas. When these four clinical areas are managed properly in diabetic patients, clinical outcomes are improved dramatically.3

Program Impact Bridges to Excellence is a not-for-profit organization that designs and creates programs that encourage physicians and physician practices to deliver safe, more effective and efficient care by offering them financial and other incentives. The organization estimates that NCQA-recognized physicians who meet the standards of the NCQA diabetes program and who fully control diabetes in their patients save an estimated $1,059 in health expenses per diabetic patient per year, and when applied to a typical NCQA diabetesrecognized physician’s patient population composed of more than 100 diabetic patients, savings can be in excess of $100,000 per year. By improving the care that diabetic patients receive, Health Partners physicians are contributing to reducing healthcare expenditures associated with diabetes and improving clinical outcomes for their patients with diabetes.4


27

NCQA Diabetes Physician Recognition Program continued

Diabetes Recognition Measures2 *Denotes poor control

Threshold (% of patients in sample)

Measure Summary3

HbA1c control ≥ 9.0%*

≤ 15%

HbA1C control ≤ 7.0%

≥ 40%

Blood pressure control ≥ 140/90 mm Hg*

≤ 35%

Blood pressure control < 130/80 mm Hg

≥ 25%

LDL control ≥ 130 mg/dL*

≤ 37%

LDL control < 100 mg/dL

≥ 36%

Eye examination

≥ 60%

Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

Foot examination

≥ 80%

Foot care programs can reduce amputation rates by 45% to 85%.

Nephropathy assessment

≥ 80%

Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%.

Smoking status and cessation advice or treatment

≥ 80%

Diabetics who smoke are three times as likely to die of cardiovascular disease as are diabetics who do not smoke.

Every percentage point drop in measurement in a patient’s HbA1c blood test results reduces the risk of microvascular complications by 40%. Blood pressure control reduces the risk of cardiovascular disease among people with diabetes by 33% to 50% and the risk of microvascular complications by approximately 33%. Improved control of cholesterol or blood lipids (for example, HDL, LDL and triglycerides) can reduce cardiovascular complications by 30% to 50%.

continued on page 28


28

NCQA Diabetes Physician Recognition Program

continued from page 27

Recognized Physicians At the date of publication, 57 Health Partners member physicians are recognized formally by NCQA for high-quality diabetic care. A complete listing of NCQA-recognized physicians can be found at www.ncqa.org. Recognized Health Partners Physician

NCQA Recognition Start Date

NCQA Recognition End Date

Recognized Health Partners Physician

NCQA Recognition Start Date

NCQA Recognition End Date

Jacqueline Amico, MD

9/22/2009

9/22/2012

Ann Koval, MD

3/24/2009

3/24/2012

Michael Baehr, MD

4/21/2009

4/21/2012

Joseph Lutz Jr., MD

4/21/2009

4/21/2012

Brian Beesley, DO

4/30/2009

4/30/2012

David Lynch, DO

4/27/2009

4/27/2012

Keith Blakely, MD

4/30/2009

4/30/2012

Peter Martin, DO

4/30/2009

4/30/2012

Steven Boysel, MD

10/28/2009

10/28/2012

Jack Mathews, MD

2/27/2009

2/27/2012

Timothy Buchanan, MD

1/22/2010

1/22/2012

Daniel Melaragno, MD

1/20/2010

1/20/2013

Stephen Bushek, MD

1/26/2011

1/26/2011

David Neiger, MD

12/26/2009

12/26/2012

Angela Caffaratti, MD

2/27/2009

2/27/2012

A. Michael Novena, MD

3/24/2009

3/24/2012

Terrance Castor, MD

3/24/2009

3/24/2012

Donna Parsley, DO

4/27/2009

4/27/2012

Maria Courser, MD

10/28/2009

10/28/2012

John Passias II, DO

4/30/2009

4/30/2012

Dana Dougherty, MD

4/30/2009

4/30/2012

Melissa Payne, MD

2/27/2009

2/27/2012

Joseph Dusseau, MD

12/29/2008

12/29/2011

Thomas Quinn, MD

2/27/2009

2/27/2012

Angela Eubanks, MD

2/27/2009

2/27/2012

Neil Richard, MD

8/17/2010

8/17/2013

Kevin Frank, MD

10/30/2009

10/30/2012

Terry Slayman, MD

8/17/2010

8/17/2013

Bryan Ghiloni, MD

1/26/2011

1/26/2014

Angela Smith, DO

4/27/2009

4/27/2012

Jennifer Giersch, MD

4/30/2009

4/30/2012

Evan Stathulis, MD

4/21/2009

4/21/2012

Nancy Graesser, DO

4/27/2009

4/27/2012

Alan Steginsky, MD

12/26/2009

12/26/2012

Raymond Gruenther, MD

2/17/2011

2/17/2014

Larry Swanner, MD

4/30/2009

4/30/2012

Ayser Hamoudi, MD

2/27/2009

2/27/2012

Patricia Toohey, MD

2/27/2009

2/27/2012

Melissa Harrold, MD

2/27/2009

2/27/2012

Tracey Trgovac, MD

2/27/2009

2/27/2012

Olivia Hower, MD

3/24/2009

3/24/2012

Charles Tweel Jr., MD

3/24/2010

3/24/2013

Trieu Hua, MD

4/21/2009

4/21/2012

John Tyznik, MD

4/21/2009

4/21/2012

Jeannine Hughes, MD

8/17/2010

8/17/2013

Daniel Wendorff, MD

7/27/2010

7/27/2013

Hillman Hum, MD

4/21/2009

4/21/2012

Joseph Winchell, MD

2/27/2009

2/27/2012

Balpreet Jammu, MD

6/29/2009

6/29/2012

Cameron Woodlief, MD

5/10/2010

5/10/2013

David Kageorge, MD

2/16/2011

2/16/2014

J. William Wulf, MD

12/26/2009

12/26/2012

Dong Kang, MD

4/30/2009

4/30/2012

Nowell York, MD

10/28/2009

10/28/2012

Stephen Koch, MD

2/16/2011

2/16/2014

Robert Zimmerman, MD

2/27/2009

2/27/2012

Daniel Konold, DO

4/30/2009

4/30/2012

This listing of the Health Partners NCQA-recognized physicians (current as of February 25, 2011) was obtained from NCQAâ&#x20AC;&#x2122;s website.


30

NCQA Heart-Stroke Physician Recognition Program Program Summary The National Committee for Quality Assurance (NCQA) and the American Heart Association/ American Stroke Association developed the Physician Heart-Stroke Recognition Program to distinguish physicians who provide high-quality heart-stroke care. The program also provides physicians with tools to support the delivery and recognition of consistent, high-quality care. This is a voluntary program to help physicians use evidence-based measures and provide excellent care to their patients with cardiovascular diseases. Physicians who participate in the program enhance their delivery of cardiovascular care through the use of a physician and practice evaluation tool and individual physician benchmarking to national cardiovascular performance standards. Additional resources are provided to participating physicians to help them control cardiovascular diseases in their patients.1

Program Impact The economic cost of cardiovascular diseases and stroke in the United States for 2007 is estimated at $286 billion. This figure includes health expenditures (direct costs, including the cost of physicians and other professionals, hospital and nursing home services, medications, home healthcare and other medical durables) and lost productivity resulting from morbidity and mortality (indirect costs). By comparison, in 2007 the cost of all cancers was $228 billion. Cardiovascular disease costs more than any other healthcare diagnostic group.3 Calendar year 2007 is the most current data available. Bridges to Excellence estimates that NCQArecognized physicians who meet the standards of the NCQA heart-stroke program and control heart disease in their patients save an average of $818 per patient per year in healthcare costs. These savings are compounded when factoring in that a typical heart attack or stroke has an average direct cost of $11,755 per patient.4


31

NCQA Heart-Stroke Physician Recognition Program

continued

Heart-Stroke Recognition Measures1

Criteria

Measure Summary

Blood pressure control (< 140/90 mm Hg) < 140/90 mm Hg < 145/90 or < 140/95 mm Hg < 145/95 mm Hg â&#x2030;Ľ 145/95 mm Hg

75% of patients in sample

About 69% of people who have a first heart attack, 77% who have a first stroke and 74% who have congestive heart failure have high blood pressure (> 140/90 mm Hg).5

Complete lipid profile

80% of patients in sample

LDL cholesterol control (< 100 mg/dL) < 100 mg/dL 100-109 mg/dL 110-119 mg/dL 120-129 mg/dL â&#x2030;Ľ 130 mg/dL

50% of patients in sample

Low-density lipoprotein (LDL) is the major cholesterol carrier in the blood. LDL can slowly build up in the wall of the arteries feeding the heart and brain, resulting in atherosclerosis. A clot (thrombus) that forms near this plaque can block the blood flow to part of the heart, causing a heart attack, or block the flood flow to the brain, causing a stroke. Testing for LDL and controlling LDL can help prevent heart attack and stroke.5

Use of aspirin or another antithrombotic

80% of patients in sample

Clinical trials have shown that aspirin helps prevent the recurrence of heart attacks, hospitalizations for recurrent angina and second strokes. Studies show that aspirin also helps prevent these events from occurring in people at high risk.5

Smoking status and cessation advice or treatment

80% of patients in sample

Cigarette smoking results in a two- to threefold increased risk of dying of coronary artery disease.5

continued on page 32


32

NCQA Heart-Stroke Physician Recognition Program

continued from page 31

NCQA Heart-Stroke Recognized Physicians At the date of publication, Health Partners has 56 member physicians who have demonstrated high-quality heart-stroke care and are currently recognized by NCQA. These physicians have passed the comprehensive NCQA audit and have been formally recognized by NCQA. Re

Recognized Health Partners Physician

NCQA Recognition Start Date

NCQA Recognition End Date

Recognized Health Partners Physician

NCQA NCQA Recognition Recognition Start Date End Date

Thomas Alexis, MD

11/25/2008

11/25/2011

David Lynch, DO

9/24/2009

9/24/2012

Nancy Alkire, MD

12/8/2008

12/8/2011

Jack Mathews, MD

1/7/2009

1/7/2012

Jacqueline Amico, MD

2/24/2009

2/24/2012

Robert May, MD

2/24/2009

2/24/2012

Michael Baehr, MD

9/4/2008

9/4/2011

Daniel Melaragno, MD

9/22/2008

9/22/2011

Edward Baltes, MD

10/28/2008

10/28/2011

Mina Mokhtari, MD

9/4/2008

9/4/2011

Keith Blakely, MD

1/7/2009

1/7/2012

Donna Parsley, DO

9/24/2009

9/24/2012

Stephen Bushek, MD

9/11/2009

9/11/2012

Melissa Payne, MD

1/7/2009

1/7/2012

Stephen Canowitz, MD

2/24/2009

2/24/2012

Thomas Quinn, MD

1/7/2009

1/7/2012

9/22/2008

9/22/2011

Feng Chen, MD

9/4/2008

9/4/2011

Neil Richard, MD

Douglas Finnie, MD

11/25/2008

11/25/2011

John Robertson, DO

1/7/2009

1/7/2012

10/28/2008

10/28/2011

Kevin Frank, MD

9/10/2009

9/10/2012

John Ryan, MD

Bryan Ghiloni, MD

9/11/2009

9/11/2012

Irina Ryazansky, MD

11/25/2008

11/25/2011

Nancy Graesser, DO

9/24/2009

9/24/2012

Kenneth Saul, DO

9/4/2008

9/4/2011

Cathy Greiwe, MD

12/8/2008

12/8/2011

Lakshmi Seshadri, MD

9/10/2009

9/10/2012

Raymond Gruenther, MD

9/4/2008

9/4/2011

Milton Setnar, DO

9/4/2008

9/4/2011

Paige Gutheil, DO

11/25/2008

11/25/2011

Terry Slayman, MD

9/22/2008

9/22/2011

Paul Gutheil, DO

11/25/2008

11/25/2011

Angela Smith, DO

9/24/2009

9/24/2012

Ayser Hamoudi, MD

7/10/2008

7/10/2011

Evan Stathulis, MD

9/4/2008

9/4/2011

Robert Hershfield, MD

9/9/2008

9/9/2011

Charles Tweel, MD

7/17/2008

7/17/2011

Olivia Hower, MD

2/24/2009

2/24/2012

John Tyznik, MD

9/4/2008

9/4/2011

Hillman Hum, MD

7/10/2008

7/10/2011

Charles VonderEmbse, DO

12/8/2008

12/8/2011

7/17/2008

7/17/2011

Daniela Jipa, MD

11/25/2008

11/25/2011

Gregory Weisenberger, MD

David Kageorge, MD

1/7/2009

1/7/2012

Samuel Weller, MD

12/8/2008

12/8/2011

1/7/2009

1/7/2012

Dong Kang, MD

9/10/2009

9/10/2012

Joseph Winchell, MD

Stephen Koch, MD

1/7/2009

1/7/2012

Robert Wolf, MD

2/24/2009

2/24/2012

Daniel Konold, DO

9/10/2009

9/10/2012

Fred Worley, MD

7/17/2008

7/17/2011

Ann Koval, MD

4/9/2009

4/9/2012

Joan Wurmbrand, MD

4/9/2009

4/9/2012

Joseph Lutz, MD

9/4/2008

9/4/2011

Robert Zimmerman, MD

1/7/2009

1/7/2012

David Lynch, DO

9/24/2009

9/24/2012

This listing of the Health Partners NCQA-recognized physicians (current as of February 25, 2011) was obtained from NCQAâ&#x20AC;&#x2122;s website.


34

Cardiology and Vascular Service Outcomes Program Summary

Cardiac Surgery

Health Partners Cardiology, Cardiac Surgery and Vascular Surgery physicians, along with Mount Carmel Health System, have established a cardiology and vascular service line program. Together they have been able to deliver clinical outcomes above national benchmarks and averages.

Mount Carmelâ&#x20AC;&#x2122;s cardiac surgery program is currently housed at Mount Carmel East and West. Cardiac surgeons and Mount Carmel staff are committed to innovation, including a Siemens hybrid operating room that supports a collaborative approach to surgery. This includes endoscopic vein harvesting, off-pump open heart surgery, a minimally invasive approach to aortic and mitral value surgery, and cardiovascular clinical research.

Outcomes Data1 Valve Surgery

Coronary Bypass Graft Surgery Mount Carmel All U.S. Hospitals

16.0%

Mount Carmel All U.S. Hospitals

24.5% 18.0%

8.2% 4.0% 1.1%

1.9% 0.2% Mortality

Major Complication (Including Mortality)

Mortality

Major Complication (Including Mortality)


35

Cardiology and Vascular Service Outcomes continued

Interventional Cardiology Mount Carmelâ&#x20AC;&#x2122;s interventional cardiology program operates at Mount Carmel East, West and St. Annâ&#x20AC;&#x2122;s. Mount Carmel has been recognized as a leader in time-to-treatment for chest pain patients. Through increased collaboration with EMS providers, the organization has significantly improved the transmission of EKG data from the field to the hospital and provided the opportunity to admit STEMI (ST elevation myocardial infarction) patients from the field directly to the cardiac catheterization lab. In addition, by collaborating with emergency room physicians and hospitalists, Mount Carmel has been able to achieve door-to-balloon time that is below the national average, resulting in better patient outcomes and higher quality of care.

Outcomes Data1 Percutaneous Cardiac Intervention (PCI) Within 90 Minutes of Arrival 93%

82.0%

Interventional Cardiology Mount Carmel All U.S. Hospitals

98.2% 97.7%

97.0% 92.9%

Mount Carmel All U.S. Hospitals

PCI

No Major Complication No Complication (Including Mortality)

continued on page 36


36

Cardiology and Vascular Service Outcomes

continued from page 35

Outcomes Data1

Electrophysiology Mount Carmel has dedicated electrophysiology labs at Mount Carmel East, West and St. Annâ&#x20AC;&#x2122;s, along with state-of-the-art diagnostic and intervention equipment. Patients considering atrial fibrillation ablation have the unique advantage of scheduling a dual consultation with an electrophysiologist and a cardiac surgeon. This collaborative approach provides a more complete and thorough consultation for the patient and further supports the development of the electrophysiology program.

Electrophysiology 99.7%

99.8%

Mount Carmel All U.S. Hospitals

98.9%

National data not available

General Cardiology ICD Survival Pacemaker Survival

Mount Carmelâ&#x20AC;&#x2122;s cardiology program has access to 3D echocardiography and 64-slice CT at all hospital campuses, along with electronic reporting and cardiac image storage. The nuclear labs are accredited by the American College of Radiology, and the online EKG system provides physicians with access to information and reports that expedite patient management. All acute myocardial infarction and heart failure admissions are evaluated against the Joint Commission ORYX core measures and are detailed in the following chart.

Outcomes Data2 Mount Carmel All U.S. Hospitals

98%

100%

Heart Failure 90%

100% 90%

100% 93%

79%

Discharge Left Ventricular (LV) ACE/ARB given for Smoking Cessation Instructions Given Assessment LV Systolic Counseling Given to Dysfunction Smokers


37

Cardiology and Vascular Service Outcomes continued

Vascular Surgery Hospital campuses are equipped with endovascular operating suites and state-of-the-art labs for intervention and diagnostic procedures. The vascular labs have the latest ultrasound equipment, and all are accredited by the Intersocietal Commission for the Accreditation of Vascular Labs. Mount Carmel has an Endovascular Committee that serves all hospital campuses and has representation from Interventional Radiology, Cardiology and Vascular Surgery. This is a forum for collaboration on quality improvement as well as diagnostic and interventional program development. Research is an important part of the vascular surgery program. Through the programâ&#x20AC;&#x2122;s participation in the Cordis SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) trial, Mount Carmel performs carotid stenting for asymptomatic, surgical high-risk patients. Each such case is reviewed by the endovascular committee, and outcomes are reported to the national database. Surgical carotid endarterectomy cases are also regularly reviewed, and the 2009 postoperative rate for CVA (cerebral vascular accident, or commonly known as a stroke) rate was 1.1%.

Mount Carmel Vascular Surgery 100%

Elective Admit for AAA (Non-Ruptured) Survival

100%

Endovascular AAA Repair Survival

100%

100%

Ruptured AAA Survival

Carotid Survival


38

Orthopedics Service Outcomes Program Summary Mount Carmel Health System and thirty-two orthopedic surgeons have formed a collaborative relationship to focus on improving the clinical outcomes of orthopedic patients treated at Mount Carmel hospitals. Throughout the past year, the program has identified key clinical areas for quality improvement and monitoring. Through this collaborative effort, measurable clinical improvements and clinical outcomes have benefited orthopedic patients.

Day of Surgery Ambulation The Day of Surgery Ambulation Project was initiated by the orthopedic surgeons and Mount Carmel Health System to collaboratively develop protocols for patients undergoing primary total knee and total hip replacements, with the goal of increasing the ambulation of patients postoperatively. The benefits of day of surgery ambulation protocols for patients undergoing primary total knee and total hip replacements are the following: • Identical goals for every patient and every surgeon develop best practice standards and standardize care processes. • Clinical outcomes are shared by site and by therapist. This assists with increasing staff accountability for proper day of surgery ambulation. • Interdisciplinary teams help identify issues and create solutions. One example: Therapists were having difficulty with extensive patient nausea and vomiting on the day of surgery. The surgeons and physical therapists worked with Anesthesia to increase the intra-operative fluid and nausea medication. This collaboration helped increase the quality of care and patient satisfaction. • Day of surgery ambulation helps to decrease length of stay (LOS).


39

Orthopedics Service Outcomes Outcomes Data The Day of Surgery Ambulation Project was measured by 1) the percentage of patients receiving a physical therapy evaluation on the day of surgery and the percentage of patients ambulating a minimum of 30 feet on the same day of the procedure, and 2) the average length of stay for patients with primary hip and knee procedures. From July 2009 to June 2010, the percentage of patients having a physical therapy evaluation on the day of surgery and the percentage of patients ambulating a minimum of 30 feet on the same day of the procedure improved by 29%, and the average length of stay decreased by 8%. In addition, patients who did not receive a physical therapy evaluation on the day of surgery and were not ambulated a minimum of 30 feet had an average length of stay 33% higher than patients who did receive physical therapy.

continued

Percent of Patients Seen by Physical Therapy and Ambulated At Least 30 Feet

75.0% 58.3%

July 2009

June 2010

ALOS for Patients Seen by Physical Therapy and Ambulated At Least 30 Feet

2.36 2.25

July 2009

June 2010

ALOS Comparison

2.69

2.02

Patients Seen and Ambulated continued on page 40

Patients Not Seen and Not Ambulated


40

Orthopedics Service Outcomes Quality Assurance and Improvement during Surgery Mount Carmel and its partnering orthopedic surgeons have focused on three surgical quality measures for monitoring and improvement, which are listed below. Together, hospitals and physicians can reduce the risk of complications such as wound infection or blood clots in surgery patients by giving the right treatments at the right time. For example, studies show a strong association of reduced incidence of postoperative infection when antibiotics are administered within 1 hour prior to surgery. After the incision is closed, however, studies show that prolonged administration of prophylaxis with antibiotics may increase the risk of certain other infections at no additional benefit to the surgical patient.1 Scientific evidence shows that the following process of care measures represent the best practices for preventing complications after orthopedic surgeries (scores near 100% are better).1 1. Prophylactic antibiotic received within 1 hour prior to surgical incision.1 2. Prophylactic antibiotics discontinued within 24 hours after surgery end time.1 3. Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery.1

Outcomes Data Mount Carmel and partnering orthopedic surgeons have on average outperformed the national and state of Ohio averages for the three surgical quality measures previously outlined. These outcomes demonstrate that orthopedic patients receive care at Mount Carmel that prevents infection, reduces harm and improves clinical outcomes.

continued from page 39


41

Post-Fracture Osteoporosis Management Program Summary Health Partners orthopedic physicians and the Mount Carmel Orthopedic Department launched a Post-Fracture Osteoporosis Management Quality Initiative in 2010. This orthopedic project focuses on ensuring that members of a Medicare Advantage Plan receive appropriate testing and/ or medication for osteoporosis after a fracture, as indicated by the Healthcare Effectiveness Data and Information Set (HEDIS) criteria. HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. This HEDIS measure states that women 67 years of age and older who suffer a fracture need to have either a bone mineral density test or a prescription drug to treat or prevent osteoporosis within 6 months following the fracture. This initiative’s protocols call for collaborations between orthopedic specialists, emergency room physicians and primary care physicians. The responsibilities include: • Orthopedic surgeons: Increase osteoporosis testing by ordering a DEXA scan for women or men with a fragility fracture within 6 months of the fracture. • Emergency room physicians: Record the patients with fragile fractures who are not admitted to the hospital. A prescription for a DEXA scan is provided to the patient at discharge from the ER. • Primary care physicians: Follow up with the patient regarding the baseline test results and begin treatment. The primary care physician assumes responsibility for management of the patient’s medication and follow-up.

Program Goals The goals of the program are to: 1. Increase the percentage of bone mineral density tests ordered or prescriptions written for drugs to treat or prevent osteoporosis in the 6 months after a fracture in women 67 years of age and older, and who suffered a fracture between July 1, 2010, and June 30, 2011. Baseline: Goal:

21% screening rate 64.4% screening rate

2. Increase the Medicare Advantage Plan’s HEDIS star rating for this measure. A maximum star rating is 5. Baseline: Goal:

1 Star 3 Star

Project results will be reported after the program concludes.

Bone Mineral Density Test or Osteoporosis Prescription Goal

64.4%

21.0%

Baseline

Project Goal


42

Oncology Outcomes Program Summary

Program Outcomes

Surgeons, oncologists and Mount Carmel Health System have developed a comprehensive cancer program based on the Commission on Cancer’s program model. The Commission on Cancer is a program developed by the American College of Surgeons and is a consortium of professional organizations dedicated to reducing the morbidity and mortality of cancer through education, standard setting and the monitoring of quality care.1 In 2009 Mount Carmel’s program received accreditation, and in 2010 the program received the award for outstanding achievement.

A key element of the Commission on Cancer’s program requirements is physician and hospitalled quality improvement activities taking place within the cancer program. The following seven quality initiatives have been implemented by Mount Carmel’s cancer program. As the program continues to develop, new quality initiatives will be adopted to further strengthen and improve cancer care in central Ohio. These initiatives have a direct benefit to the patient through complete and comprehensive high-quality patient care.

The Commission has established five key elements for a successful cancer program: 1. The Cancer Committee leads the program through the setting of goals, monitoring activity, evaluating patient outcomes and improving care. 2. The Clinical Services provide state-of-the-art pretreatment evaluation, staging, treatment and clinical follow-up for cancer patients seen at the facility for primary, secondary, tertiary or quaternary care. 3. The Cancer Conferences provide a forum for patient consultation and contribute to physician education. 4. The Quality Improvement program is the mechanism for evaluating and improving patient outcomes. 5. The Cancer Registry and Database is the basis for monitoring the quality of care.1


43

Oncology Outcomes

continued

Quality Initiative

Quality Initiative Accomplishments

Ensure appropriate access to the Cancer Risk Program for patients identified with microsatellite instability (MSI) through immuno-histo-chemistry.

All colon-rectal cancer patients with MSI are referred to the Cancer Risk Program for appropriate risk assessment and counseling.

Identification of patients with hereditary non-polyposis colorectal cancer or Lynch syndrome can change the medical and surgical management of the patient, preventing or curing a genetically predisposed condition.

Initiate the use of College of American Pathologists protocols for pathology reporting.

Templates developed for top five cancer sites at Mount Carmel Health System. Standardized reporting elements and format have been developed to ensure more complete information.

Standardization of pathology reporting ensures that all elements related to the staging of cancer are addressed. Appropriate staging leads to more precise therapies in patient care.

Establish standard for lymph node dissection with total cystectomy.

Agreement with urology and pathology that dissection of node-bearing areas up to the iliac bifurcation should be at the minimum carried out during radical cystectomy, and up to the aortic bifurcation is preferred.

Accurate staging of any cancer is imperative to ensure that appropriate treatment protocols are followed during patient care.

Benefit to the Patient

Establish standard for patient selection for Development of a standard care plan for Whipple procedures. patient management.

Standard care plans reduce any potential variability in the providerâ&#x20AC;&#x2122;s approach to care.

Implement Cyberknife service for stereotactic radiosurgery.

Implement a new treatment technique resulting in Mount Carmel setting the community standard.

Patients in central Ohio have access to state-of-the-art and standard-of-care cancer treatments.

Establish standard-of-care mediastinoscopy performed prior to lung surgery for cancer.

Development of staging guidelines that are followed according to National Comprehensive Cancer Network guidelines.

Accurate staging of any cancer is imperative to ensure that appropriate treatment protocols are followed during patient care.

Improve communication with referring physicians.

Allow primary care physicians to be knowledgeable and up-to-date regarding their patientsâ&#x20AC;&#x2122; cancer care.

All physicians involved in the care of a patient work in a collaborative nature to improve patient outcomes and reduce patient stress, duplicative testing and/or patient inconvenience.


44

Physician Credentialing and Board Certification Program Summary

Program Results

The Health Partners Credentialing Committee, composed of practicing Health Partners member physicians and Mount Carmel administrative staff, performs a complete review of physicians applying to join the organization and uses credentialing and recredentialing guidelines developed by the National Committee for Quality Assurance (NCQA). NCQA is recognized by payers and providers for specific guidelines that are unbiased and universal across the healthcare industry. These standards protect a physicianâ&#x20AC;&#x2122;s personal and professional information, which is accessed only by appropriate individuals.

The result of this formal approach to credentialing physician applicants and the periodic recredentialing of physician members of Health Partners, along with setting board certification as a criterion for membership, is a physician network that is high-quality, minimizes risks to patients and provides a means to ensure that physician quality is maintained and monitored. The process ensures that patients are treated by physicians who meet a national standard of care and who are continuously held to these national standards.

The committee reviews each physicianâ&#x20AC;&#x2122;s medical education and residency completion dates, medical licensure expiration dates, DEA expiration date, Medicare/Medicaid sanctions, hospital privileges (to ensure they are in good standing), malpractice limits and expiration date, and settlements reported to the National Practitioner Data Bank, and it verifies all work and education gaps. Also reviewed are any cause for inability to perform the essential functions of the position with or without accommodation, history of substance abuse (alcohol or drugs), felony convictions, loss or limitation of privileges or disciplinary activity (hospital, professional society, group practice, managed care organization). If at any time a physician does not meet any of the standards, the credentialing committee will perform a focused review.1 Health Partners follows the NCQA credentialing policies to ensure that national credentialing standards are followed and that physiciansâ&#x20AC;&#x2122; personal and professional information is protected and used only by authorized individuals.

Percent of Physicians Who Are Board Certified or Board Eligible

99.6%

Member Physicians


45

Genesis Information Program Summary Health Partners, as a joint venture of Mount Carmel Health Systems and its medical staff, is committed to an unrelenting focus on quality and patient safety. One initiative that is underway to achieve these goals is Genesis. Genesis will create a common electronic platform for Mount Carmel’s primary clinical and revenue information systems. This implementation will include electronic health records (EHR) and computerized physician order entry (COPE) at Mount Carmel hospitals. Mount Carmel will go live with Genesis on April 27, 2012. The organization has begun to prepare for this change, which will transition nearly all of the health system’s paper processes to electronic processes. This electronic health record will unite state-of-the-art computer systems with best-known practices to enable us to transform patient care and safety and support Mount Carmel’s efforts to enhance patient satisfaction and outcomes. This conversion will affect every physician who practices at Mount Carmel. The Genesis program is seeking the assistance of both Mount Carmel Health System leaders and physician leaders in educating associates and medical staff members about Genesis. To launch the Genesis readiness activities, Mount Carmel hosted a kick-off meeting in February 2010 to provide physicians and leaders with more information about this initiative. Since that time, Mount Carmel has named a Genesis readiness team and formally engaged associates to serve as resources for their peers. Associates and members of the medical staff had an opportunity to attend product overview sessions to get a first look at the system. The Genesis team has begun the work of documenting current-state processes, identifying gaps that must be filled to reach future-state processes and devising solutions to make this transition. Physician champions and staff who are helping make this transition have begun early application training for some hands-on experience. Order sets, equipment inventory and training needs are being reviewed to ensure we are ready by our go-live date.

In November 2010, Thomas Bronken, MD, MPH, was appointed Chief Medical Information Officer (CMIO). In this position he will be responsible for reviewing medical informatics trends and supporting the development, implementation and use of clinical information systems to help clinicians deliver safe, high-quality care. During Mount Carmel’s Genesis readiness planning and go-live, Dr. Bronken will serve as an advocate for the interests of the health system’s physician partners and will seek to engage them in readiness efforts. Dr. Bronken has 25 years of healthcare experience, including medical informatics and clinical transformation associated with introducing new information technologies in the clinical setting. Once Mount Carmel has made this transition, the organization and its medical staff will realize numerous benefits. Genesis will connect all Trinity Health hospitals, allowing them to share best practices and patient data. Physicians will have access to a computerized physician order entry (CPOE) model that will reduce transcription errors. As payers increasingly request outcome data, the system will streamline reporting. Genesis is truly a physician-hospital partnership that will result in both higher-quality care and improved patient safety. Physician collaboration is key to this effort. While the health system has extensive work ahead, Mount Carmel is excited to be making this transition in 2011 and into 2012.


46

Physician-Led Quality Improvement in the Hospital Setting Program Summary Physicians provide the clinical leadership for patient care and clinical quality improvement in the hospital setting. Their leadership is becoming increasingly important as the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission enhance their review of clinical outcomes of hospitals and their medical staffs and publicly report this data. As members of Mount Carmel Health System’s medical staff and as “partners” in the Health Partners organization, Health Partners member physicians are actively involved in hospital outcomes measurement. CMS and the Joint Commission collectively monitor 58 measures for inpatient care that represent diverse patient care processes.

Program Result The following tables provide information regarding Mount Carmel Health System’s performance for selected CMS publicly reported clinical measures. These measures are being reported by Health Partners, as they demonstrate physician-provided or physician-directed care processes taking place in the Mount Carmel hospital setting. These measures and the clinical care that these measures represent are important to the Health Partners organization because they demonstrate the high-quality patient care provided by Health Partners physicians. Mount Carmel Health System is a partner in our Clinical Integration program, and the clinical outcomes of Mount Carmel are important to our physician members. Data in the following tables is from the CMS website, www.hospitalcompare.hhs.gov, and was published on October 7, 2010. Data was collected between January 1, 2009, and December 31, 2009, and is the most current information available.1


47

Physician-Led Quality Improvement in the Hospital Setting continued

Heart Attack or Chest Pain Process of Care Measures Physician-Directed Care Measures

St. Annâ&#x20AC;&#x2122;s

East & West

New Albany

Ohio

U.S.

Average number of minutes before outpatients with chest pain or possible heart attack had an ECG (a lower number of minutes is better)

4 minutes

6 minutes

NA

8 minutes

42 minutes

Outpatients with chest pain or possible heart attack who received aspirin within 24 hours of arrival (higher numbers are better)

95%

100%

NA

94%

93%

Heart attack patients given aspirin at arrival

100%

99%

NA

96%

95%

Heart attack patients given aspirin at discharge

100%

100%

NA

94%

94%

Heart attack patients given ACE inhibitor or ARB for left ventricular systolic dysfunction (LVSD)

100%

100%

NA

93%

93%

Heart attack patients given smoking cessation advice/counseling

100%

100%

NA

96%

97%

Heart attack patients given beta-blocker at discharge

98%

100%

NA

96%

94%

Heart attack patients given PCI within 90 minutes of arrival

83%

96%

NA

85%

84%

St. Annâ&#x20AC;&#x2122;s

East & West

New Albany

Ohio

U.S.

Heart failure patients given discharge instructions

96%

98%

NA

86%

80%

Heart failure patients given an evaluation of left ventricular systolic (LVS) function

100%

100%

NA

96%

91%

Heart failure patients given ACE inhibitor or ARB for left ventricular systolic dysfunction (LVSD)

100%

100%

NA

93%

90%

Heart failure patients given smoking cessation advice/counseling

100%

100%

NA

95%

93%

Heart Failure Process of Care Measures Physician-Directed Care Measures

continued on page 48


48

Physician-Led Quality Improvement in the Hospital Setting continued from page 47

Use of Medical Imaging Physician-Directed Care Measures

St. Ann’s

East & West

New Albany

Ohio

U.S.

Outpatients with low back pain who had an MRI without trying recommended treatments first, such as physical therapy. (If a number is high, it may mean the facility is doing too many unnecessary MRIs for low back pain.)

33.6%

33.7%

22.2%

30.2%

32.7%

Outpatients who had a follow-up mammogram or ultrasound within 45 days after a screening mammogram. (A number that is much lower than 8% may mean there’s not enough follow-up. A number much higher than 14% may mean there’s too much unnecessary follow-up.)

8.7%

6.4%

NA

8.4%

8.4%

St. Ann’s

East & West

New Albany

Ohio

U.S.

Pneumonia patients assessed and given pneumococcal vaccination

91%

88%

NA

93%

88%

Pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics

97%

96%

NA

95%

93%

Pneumonia patients given smoking cessation advice/counseling

99%

99%

NA

94%

91%

Pneumonia patients given initial antibiotic(s) within 6 hours after arrival

98%

96%

NA

91%

98%

Pneumonia patients given the most appropriate initial antibiotic(s)

98%

94%

NA

91%

89%

Pneumonia patients assessed and given influenza vaccination

80%

79%

NA

89%

86%

Pneumonia Process of Care Measures Physician-Directed Care Measures


49

Physician-Led Quality Improvement in the Hospital Setting continued

Surgical Care Improvement Project Process of Care Measures Physician-Directed Care Measures

St. Annâ&#x20AC;&#x2122;s

East & West

New Albany

Ohio

U.S.

Outpatients having surgery who received an antibiotic at the right time â&#x20AC;&#x201D; within 1 hour before surgery (higher numbers are better)

50%

98%

100%

86%

87%

Outpatients having surgery who received the right kind of antibiotic (higher numbers are better)

93%

92%

100%

92%

93%

Surgery patients taking heart drugs called beta-blockers before coming to the hospital, who were kept on the beta-blockers during the period just before and after their surgery

96%

92%

86%

90%

87%

Surgery patients who were given an antibiotic at the right time (within 1 hour before surgery) to help prevent infection

98%

97%

99%

95%

93%

Surgery patients who were given the right kind of antibiotic to help prevent infection

98%

99%

100%

97%

95%

Surgery patients whose preventive antibiotics were stopped at the right time (within 24 hours after surgery)

96%

96%

98%

93%

91%

Heart surgery patients whose blood sugar (blood glucose) was kept under good control in the days immediately following surgery

NA

92%

NA

93%

91%

Surgery patients receiving hair removal from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream â&#x20AC;&#x201D; not a razor)

100%

100%

100%

99%

98%

Surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries

99%

97%

100%

93%

98%

Patients who received treatment at the right time (within 24 hours before or after their surgery) to help prevent blood clots after certain types of surgery

98%

93%

100%

90%

88%

continued on page 50


50

Physician-Led Quality Improvement in the Hospital Setting continued from page 49

Survey of Patients’ Hospital Experiences Physician-Directed Care Measures

St. Ann’s

East & West

New Albany

Ohio

U.S.

Patients who reported that their doctors “always” communicated well

77

79

85

78

80

Patients who reported that their pain was “always” well controlled

68

68

76

69

69

Patients at each hospital who reported that YES, they were given information about what to do during their recovery at home

83

83

90

83

81

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)

66

66

87

67

66

Patients who reported that YES, they would definitely recommend the hospital

70

71

91

69

69

Readmission Tables Physician-Directed Care Measures

St. Ann’s

East & West

New Albany

The U.S. national rate for readmissions for heart attack patients = 19.9 %

No different from U.S. national rate

No different from U.S. national rate

NA

The U.S. national rate for readmissions for heart failure patients = 24.7 %

No different from U.S. national rate

Better than U.S. national rate

NA

The U.S. national rate for readmissions for pneumonia patients = 18.3 %

No different from U.S. national rate

No different from U.S. national rate

NA

* Hospitals compared to national CME database for readmission rates. Hospitals could be classified as: better than U.S. national rate, no different from U.S. national rate, or worse than U.S. national rate. Readmission rates are based on adjusted mortality.


51

References Clinical Integration

NCQA Diabetes Recognition Program

1. Gary Edmiston, David Wofford. Physician Alignment: The Right Strategy, The Right Mindset. www. hfma.org.

1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2007. 2. National Committee on Quality Assurance. The Diabetes Physician Recognition Program. www.ncqa.org. 3. Centers for Disease Control. Diabetes Statistics and Research. www.cdc.gov. 4. Bridges to Excellence. Diabetes Care Analysis — Savings Estimate. www.bridgestoexcellence.org.

2. Dixon Hughes Healthcare Consultants. 3. Dixon Hughes Healthcare Consultants.

Clinical Guidelines 1. Ambulatory-care-sensitive admission rates: A key metric in evaluating health plan medical-management effectiveness, Milliman, January 2009. 2. Boyle et al. Projection of the year 2050 burden of diabetes in the U.S. adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics 2010, 8:29. 3. Gorman Health Group, www.gormanhealthgroup.com.

Generic Prescribing 1. Express Scripts. Generic drugs first for millions. http:// phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irolnewsArticle&ID=860127&highlight. 2. Advocate Health Partners. 2009 Value Report.

Primary Care Physician HEDIS Improvement 1. NCQA, http://ncqa.org/tabid/187/Default.aspx.

Female Preventive Screenings by OB/GYN Physicians 1. http://www.statehealthfacts.org/comparetable.jsp?ind=90& cat=2&sub=26&yr=92&typ=2. 2. CDC, http://www.cdc.gov/cancer/colorectal/statistics/ screening_rates.htm. 3. http://www.medscape.com/viewarticle/556732.

Optimal Prenatal and Postpartum Care 1. March of Dimes, www.marchofdimes.com/mission/ prematurity_costs.html. 2. March of Dimes, www.marchofdimes.com/mission/ prematurity.html.

Reduction in Emergency Room Medically Treated and Released Visits 1. Health Partners affiliated health plan data.

Patient-Centered Medical Home 1. NCQA, http://ncqa.org/tabid/631/Default.aspx. 2. Maryland Healthcare Commission, http://mhcc.maryland. gov/pcmh/employer/Basic_Employer_Presentation_FINAL. pdf. 3. Grumbach, Bodenheimer, Grundy. The Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence on Quality, Access and Costs from Recent Prospective Evaluation Studies, August 2009. www.pcpcc.net/files/evidenceWEB%20 FINAL%2010.16.09_1.pdf.

NCQA Heart-Stroke Recognition Program 1. National Committee on Quality Assurance. Heart-Stroke Recognition Program. www.ncqa.org. 2. American Heart Association. Cardiovascular Diseases. www.americanheart.org. 3. American Heart Association. Heart Disease and Stroke Statistics — 2011 Update. http://circ.ahajournals.org. 4. Bridges to Excellence. Cardiac Care Analysis — Savings Estimates. www.bridgestoexcellence.org. 5. American Heart Association. Circulation 2009. www.circ. ahajournals.org.

Cardiology and Vascular Service Outcomes 1. Society of Thoracic Surgeons (STS) National Audit Cardiac Surgery Database, April 2010 (data for calendar year 2009). 2. Centers for Medicare and Medicaid Services (CMS) Hospital Centers for website (data from calendar year 2009).

Orthopedic Service Outcomes 1. Medicare, www.hospitalcompare.hhs.gov/staticpages/forprofessionals/poc/technical-appendix.aspx#Surgical. 2. Medicare, www.hospitalcompare.hhs.gov/.

Post-Fracture Osteoporosis Management 1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Bone/ Osteoporosis/default.asp. 2. International Osteoporosis Foundation, www.iofbonehealth.org/facts-and-statistics.html.

Oncology Service Outcomes 1. American College of Surgeons.

Physician Credentialing and Board Certification 1. Health Partners Organizational Policies and Procedures.

Physician-Led Quality Improvement in the Hospital Setting 1. CMS, www.hospitalcompare.hhs.gov.


MOUNT CARMEL Health Partners, Inc.

Mount Carmel Committment to Quality Report - 2010  

Mount Carmel Committment to Quality Report - 2010

Read more
Read more
Similar to
Popular now
Just for you