Clinician Report Cards

Daren Wu, MDOpen Door Family Medical

Centers, Inc.

Who We Are…

• A federally-qualified community health center in Westchester County

• 4 primary care sites, 5 school-based sites• 60 clinicians, 32 in primary care• 36,000 patients• 200,000 visits expected by year-end

Who We Are…

• EMR implementation in 2007• Level 3 Medical Home in November 2009• Won the HIMSS Davies Award for best

implementation of an EMR in a community health center

Why Have a Report Card?

Why Have a Report Card?

It sure beats running on a hamster wheel!

Why Have a Report Card?

• The desire to excel is wired in most clinicians’ DNA

• Quality concerns should outweigh Quantity concerns

What Report Cards are NOT

• It is impossible to judge any clinician solely by a report card

• It is impossible to capture all the work and effectiveness of a clinician by a simple set of metrics

What Report Cards are NOT

• They are not a substitute for bad management…

What Report Cards are NOT

• They are not a substitute for coaching…

Not a Cakewalk• Difficult to create a reliable, reproducible, valid report

card

• Can take away from the emphasis on team-based care when focusing on a single individual

• Do not want clinicians to cherry pick patients to inflate their measures

• Often what needs attention are systemic changes, not just individual clinician improvements

A Report Card Must Be…

• Non-Punitive!!

Instead, it Should Be…

• Done in the spirit of continuous lifelong learning

• Looked upon as a way to improve upon one’s clinical weaknesses

• Viewed by senior administration as a means to help make systemic organizational changes

What Makes a Good Report Card?

• Transparent

• Reproducible

• Clinically relevant

How We Do It

• Quarterly• Provider meeting format• Single one-on-one (all providers annually;

selected providers quarterly)What might be contributing to this measure?What would you like to work on?A great resource on this that I’ve used is…How do you think your team can help you with this?

Provider Name % with A1c %A1c <7.0 % A1c 7.0 to 9.0 %A1c >9.0Hypertension w/o DM

with BP <140/90% DM/ HTN with

BP <130/80% with Asthma

Action Plan% well-controlled

Asthma

% of Persistent Asthma on

Controller Med% Screened for Colon

Cancer% Screened

w/ pap smear% Screened w/ mammogram % HIV Tested (ever)

% with Depression screening

Unlocked Notes

% of meds done by e-Rx

% of visits with PCG

Total 96% 48% 34% 18% 63% 41% 48% 69% 94% 27% 67% 45% 32% 14% 2090 48% 54%

Amenedo n/a n/a n/a n/a n/a n/a 71% 100% 100% n/a 0% n/a 0% 50% 12 63% n/a

Anderson 100% 100% 0% 0% 87% 33% 0% n/a 50% 24% 88% 42% 47% 12% 355 24% 38%

Arraiano 95% 52% 33% 10% 72% 48% 9% 38% 93% 31% 80% 44% 44% 18% 32 6% 37%

Begum 90% 38% 34% 17% 65% 59% 8% 50% 100% 24% 65% 42% 26% 12% 104 80% 40%

Caamano 100% 50% 17% 33% 58% 50% 24% 50% 100% 24% 58% 43% 35% 14% 34 50% 43%

Carlsen 100% 50% 13% 13% 79% 38% 42% 71% 100% 23% 57% 40% 15% 22% 8 23% 45%

Cohen 98% 30% 39% 29% 74% 55% 15% 64% 96% 35% 58% 41% 19% 10% 49 11% 59%

Dillon n/a n/a n/a n/a n/a n/a 97% 87% 93% n/a n/a n/a n/a 67% 10 1% 85%

Dunn 97% 50% 31% 16% 61% 41% 33% 75% 75% 29% 58% 38% 29% 9% 22 5% 30%

Gallin 50% 0% 0% 50% 50% 50% 65% 94% 64% n/a 24% 100% 22% 55% 14 91% 88%

Gerson 92% 23% 69% 0% 78% 31% 30% 100% 80% 15% 77% 52% 31% 11% 23 79% 53%

Guerra 100% 30% 40% 30% 60% 30% 0%   100% 62% 17% 15% 30% 28% 36 80% 1%

Islam 100% 52% 33% 14% 56% 38% 33% 100% 100% 31% 52% 35% 29% 21% 160 55% 42%

Meyer 96% 32% 51% 13% 54% 43% n/a 73% 100% 49% 57% 44% 42% 8% 316 89% 78%

Moysak 95% 40% 35% 20% 70% 40% 0% 100% 100% 21% 82% 55% 44% 13% 51 54% 49%

Michelson n/a n/a n/a n/a 50% n/a 50% 100% 100% 35% 97% 54% 75% 14% 1 n/a 47%

Neptune n/a n/a n/a n/a n/a n/a 100% 96% 96% n/a n/a n/a n/a n/a 6 85% 97%

Pace n/a n/a n/a n/a n/a n/a 78% 68% 97% n/a n/a n/a 45% 10% 50 84% 81%

Pozzuoli n/a n/a n/a n/a n/a n/a 21% 86% 100% n/a n/a n/a 15% 8% 42 65% 75%

Puthiyamadam 100% 54% 35% 11% 61% 48% 57% 57% 97% 54% 77% 63% 53% 32% 71 89% 79%

Rai 100% 42% 33% 25% 78% 58% 33% 67% 100% 23% 76% 61% 17% 7% 38 5% 35%

Rajan 99% 42% 30% 26% 56% 43% 9% 50% 84% 21% 53% 35% 23% 12% 305 74% 42%

Rovito 96% 46% 41% 23% 69% 43% 50% 50% 100% 29% 55% 36% 3% 8% 85 5% 76%

Samuel 0% 0% 0% 0% n/a 0% 21% 77% 100% n/a n/a n/a 7% 7% 35 61% 56%

Statile 100% 36% 36% 27% 52% 36% 27% 100% 71% 14% 58% 31% 36% 18% 10 53% 28%

Steinberg 100% 50% 25% 25% 50% 63% 36% 50% 92% 19% 80% 52% 51% 21% 55 95% 41%

Uribe 94% 31% 56% 6% 76% 44% 18% 70% 76% 23% 81% 56% 41% 12% 85 8% 51%

Wu 100% 65% 29% 6% 60% 44% 50% 86% 95% 30% 63% 60% 33% 36% 14 93% 58%

Yuen 99% 46% 31% 22% 55% 30% 33% 78% 90% 27% 53% 36% 30% 10% 33 10% 63%

Zeppieri 100% 52% 30% 18% 67% 39% 24% 67% 96% 20% 54% 37% 39% 34% 34 31% 49%

Total 96% 48% 34% 18% 63% 41% 48% 69% 94% 27% 67% 45% 32% 14% 2090 48% 54%

Cruelty to Eyeballs

August 2010 Total Rai Rajan Rovito Statile Steinberg Uribe Wu Yuen Zeppieri Total

% with A1c 96% 100% 99% 96% 100% 100% 94% 100% 99% 100% 96%

% with A1c between 7 and 9 34% 33% 30% 41% 36% 25% 56% 29% 31% 30% 34%

% with A1c >9 18% 25% 26% 23% 27% 25% 6% 6% 22% 18% 18%

% DM/ HTN with BP Controlled <130/80 41% 58% 43% 43% 36% 63% 44% 44% 30% 39% 41%

% with AAP 48% 33% 9% 50% 27% 36% 18% 50% 33% 24% 48%

% with asthma well controlled 69% 67% 50% 50% 100% 50% 70% 86% 78% 67% 69%

% persistent asthma with controller med 94% 100% 84% 100% 71% 92% 76% 95% 90% 96% 94%

% with PAP in 3 years 67% 76% 53% 55% 58% 80% 81% 63% 53% 54% 67%

% with mammogram 45% 61% 35% 36% 31% 52% 56% 60% 36% 37% 45%

% Screened Colon Cancer 27% 23% 21% 29% 14% 19% 23% 30% 27% 20% 27%

Hypertension no DM Well Controlled <140/90 63% 78% 56% 69% 52% 50% 76% 60% 55% 67% 63%

% HIV Tested 32% 17% 23% 3% 36% 51% 41% 33% 30% 39% 32%

% Depression screening 14% 7% 12% 8% 18% 21% 12% 36% 10% 34% 14%

% RX eprescribed 48% 5% 74% 5% 53% 95% 8% 93% 10% 31% 48%

% of visits PCG 54% 35% 42% 76% 28% 41% 51% 58% 63% 49% 54%

Partial Group Shot

Trending Over Time…

D. Wu Dec-09 Apr-10 Aug-10 Open Door% with A1c 100% 100% 100% 96%

%A1c <7 61% 68% 65% 48%%A1c 7-8.9     29% 34% % A1c > 9     6% 18%

% Lipid 70% 84%    % Microalbumin

65%      % DM/ HTN with BP

Controlled <130/8040% 42% 44% 41%

% with AAP 45% 49% 50% 48%% with asthma well controlled

96% 87% 86% 69%% with PAP in 3 years 52% 71% 63% 67%% with mammogram 54% 60% 60% 45%

% with Colorectal Screening

    30% 27%Hypertension no DM Well

Controlled <140/90 66% 64% 60% 63%

% HIV Tested 20% 25% 33% 32%

% with Depression screen     36% 14%

% e-prescribing     93% 48%

Hypertensives with BP < 140/90

Diabetics with A1c < 7.0

Next Steps…

• We will begin modeling a P4P component to compensation starting June 2011

• Implement P4P payments to our primary care providers in 2012

Questions?