BIG NEWS for Quality Measures Part 2!

wordleI have been discussing the “2016 Prior Year Benchmarks” report for all the quality measures included in the 2016 Quality and Resource Use Reports (QRUR).

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PY2016-Prior-Year-Benchmarks.pdf

In a previous blog, I explained why benchmark rates matter. If you missed that blog you can read it here: https://carolinefifemd.com/2017/04/12/quality-measures-big-news/

There is HUGE news for wound care, hyperbaric medicine and podiatry.

Quality Measure performance is a test graded on a curve. To have a chance at bonus money, a clinician needs to score in the top decile of measure performance. This is a problem for subspecialists when they report national quality measures like BMI screening and follow-up, or tobacco screening and follow-up, which are often reported by primary care physicians and for which the performance of primary care physicians is likely to be close to 100%. In other words, if the only measures available to a practitioner are national measures that are NOT in their specialty, their performance will have to be perfect.

To get ahead of the national pack, clinicians need some high value measures like “appropriate use” or risk stratified outcome measures, and to report a few specialty specific measures that are not going to be reported by practically every clinician in the USA. Those measures exist in the US Wound Registry.

In addition to the benchmark rates for USWR measures that I have previously blogged about, the REALLY big news is that the USWR has set the national benchmark rates for Diabetic Foot Ulcer (DFU) healing/closure and Venous Leg Ulcer Healing/closure. These are high value measures so clinicians get a bonus point simply for reporting one of them, with an additional bonus points for reporting through a QCDR like the USWR.

In point of fact, these outcome measures are risk stratified by the Wound Healing Index (WHI) and we’ve been struggling a bit with the CMS contractor over the way they are handling the math of the stratification. We are working with CMS on that part, so be prepared for these numbers to change as we get the risk stratification levels incorporated.

Why is risk stratification important? It’s important because we can’t continue to say that we heal everyone. Besides being unbelievable, CMS doesn’t allow it. What we will begin doing is reporting healing in relation to the predicted likelihood of healing.

In the near future, patients and payers will seek out a wound care clinician not based on their reporting of unrealistically high healing rates (e.g. >95%) but because the practitioner proudly reports healing rates of, for example, 75% — among wounds in which the predicted healing rate was less than 50%! In other words, in the future, patients and payers will identify the most skilled wound care practitioners based on their success with the most difficult wounds.

In the mean time, the benchmark rates reported by CMS in the 2016 document collapsed all the risk groups into one large group, so I will portray it that way below. Are you ready for the national benchmark healing rates?

The 2016 national benchmark healing rate for Diabetic Foot Ulcers is 78%

The 2016 national benchmark healing rate for Venous Stasis Ulcers is 88%

Find out more information about the WHI here:

http://onlinelibrary.wiley.com/doi/10.1111/wrr.12107/abstract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900227/

Fife Caroline E., Horn Susan D., Smout Randall J., Barrett Ryan S., and Thomson Brett. Advances in Wound Care. June 2016, 5(7): 279-287. doi:10.1089/wound.2015.0668.


Caroline Fife, MD    Twitter Facebook  |  LinkedIn