January 15, 2022
Quality Performance Challenges
In 2022, as we move into downside risk for multiple lines of business (commercial, Medicare) the reality is that the performance of the individual provider remains important, but group performance is paramount. Our downside risk will be measured at the group level.
The COVID 19 pandemic continues to put the brakes on the return to “normal”. With the arrival of a new and more infectious variant, medical staffing, supplies, and stamina will be stretched to the limit in 2022. 2020 and 2021 have taught us that fewer patients seeking care has had a negative impact on completion of preventative services and patients presenting with more advanced illnesses. Our success depends on preventative medicine services that close HEDIS/quality gaps in care. This may require resumption of alternative care delivery options like telemedicine services.
Experts have mixed opinions whether 2022 will be a catch-up year or continue with decreased services similar to 2020 and 2021. A significant number of ambulatory patients in spite of being vaccinated remain uncomfortable to venture to the office or hospital for services.
Some of the ambulatory metrics that we must address in 2022 are:
- The MPP Top Ten Quality Metrics – particularly breast cancer screening, cervical cancer screening, colorectal cancer screening and comprehensive diabetic care
- Statin utilization in patients with diabetes or cardiovascular disease – a standard of care
- BP monitoring – paying particular attention to the last reportable BP of the year
- Annual Wellness Visits – a visit to develop or update personalized preventative plan and obtain a health risk assessment of the patient. So important to the completion of the ambulatory quality measures.
MPP Support to the Provider and Practice:
- To support you and your practice, MPP has updated our Top Ten Quality Metrics Quick Reference Guide for 2022, available in early 2022, which provides key information relating to each metric and includes details and specifications of each metric, as well as tips on how to properly close a gap in care.
- Many payers provide updated lists of patients that have a coded diagnosis of diabetes or cardiovascular disease who are not on a statin medication. Contact these patients, discuss the need for the medication and prescribe the medication. If an exclusion is necessary, please bill the exclusion using an ICD-10 exclusionary code.
- BP readings and control – the CPT Category II codes are very useful in documenting a systolic and diastolic BP reading. Whether you are using the readings to close a HEDIS quality gap (BP less than 140/90) or using the reading to clinically improve the parameters of BP above 130/80 (Stage 1 high blood pressure), the effect is beneficial to the patient.
- MPP is also providing lists of your ACO patients who have not had an AWV in the prior 12 months – get the patient in the office for a face to face or perform a virtual visit for this encounter.
- Persivia, our population health registry, enables you to monitor your performance on your Quality Metric and Clinical Integration scorecards in near real-time. Our best-in-class providers can identify key areas to focus on by reviewing open gaps in care by metric. To obtain access to Persivia, you must complete the required educational module on our website at www.mclarenpp.org. Upon completion of the module, Persivia will send your username and password to your email address on file.
- And finally, the MPP Quality staff can assist in patient outreach activities including identifying patients with gaps in care, sending notification/reminders to patients to seek the necessary care or service.
- Please reach out to your regional Quality Performance Specialist or Regional Medical Director for further assistance.
Proficiency in population management and group performance will provide better outcomes for our patients and MPP continues to support the practice and providers in the delivery of care.
For more information, please contact Dr. Lawrence Cowsill at 248-935-6806 or [email protected]