CANCÚN, MEXICO — Feeling the squeeze from government cutbacks and the need to wean itself from big pharma dollars, the Mayo Clinic has found a new source of support for resident education: the Physician Quality Reporting Initiative (PQRI) program.
Launched last year, a program aimed at tracking key measures of diabetes care has helped the Mayo Clinic of Jacksonville, Fla., turn its already strong performance in diabetes care into a revenue stream for the residency program while also improving the consistency of care and giving residents an invaluable window on the logistics of conducting quality improvement projects.
From the outset, however, the goal was on improving diabetes care, Dr. Jerry Sayre emphasized.
The project was spurred by a request from the leaders of Mayo's family medicine department to create a diabetes care improvement program. “In Florida, we spend more than $12 billion each year to care for patients with diabetes,” Dr. Sayre said.
These patients use more health care resources than nondiabetic patients in the clinic's family medicine sector and cost 42% more to care for than nondiabetic patients. Nearly one-quarter of patients hospitalized each year at the Mayo Hospital in Jacksonville have diabetes as a primary diagnosis or comorbidity.
Consistently good preventive care really pays off for this group, Dr. Sayre said. “A hemoglobin A1c that's decreased by 1% decreases diabetic complications by 35%. And keeping LDL and blood pressure [in normal ranges] decreases cardiovascular morbidity by 50%.”
Using the American Board of Family Medicine's 2010 Diabetes Module, physicians at the clinic identified their most consistently implemented care measures and pinpointed those that needed improvement, he said.
Data collected for the ABFM module can be used to fulfill requirements for the PQRI. Under that program, physicians who meet certain clinical quality standards data for 30 individual Medicare patients can earn an incentive payment of 2% of their total allowed charges for Medicare Physician Fee Schedule–covered professional services.
In the Mayo Clinic's case, that incentive payment amounts to $86,000, which Dr. Sayre plans to funnel back into resident education projects.
In addition to providing an alternative means for fulfilling PQRI requirements, the ABFM's Diabetes Module provides data for generating research and satisfies certification and continuing medical education requirements, said Dr. Sayre.
The module measures how often six clinical tests are performed against what the ABFM considers benchmark rates for patients each year: HbA1c (benchmark 95%), LDL-cholesterol control (94%), hypertension control (100%), diabetic eye exams (60%), microalbumin testing for diabetic neuropathy (80%), and diabetic foot exams (visual, monofilament, and pulses [77%]). Patient records must contain documentation that each measure was performed in the prior year.
Data were collected on 600 patients seen in Mayo's family medicine clinic during 2009 and were compared with data from a fee-for-service regional medical clinic and national benchmarks.
Mayo physicians were doing “a pretty consistently good job” in most areas, exceeding the benchmark goal for each parameter, Dr. Sayre said. However, “we could have done better in some areas,” such as diabetic foot exams, which were performed 95% of the time. Mayo's goal is to perform it at every visit. As it turned out, a key reason for the shortfall was the lack of monofilaments in every office. “So we purchased monofilaments for each exam room.”
Other measurements included HbA1c testing documentation (98%), LDL testing (97%), blood pressure control (99%), eye exam (68%), and microalbumin testing (92%).
Scores at the regional medical clinic were almost identical, although two were slightly higher than they were at Mayo: blood pressure control (100%) and eye exams (71%).
Once the data were available, Dr. Sayre and his Mayo Clinic colleagues, Dr. Scott Simmons and Dr. Ramon Cancino, “created a kind of 'doctor report card' to show patients how their doctors are measuring up to these goals,” he explained.
The report shows how each patient's doctor compares with the overall picture of care at the facility and also against national benchmarks.
Dr. Sayre reported having no relevant financial conflicts.
Data from the module can fulfill PQRI incentive requirements; those payments then go back to fund the program.
Source DR. SAYRE