Medicare’s Physician Quality Reporting Beneficiary Attribution

Dowd, Bryan E; Li, Chia hsuan; Swenson, Tami; Coulam, Robert F.; Levy, Jesse M.

doi:10.5600/mmrr.004.02.a04

Cited by 18 publications

(12 citation statements)

References 4 publications

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“…Cost-effective methods for quality improvement need to be discussed. In the United States, the Center for Medicare & Medicaid Services has a Physician Quality Reporting System in which physicians voluntarily report endoscopy quality indicators and receive incentives [28]. In Spain, all screening colonoscopy data are coded by the coordinating staff in the Basque Country CRC Screening Program.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy quality in community hospitals and nonhospital facilities in Korea

Lee

Han

Joο

et al. 2021

Korean J Intern Med

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Background/Aims: High-quality colonoscopy is essential to reduce colorectal cancer-related deaths. Little is known about colonoscopy quality in non-academic practice settings. We aimed to evaluate the quality of colonoscopies performed in community hospitals and nonhospital facilities. Methods: Colonoscopy data were collected from patients referred to six tertiary care centers after receiving colonoscopies at community hospitals and nonhospital facilities. Based on their photographs, we measured quality indicators including cecal intubation rate, withdrawal time, adequacy of bowel preparation, and number of polyps. Results: Data from a total of 1,064 colonoscopies were analyzed. The overall cecal intubation rate was 93.1%. The median withdrawal time was 8.3 minutes, but 31.3% of colonoscopies were withdrawn within 6 minutes. Community hospitals had longer withdrawal time and more polyps than nonhospital facilities (median withdrawal time: 9.9 minutes vs. 7.5 minutes, p < 0.001; mean number of polyps: 3.1 vs. 2.3, p = 0.001). Board-certified endoscopists had a higher rate of cecal intubation than non-board-certified endoscopists (93.2% vs. 85.2%, p = 0.006). A total of 819 follow-up colonoscopies were performed at referral centers with a median interval of 28 days. In total, 2,546 polyps were detected at baseline, and 1,088 were newly identified (polyp miss rate, 29.9%). Multivariable analysis revealed that older age (odds ratio [OR], 1.032; 95% confidence interval [CI], 1.020 to 1.044) and male sex (OR, 1.719; 95% CI, 1.281 to 2.308) were associated with increased risk of missed polyps. Conclusions: The quality of colonoscopies performed in community hospitals and nonhospital facilities was suboptimal. Systematic reporting, auditing, and feedback are needed for quality improvement.

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Section: Discussionmentioning

confidence: 99%

Colonoscopy quality in community hospitals and nonhospital facilities in Korea

Lee

Han

Joο

et al. 2021

Korean J Intern Med

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show abstract

“…We selected all quality metrics that were routinely collected and tracked during our study period by our study ambulatory practices for external reporting and/or pay for performance incentives ( 12 , 13 ). These Center of Medicaid and Medicare outpatient measures of quality were consistent with what other primary care practices nationwide measure and report on.…”

Section: Methodsmentioning

confidence: 99%

The Relationships Between Patient Experience and Quality and Utilization of Primary Care Services

Aysola

Huo

et al. 2020

Journal of Patient Experience

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We lack knowledge on how patient-reported experience relates to both quality of care services and visit attendance in the primary care setting. Therefore, in a cross-sectional analysis of 8355 primary care patients from 22 primary care practices, we examined the associations between visit-triggered patient-reported experience measures and both (1) quality of care measures and (2) number of missed primary care appointment (no shows). Our independent variables included both overall patient experience and its subdomains. Our outcomes included the following measures: smoking cessation discussion, diabetes eye examination referral, mammography, colonoscopy screening, current smoking status (nonsmoker vs smoker), diabetes control Hemoglobin A1c (HbA1c [<8]), blood pressure control, cholesterol control Low Density Lipoprotein (LDL) among patients with diabetes (LDL < 100), and visit no shows 2 and 5 years after the index visit that triggered the completed patient-experience survey. We found that patient experience, while an important stand-alone metric of care quality, may not relate to clinical outcomes or process measures in the outpatient setting. However, patient-reported experiences with their primary care provider appear to influence their future visit attendance.

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“…In order to calculate a HEDIS immunization measure at the provider level, the authors used a passive patient-to-provider attribution algorithm based on the first presence of Evaluation and Management, preventative medicine Current Procedural Terminology (CPT) codes signaling the child’s first, outpatient visit with a PCP, which is a similar approach used by Medicare for quality reporting programs [21] , [22] . Because Medicaid may not necessarily confirm that a child’s visit is initial versus periodic (e.g., CPT code 99381 versus 99391), we included codes 99391 and 99392.…”

Section: Methodsmentioning

confidence: 99%