“Tese are national standards that clinicians use to practice medicine all across the country, whether it’s rural Texas, urban Texas, or a state outside of Texas.”
bonuses, while 95 physicians earned bonuses totaling $21,600 through the cardiac care program. An analysis prepared by BCBSTX, however, indicates that nearly 17,000 Texas physicians treating diabetes patients within its network could earn up to $15.7 million in annual bonuses. And more than 11,000 physicians treating cardiac patients could earn as much as $7.2 million in annual bonuses. Dr. Sanchez says BCBSTX would like to see a substantial
increase in the number of participating physicians. The com- pany carried out major recruitment efforts in March and June to raise awareness of the program and get physicians to “take advantage of what we think is one of the few programs that truly rewards high quality in a relatively simple way,” he said. In September, BCBSTX approved a $500 bonus for physi- cians currently recognized in diabetes care or who are recog- nized by the end of the year. This bonus, intended to encour- age them to achieve recognition and follow evidence-based guidelines, will offset application fees and administrative costs.
Doing the two-step The BCBSTX Bridges to Excellence programs are voluntary, and Dr. Sanchez says there will be no adverse actions against physicians who choose not to participate or who apply but fail to gain recognition.
TMA officials say earning the bonuses is a two-step process.
First, physicians apply for recognition to Bridges to Excellence. That makes these programs unlike the physician-ranking sys- tems that many of the health plans, including BCBSTX, use to purportedly rate physicians’ quality of care based on claims data. Bridges to Excellence is a third-party administrator that independently rates physicians’ performance on the evidence- based standards and provides recognition. Once recognized by Bridges to Excellence, the physician is automatically included in the program. Then BCBSTX pulls data on all of its beneficiaries with diabetes or cardiac disease who have seen that physician in the past 15 months. Those patients are “attributed” to that physician if he or she provided most of the diabetes or cardiac care during that time period. The physician then must collect biometric information on each patient and submit it to BCBSTX for approval. The health plan then makes the incentive payments. Jill Brooks, RN, medical program specialist with BCBSTX, says the information submitted to get the bonus is essentially
20 TEXAS MEDICINE October 2011
the same as what physicians turn in to Bridges to Excellence to gain recognition. The difference is that Bridges to Excellence actually scores quality of care, whereas BCBSTX rewards the physicians for providing the correct care in a timely manner. To be eligible for Bridges to Excellence recognition, a physi- cian must submit data on the clinical measures outlined above on at least 25 patients. Group practices that apply for recogni- tion must have an overall average of 25 patients per physician in the practice, but no individual physician may have fewer than 10. The patients do not have to be BCBSTX beneficiaries for the physician to gain recognition. BTE recognition is sepa- rate from the BCBSTX incentive program. You don’t have to submit data on BCBSTX patients to get BTE recognition. But once physicians are recognized, data they submit to BCBSTX to get the bonus payment must come from patients who have been attributed to them by BCBSTX.
Finding a pathway
Physicians may submit their data to Bridges to Excellence through one of four pathways (for more information on these pathways, see “Taking the Right Path,” page 19):
• Directly from their EMR or registry system; • Uploading data online to the Bridges to Excellence IPRO Direct Submission Portal (
http://pao.ipro.org/);
• Completing the National Committee for Quality Assurance (NCQA) Diabetes Recognition Program or Heart/Stroke Recognition Program; or
• Completing the American Board of Internal Medicine main- tenance of certification modules in diabetes or cardiac care.
Ms. Brooks says the IPRO portal is the fastest and easiest way to submit data for recognition. IPRO is a performance assessment organization, based in Long Island, N.Y., formerly known as Island Peer Review Organization. To use the IPRO portal, physicians must register and upload biometric data on 25 patients. Forty-eight hours later, IPRO sends them a score, and Bridges to Excellence notifies them whether they have been recognized, Ms. Brooks says. The IPRO portal also is one of the least expensive ways to
gain recognition. The IPRO fee is $95 per physician, or $295 for groups of three or more physicians. That compares with more than $400 for NCQA recognition.
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