NWPHO Institutes Withhold Process Gates

NWPHO Institutes Withhold "Process Gates"
From Jeffrey Murphy, Executive Director, NWPHO
February 2010

The Newton-Wellesley PHO Board has approved the introduction of withhold "process gates" pertaining to our CY2010 pay-for-performance agreements in an effort to ensure we maximize our collective performance on these measures and maximize the return of risk withhold to all NWPHO participating physicians. By instituting these process gates, the Board is seeking to ensure that all practices and physicians actively use the systems and medical management programs established by the NWPHO that are designed to help achieve the performance targets for the measures contained within our contracts.

Not surprisingly, the bar is being raised on our performance targets making it all the more important that all practices are working collaboratively with the NWPHO clinical and administrative team in the use of these established systems and programs. Practices and physicians that fail to meet the process gates defined below will be subject to forfeiture of all or a portion of their risk withhold on the specific measure associated with the process gate.

The performance measures and process gates include the following:

Pharmacy Process Gate: The NWPHO’s pharmacy switch program identifies patients who may be candidates for a change in their medication to a lower cost agent. The NWPHO’s clinical pharmacists make outreach calls to patients to review a potential switch upon the approval of the prescribing physicians. No calls are made without the physician’s consent that such as switch is clinically appropriate. This process gate will require all physicians to respond to switch requests within two weeks of having received a list. Physicians failing to respond within the two week window of time will have the list re-sent and granted one more week to respond. Failure to respond following this second request will result in the physician’s forfeiture of the withhold associated with the pharmacy measure.

EMR Documentation Process Gate: Consistent with our standards in recent years, all EMR users must document at least 80% of their office based visit notes. Failure to achieve this documentation level will result in the forfeiture of all the withhold associated with the EMR performance measure. 

Computer Generated prescribing (e-prescribing) Process Gate: EMR users are expected to use the computer generated prescribing (CGP) functionality within their EMR system. In CY2010, the CGP target for PCPs is 90% and the CGP target for Specialists is 80%. The PCP target is higher in CY2010 in recognition that PCPs were first to deploy the EMR. It is our expectation that all physicians will have a 90% target in CY2011. Physicians failing to meet this targeted level of e-prescribing will forfeit their risk withhold associated with the CGP prescribing measure.

Radiology/High Cost Imaging Process Gate: All NWPHO practices must use the NOAH radiology prior authorization system when ordering high cost imaging tests (MR, CT, Nuclear Cardiology, PET) in the ambulatory setting. This system allows us to track ordering patterns and access opportunities for potential improvements in the utilization of these high cost diagnostic tests. All practice ordering these high cost imaging tests must process at least 85% of all imaging prior authorizations via the NOAH system. Failure to achieve this target will result in a forfeiture of the risk withhold associated with the radiology measure.

Quality Measures Process Gate (PCP practices only): All primary care practices need to be active users of the MATRIX patient registry system in order to ensure we achieve our performance targets on the quality measures. To meet this standard of effective use of the MATRIX system, practices must:

• Generate and mail initial and follow-up patient reminder letters
• Input any missing laboratory values into the LMR or GE Centricity to allow for the upload to MATRIX
• Document in MATRIX at least 3 outreach attempts to non-compliant patients in the last quarter of the year
• Update scheduled appointments in MATRIX in the last quarter of the year if the practice uses LMR mini-registration. Practices that fail to effectively utilize MATRIX as detailed above will be subject to forfeiture of the risk withhold associated with the quality measures.

Please feel free to contact Bill Holgerson, MD, NWPHO Medical Director, or Jeff Murphy, NWPHO Executive Director if you have any questions regarding these measures or your practice’s current status on any of these process gates.