This is the Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is module 4.1.5, Primary Care Performance Measurement. Physician quality reporting system, Medicare shared savings program, in this particular lecture, the learning outcomes are better discussed how primary care performance is measured along these domains. We are back to our familiar diagram of the quadruple aim and again, just like for all of the other delivery providers, primary care physicians and primary care clinics are also measured according to these four domains. So, here's the schematic that we have seen for the hospitals and post acute care providers. So very similarly for primary care clinics and physicians there are many many different types of [INAUDIBLE] and systems that measurement happens in. So here's, let's take one example of physician quality reporting system through Medicare would have various different measures like diabetes, smoking, depression, medications, immunizations. All of those would then flow to Medicare federal government and then be reported onto a transparent, public facing website called Physician Compare, where hopefully the patients will go and then be able to visualize those metrics. And then close the loop and make a judgment about how their primary care practice or physician is. And if the quality is not good, they have the option of switching. So again, it's a way to be very transparent in all of these metrics to the end user or the end customer. Dig into some of these systems. The first one, which is a governmental system from CMS or Medicare is called the Physician Quality Reporting System, it has quality measures that can either be directly abstracted from claims. So a claim is a bill that is sent to through Medicare and Medicare can pull some of the quality reporting directly through that. Or there are some metrics that need to be specially uploaded electronically into the federal government. This could be done directly by the clinic practice or they outsource it to a third party that does this for many many clinics and groups. The payment is then modified up or down based upon the reporting of these metrics to Medicare or the Federal government. Other way of quality measurement for primary care is through the Accountable Care Organizations, so for example, a Medicare ACO is the Medicare Shared Savings Program, MSSP, and it has a long list of screening and ambulatory service, sensitive conditions that it measures measures for all of the ACOs, and recall that the way that the ACOs get paid is that the first gate is the quality gate. So you need to measure the quality and then hit the target and exceed the quality measures first, before you can get to the next gate of cost. So if you reduce the cost, you get a share in those value creations. System linked to the electronic health record is called the meaningful use, it is slowly being phased out as of this year. However, it was in place for the last several years and it came in stages. So they were increasing metrics for primary care and specialty care physicians, which had incentive payments related to quality and safety communications. And also, is the electronic health record communicating and connecting with, for example, pharmacies, other sites of care and with the patient? So again, came in stages and there were dollar incentives on hitting those targets. Another measurement system for primary care for the commercial insurance payers is called the Healthcare Effectiveness Data and Information Set. It is used by over 90% of the private insurance payers in the US. And there are numerous quality measures, such as screening, immunizations, medication management, and then many measures around outcomes and effectiveness of treatment. Again, as you can see, the same primary care physician practice is being measured by the government by the pair, by the ACO, by other regulatory bodies. So as you can see, this can get a little confusing and a whole infrastructure is needed to make sense of all of these measures. Do a quiz. The other domain of primary care measurement is along patient experience metrics. And again, here's our familiar CAHPS and there's a special to for clinicians and groups in primary care called the clinician and group consumer assessment and health care providers of systems. And again these metrics are reported to the government and then posted and part of the physician compare website. So again, the questions are tailored to primary care practices and a third party vendor collects the surveys by measuring and surveying the patients, and then uploads those results to the Federal government, which then uploads them onto this transparent website. The metric of primary care measurement is the engagement of physicians and staff, and as we have discussed before, there are increasing levels of physician burnout in the US that is being actively looked at and worked on. Also, typically it is measured through a survey methodology that is repeated either every year or every other year. Another way of measuring of the primary care clinic or primary physician performance is obviously the financial metrics. So how is the practice or the clinic is doing is it creating a margin, are the physician's' productivity metrics being hit, is a physician supposed to see. Number of patients in a month, but was unable to see those, what were the reasons there? Another metric might be Accountable Care Organization metrics, so was there shared savings? Did we hit all of the quality metrics? And also a discussion around the brand. So, that's a measure of stickiness to the patients of the community, are the the patients happy and satisfied with the clinic? Will they keep coming back or are they switching to a different primary care clinic? And there are many measures of customer retention in a particular committee in a particular community that are being measured and tracked by primary care clinics over time. In summary primary care is measured also along the quadruple aim domains. And there's the transparent Federal government website of Physician Compare that transparently displays these results to the end customers, hoping to make them more educated and more savvy as they choose these services.
