This past summer, on August 1st-3rd, two representatives of Methodist Physicians Group, Sue Ginn, RN and Quality Improvement Specialist & Analyst, and Tiffany Smith, RN and Population Health Coordinator, accompanied Trudi Matthews, Robin Huffman, and Kelly Fountain to the Transforming Clinical Practice Initiative (TCPI) National Expert Panel (NEP) conference in Columbia, Maryland. They represented the CMS sponsored Great Lakes Practice Transformation Network (GLPTN) as one of the designated Exemplary Practices within the GLPTN consortium of four states. As a designated Exemplary Practice, an organization must currently be in Phase 4 out of 5 phases of practice transformation, as defined by CMS. They must also have an improvement in least one outcome Quality measure, and be identified an Exemplary Practice by CMS. Methodist has seen improvement in their diabetic measure, and are currently in Phase 4; they are nearing completion of Phase 5.
Methodist has locations in Webster, Henderson, and Union counties in Western Kentucky. They see nearly 10,000 patients per month at two hospitals, 18 clinics, and an urgent care clinic. Ms. Ginn spoke at the conference and shared their experiences with attendees, as they have made significant improvements and changes in their organization. After the conference Sue said, “the highlight for me was listening to the comments and strategies of other practices to get provider buy in, patient compliance, and in general how they achieved the CMS Exemplar Practice Goals. I came back with some great ideas to try with our providers and staff. Listening to the patient stories was motivating, to understand their thoughts on the different processes within the practices and how to make things better for them.”
They have seen significant successes in the reduction of hospital readmissions and ER visits. Methodist also improved their diabetic quality measures, with a decrease of 10% in their A1C numbers from 2017 to 2018. Many of their successes have been due to the addition of hiring a Quality Improvement Specialist, along with adding five Care Coordinators to their QI team. They have also tied Quality Performance standards to provider contracts, and Sue meets often with each individual provider at their organization to review Quality metrics and requirements in order to achieve the required standards. Regarding their quality journey, Sue states that she was surprised by “the overall improvement on the individual measures from 2016 to 2017.” She said, “Our providers and clinical staff have accepted the changes, for the most part, that have been put into place to meet the measures. Our administration has been very supportive of the quality program and emphasized to the providers the importance of meeting the thresholds.”
Methodist has achieved this during a time when they faced significant hurdles, as they switched EHRs and had, “two systems that housed the necessary data”, and had to do “manual extraction of all the data for reporting via web interface.” Sue said, “I think 2018 data collection will be easier. The majority of the information will be in our new EHR but some of it may still be in the previous EHR, such as colon cancer screening or pneumonia vaccines.” Not all will be solved right away, as Sue remarked, “We are still struggling to find a way to track the patients with a new diagnosis of depression so we can meet the depression remission at 12 months. Our new EHR doesn’t have a mechanism for alerting the provider or staff that a new PHQ9 is needed at a specific date. If we could run a report to collect the data, if no office visit, we could call the patient and complete the PHQ9 via phone.” They are still working on how to build a report that will help them with this measure.
The Methodist team is wonderful for Kentucky REC Quality Improvement Advisors to work with, and they are willing to work on suggestions to improve their efforts and make the lives of their patients better. They have gone from a negative payment adjustment in previous years to a positive payment adjustment for 2017, with a nearly perfect MIPS score. Besides speaking at the conference, they shared their tips during a live Q-Source webinar in July for practices seeking ideas and help with improvement in MIPS and Quality performance.
Many practice representatives from across the nation at the National Expert Panel were able to speak with Sue and Tiffany during the conference. They were able to learn from their presentation, and gain valuable lessons and ideas and solutions for their own improvement endeavors. Our team at Kentucky REC has now made new long term friends from this quality improvement journey, culminating in the trip to Maryland. We are proud to share Methodist’s achievements on a national level.