Physician Consortium for Performance Improvement ®

1. Physician Consortium for Performance Improvement® Excellence in health care delivery and Fairness in provider accountability

2. Quality of Health Care in US • Adults do not receive almost half of the clinical services from which they would likely benefit1 • Other countries achieve better performance on many measures despite higher per capita health care spending in US vs. other industrialized countries2 • Spending levels vary widely among U.S. regions3 • No evidence that more expensive regions have either better quality or improved health outcomes • From IOM, Pathways to Quality Health Care (Dec. 2006) • McGlynn et al, 2003 • Hussey et al., 2004; Reinhardt et al., 2004 • Baicker and Chandra, 2004; Fisher et al., 2003a,b

3. “The full potential of current [quality improvement] initiatives cannot be realized without a coherent, robust, integrated performance measurement systemthat ispurposeful, comprehensive, efficient, and transparent.” • From IOM Pathways to Quality Health Care (Dec. 2006)

4. Measure Development National Selection and Endorsement Measure Implementation AMA-convened Physician Consortium for Performance Improvement® (Consortium), National Committee for Quality Assurance (NCQA), JCAHO, specialty societies, others National Quality Forum™ Ambulatory Care Quality Alliance Centers for Medicare and Medicaid Services (CMS), private plans, NCQA, medical specialty boards, continuing medical education (CME), electronic health record vendors, physicians/practices, private sector regional measurement initiatives Landscape: Who Does What

5. PCPI Mission • Improve patient health and safety by • Identifying and developing evidence-based clinical performance measures • Promoting the implementation of clinical performance improvement activities • Advancing the science of clinical performance measurement and improvement

6. PCPI Membership (1) • PCPI Membership is open to • National medical specialty societies and state medical societies in the AMA House of Delegates who wish to participate • ABMS and its member boards • Health care professional organizations • Individuals/organizations committed to health care quality improvement and/or patient safety, and participants in the development, review, dissemination or implementation of performance measures and measurement resources.

7. Current PCPI Membership (2) • More than 100 national medical specialty and state medical society representatives • Council of Medical Specialty Societies • American Board of Medical Specialties and its member boards • Experts in methodology and data collection • Agency for Healthcare Research and Quality • Centers for Medicare and Medicaid Services • Convened and staffed by AMA

8. PCPI Governance • Governance • In October 2006, formal PCPI governance and structure (Bylaws and Rules and Procedures) was adopted by its members, the AMA, and the Council of Medical Specialty Societies (CMSS) • PCPI Executive Committee • Expanded to include representatives from the AMA, CMSS, and the six largest national medical societies, as well as others from the Consortium membership.

9. Measure Development (1) • Identifying opportunities for improvement • Involving representatives from all medical specialties and other relevant health care disciplines in the process • Linking measures to an evidence base • Supporting clinical judgment and patient preferences • Testing measures • Promoting a single set of measures for widespread use

10. Measure Development (2) • The Consortium does not develop clinical guidelines. • It relies on available guidelines to identify aspects of care for measure development • Work groups prefer to base measures on guideline principles that have the highest level of evidence and the strongest recommendations. • Measures leave room for valid medical and patient reasons for deviating from recommendations

11. Notable PCPI Achievements (1) • To date, the AMA/PCPI has developed performance measures for more than 40 areas of clinical care, comprising more than 250 individual, physician-level clinical performance measures (all completed and approved measures can be accessed from the Consortium web site – www.physicianconsortium.org) • 112 of the 153 total measures in the CMS Physician Quality Reporting Initiative (PQRI) for 2009 were developed by the PCPI with medical specialty societies, and in conjunction with the National Committee for Quality Assurance (NCQA) *updates can be accessed from the PCPI web site

12. Notable PCPI Achievements (2) • Focused on quality • Measures derived from best available evidence • Cross-specialty representation & consensus • Driven by physicians • Consideration of exclusions, patient preferences, system issues • Harmonization of measures with other groups • Measures being implemented by many types of groups

13. Ongoing PCPI Activities • Review of all PCPI measurement sets - incorporate testing and implementation results, bundling or grouping of measures, new measures of intermediate and long-term outcomes and care coordination where feasible • Adopt new format for measurement sets which document key components of measurement • Develop measures on appropriateness (including overuse) • Develop measures on patient safety • Increase involvement with key stakeholders (consumers, purchasers, ABMS and member boards)

14. Who are using PCPI measures? (1) Physicians – internal quality improvement; fulfill requests from outside stakeholders Medical Boards - Maintenance of Certification programs Medical Specialty Societiesand other CME providers - CME programs Electronic Health Record Vendors – in discussion

15. Who are using PCPI measures? (2) • Private/Public Health Plans - recognition, pay for reporting, pay for performance programs • Employers –to ensure healthcare purchased is high quality • Local and national quality improvement initiatives and CMS demonstration projects

16. Use of measures in CMS demonstration projects

17. Measures Feasibility/Validity Testing • Testing protocol developed - are we really measuring what we think we’re measuring? • recommends studies of feasibility, reliability, validity, and unintended consequences that should be undertaken to evaluate all AMA/PCPI measures. • encourages measures testing in varying types of physician practices and multiple data sources (electronic, paper, administrative). • Recommends cataloging of testing projects that have been completed to date, as well as opportunities for future testing. • Continually seeking opportunities/partners to test measures • Testing Needed: • All PCPI measures • Different sized practices • Different data sources (paper, EHRS, administrative claims)

18. Examples of Current PCPI testing projects (as of January 2009*)

19. Future Strategic Priorities • Identify coordination of care measures • Move PCPI measure development beyond the current focus on measures for the individual physician • Foster quality improvement collaboratives • Foster quality measurement registries

20. Contact Information www.physicianconsortium.org 312/464-4956 Karen Kmetik, PhD Karen.Kmetik@ama-assn.org Heidi Bossley, MSN, MBA Heidi.Bossley@ama-assn.org