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Understanding Building Blocks of Delivering Quality Care-PQRS

April 10, 2014
PQRSEligible Professional’s (EPs) who bill Medicare (using the new 1500 claim form) and satisfactorily report quality-measures data for services furnished in year 2014 are eligible to earn a extra incentive equal to 0.5% of the estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services.

These new quality care incentives, although many medical providers question the use of the word “incentives,” mandate that physicians continue delivering quality patient care to satisfy the stated guidelines. Ensuring high quality care is a challenge, compounded by numerous new regulations, which can best be faced with provider understanding of the components of high care performance.

According to Medical News Today, there are identifiable features, or building blocks, that researchers have identified as key elements in delivering consistent quality patient care. Physicians and practices committed to a continuing delivery of quality care in the face of changing and expanding government regulations should consider these essential building blocks.

Doctors and practice managers should take the time to introspectively analyze whether they employ these foundations. If some of these key elements are being overlooked, providers should strongly consider introducing missing elements to their procedures. Research indicates they will be pleased they took the time to integrate these elements into their policies and procedures.

Key Elements of Delivering Consistent Quality Care

Consider these important “foundational elements.”

  • Ensure engaged practice leadership,
  • Improve data collection and recording,
  • Practice empanelment as routine procedure, and
  • Implement team-based care.

These foundation elements, help providers successfully install the remaining components.

  • Create a patient/team partnership environment,
  • Consider population management as a practice priority,
  • Commit to continuity of care,
  • Always provide prompt access to care,
  • Coordinate and explain care procedures, and
  • Create a “template” of the future.

Research identified these essential features after study of high-performing primary care practices. The common shared vision of these practices: Creating a patient-centered environment.

Physician Quality Reporting System (PQRS) Role

PQRS is intrinsic to creating a quality care practice. Although potentially burdensome, PQRS gives providers 2014 to install the system before downward “payment adjustments” take effect in 2015 for unsatisfactory reporting.

EPs should understand the system to create documentation evidencing quality care for reimbursement purposes. Dissenters believe PQRS is a another example of the government requiring the medical community to do some of its work—at provider cost—to administer its bureaucracy. Whether a desired or unintended consequence, non-compliance can result in penalties for inadequate reporting.

EPs who deliver Medicare and Medicaid services should use 2014 as a training and implementation time period to integrate PQRS into their practices. This action plan should minimize or eliminate costly claim denials in 2015 and beyond.

Developing a Model That Works for You

We cannot overstress the importance of integrating these elements into your own practice. If, after introspective evaluation, your practice lacks one or more of these vital components, strongly consider installing them as soon as possible. Be specific, not general. Devise attitudes and techniques that will integrate these elements into your daily practice routine.

Commit to creating the mindset in yourself and your staff that alternative options run the risk of falling short of achieving efficient and effective quality patient care—and having the evidence (data) to validate your commitment. The extensive recording and documentation regulations will provide the evidence you need to prove your practice is more than just in compliance. Your records will display you have gone beyond planning to build a working quality care model—you have done it.

While all of these key elements are important and necessary, it all starts with engaged leadership. If you tend to focus on delivering quality care only, be sure the other leaders in your practice are thoroughly engaged. How will you know?

Your leaders truly care about making the practice all that it can be. Engaged leaders do not view their position as a “job.” They do make the practice part of their fabric and personality. Engaged leaders are totally committed to high performance by everyone involved, regardless of titles or duties. Identical to every other organization, medical practice excellence starts at the top and works its way through everyone involved.

Build or maintain your practice excellence by heeding these foundations. Employ all, making them part of every day operations. You will deliver consistent, optimal patient care and enjoy more efficient, profitable practice performance.


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