Once shy about sharing data, leading health information exchange now posts public scorecard that compares doctors' success treating diabetes, heart problems and other conditions.
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The Indiana Health Information Exchange (IHIE) has launched the first practice-level public quality reporting site in Indiana. More than 750 Indiana physicians from 174 practice sites around the state have agreed to post their clinical quality measure scores on the website of IHIE's Quality Health First (QHF) program.
The scorecard shows how well each practice does on 21 measures compared to other practices in their region and the entire state. The clinical measures include process and outcome metrics for treating such conditions as diabetes, heart health and respiratory issues, as well as results for women's and children's health care.
In a statement, Harold J. Apple, president and CEO of IHIE, one of the leading information exchanges in the country, said, "QHF was developed as a tool to help physicians better manage and monitor the care provided to patients with chronic diseases. Reporting these quality scores is a significant milestone for physician practices seeking to demonstrate their commitment to improving the quality of care provided to patients."
Indiana physicians apparently were not always eager to participate in public quality reporting. Several years ago, the Robert Wood Johnson Foundation (RWJF) wanted to include IHIE in its Aligning Forces for Quality program, which now encompasses 16 communities across the U.S., recalled Michael Painter, M.D., senior program officer for RWJF, in an interview. But IHIE would not commit to publishing quality reports, which was one of the program requirements, so RWJF looked elsewhere, Painter said.
Josh Nelson, M.D., chief medical officer of IHIE, told InformationWeek that he had no knowledge of that episode, which occurred before he joined the organization. The recent decision to publish quality reports, he said, was made by all the stakeholders in Quality Health First, including provider groups, health plans and employers.
Previously, there was community-wide reporting that showed how well all providers were doing on the quality measures, he said. Payers and employers believed that practice-level reporting would be meaningful to consumers, and the physician groups agreed that it would help them improve performance.
Although some solo practices are included among the reporting providers, QHF's stakeholders chose not to report individual doctors' numbers. One reason, Nelson said, is that some physicians don't have enough patients with particular conditions to make measures related to those conditions statistically significant. "If we had gone to the individual doctors, we would have lost a lot of measures," he said.
Only primary care practices are included in the report card because specialists don't participate in the QHF, he noted. The data is risk-adjusted for each practice's payer mix, broken down into commercial, Medicare, and Medicaid patients.
Anthem Blue Cross Blue Shield, the largest payer in the market, is giving bonuses to practices that improve their quality scores, said Nelson. But although plans and employers are letting their members and workers know about the quality reports, he was not aware of any effort to use the data to "tier" providers by quality scores.
The physician practices enter the quality data on a secure website. Only some of the participating groups -- primarily the larger ones -- have electronic health records, Nelson said. Other practices are doing manual chart reviews to gather the data.
Payer claims data is combined with the clinical data in the report cards, he added. If physicians notice that they provided a service but it's not indicated in the claims information, their staff can add the missing data to the database on the website. The doctors also have an opportunity to review the reports before they're published.
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