September 13, 2005

NCQA Program Urges Doctors to Adopt Health Information Technology

Leading legislators, MedPAC, ABIM view Physician Practice Connections standards as path to better care; comments due October 11

WASHINGTON—The National Committee for Quality Assurance (NCQA) has unveiled for public comment revised standards for its Physician Practice Connections (PPC) program, a two-year-old program that recognizes doctors who use clinical information and technology to improve patient care. The PPC program has generated extensive interest since its launch: the Bridges to Excellence pay-for-performance program uses it as the basis for paying rewards to doctors in several metropolitan areas and the American Board of Internal Medicine (ABIM) will include the PPC standards in its practice improvement modules (PIMs) that will expose the standards to thousands of doctors annually. NCQA and ABIM have collaborated on the effort over the past two years.

The public sector has been similarly supportive of the PPC program. On Capitol Hill, the program has been cited by the Medicare Payment Advisory Commission (MedPAC). PPC has also been noted as a model initiative for driving improvement and investment in health information technology in the recently introduced Medicare Value Purchasing Act of 2005. That bill is expected to be considered by the Senate in the fall.

“There’s probably no single more important step a doctor or medical group can take than to incorporate information technology into their practice,” said NCQA President Margaret E. O’Kane. “It makes the difference between having all the information you need to provide exactly the right care, and relying on memory and educated guesses. The latter just isn’t good enough anymore. Health information technology is crucial—that’s what the PPC program promotes.”

Several recent studies, including the Institute of Medicine’s Fostering Rapid Advances in Health, have shown that use of electronic information systems help improve health care quality, enhance patient safety and reduce waste; yet such systems remain rare in today’s health care system, found in only about 15% of physician practices. A notable exception is the Veterans Administration, where all health records are electronic; not surprisingly, the VA has become an oft-cited example of a system that consistently provides some of the nation’s best health care.

“The Medicare Value Purchasing Act was designed to help build on the significant strides being made in the private sector under the leadership of organizations such as the National Committee for Quality Assurance,” said Sen. Chuck Grassley (R-Iowa), Chairman, Senate Finance Committee. “The Physician Practice Connections program recognizes that a doctor is only as good as the information he or she has to work with. Our bipartisan legislative initiative works to encourage the adoption of health information technology by rewarding doctors who provide higher quality, more efficient care.”

The revamped standards also align with MedPAC’s recent call for measures assessing the use of IT in physicians’ quality improvement efforts. In a recent report to Congress, MedPAC recommended further development of clinical process measures such as those in PPC. The report also called for collaboration between the public and private sectors to expand their adoption in the health care marketplace.

“NCQA's Physician Practice Connections sets clear expectations about how practices can and should use information technology to improve care,” said Glenn Hackbarth, J.D., Chairman, MedPAC. “By developing this program, NCQA has once again demonstrated its leadership in improving the quality of care.”

ABIM’s support of PPC holds enormous potential to introduce the program to a significant number of doctors over the next few years and to provide consistent guidance for quality improvement efforts among its diplomates. ABIM offers seven PIMs for internists that incorporate PPC standards as a means for assessing a practice’s use of care management, quality improvement, and health information technology. The same standards will be incorporated into new PIMs as they are completed over the next several months. Approximately twelve thousand ABIM diplomates apply for recertification every year, meaning that they will be examining their performance in practice and ways to improve their systems of care. The PIMs provide a convenient way to do this.

“For doctors, the advantages of adopting good information systems are right there on the surface – easier access to patient information, support for clinical decision-making, and more effective communications with patients,” said ABIM Executive Vice President F. Daniel Duffy, M.D. “The strong signal that NCQA and ABIM are sending by working together to advance standards for office information systems will accelerate that adoption.”

The revised PPC standards have been fine-tuned to make them consistent with other public and private initiatives promoting the adoption of EHRs in doctors’ offices. The new standards are sorted into three categories; while electronic systems are required for meeting more advanced standards, physician groups without these systems can earn Recognition by meeting the basic requirements. (See below for descriptions of the standards).

“A typical quality challenge for doctors today might be, for instance, to quickly determine which of their 800 patients have diabetes and which of those have their blood sugar screened and under control,” said Phyllis Torda, NCQA Vice President for Product Development. “You can’t do that without technology. But with technology it’s not just realistic—it’s incredibly useful for making sure those patients get the extra help they need. That’s the sort of thing that PPC measures, and why it drives not just adoption of technology, but the right use of technology.”

There are currently 80 PPC-Recognized practices representing nearly 700 physicians. The practices range in size from large to small, with the typical group including just four doctors. Of the 80 practices recognized, 10% have received recognition by meeting advanced standards (see descriptions below) related to electronic health records (EHRs); the other 90% received recognition by meeting basic standards related to use of patient registries and other such systems. For more information about the program, visit the NCQA PPC Web page. To see a list of PPC-Recognized practices in your area, visit http://recognition.ncqa.org.

The revised standards are available for public comment on NCQA’s Web site. Public comments will be accepted through October 11; final standards for the new version of PPC will be published in early 2006.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. NCQA provides health care quality information free of charge through the Web and media in order to help consumers, employers and others make more informed health care choices.

THREE LEVELS OF PPC STANDARDS

Basic standards assess the use of evidence-based standards of care, practice-wide measurement of clinical quality, maintenance of patient registries for the purpose of identifying and following up with at-risk patients and provision of educational resources to patients.  

Intermediate standards ask whether practices use electronic systems to maintain patient records, provide decision support, enter orders for prescriptions and lab tests and provide patient reminders.  

Advanced standards ask whether a practice’s electronic system is “interoperable” with other systems, whether it uses nationally accepted medical code sets and whether they can automatically send, receive and integrate data such as lab results and medical histories from other organizations’ systems.