The program is voluntary. It’s also confidential in that the clinical informa- tion used in the quality recognition is not derived from or sent to any specific payer. “So [physicians] remain in control of clinical data from beginning to end,” she explained. For example, to gain recognition, physicians choose a minimum sample of 25 qualifying patients to report, regard- less of payer, which they can do on their own or with the help of an electronic medical record (EMR) vendor. And their scores are not shared publically, whether or not they earn BTE recognition. The quality measures used also em- phasize processes and other elements that have the most impact on patient outcomes, such as preventing complica- tions, which also tend to drive cost sav- ings, Ms. DiLorenzo added.
Even without the benefit of incentive
payments, “there’s value for clinicians who want to see how they are doing compared with their peers,” she said, adding physicians can use their perfor- mance reports “to demonstrate to payers that you are consistently delivering high- quality care, and that’s a good place to be in contract negotiations.” TMA officials say BTE also is an op- portunity for practices of any size to participate in emerging value-based payment models that factor in quality versus straight fee-for-service payments. Whereas medical homes and account- able care organizations tend to require larger groups with a certain level of in- frastructure, BTE allows smaller prac- tices to take steps toward those models, while getting compensated for deliver- ing high-quality care along the way, said then-TMA Director of Clinical Advocacy Joseph Gave. For example, the process to become
BTE-recognized, in addition to ongoing participation, can help a practice evalu- ate “how ready you are to deal with population health and provide a panel of care versus patient-by-patient treat- ment,” he said. Dr. Fuller says participation in BTE’s diabetes recognition program helped his practice, North Hills Family Medicine, put certain processes in place when it became a certified medical home.
“We understood how these kinds of measures were used, and that helped us in looking at our medical home pro- cesses for diabetic care,” he said, which included everything from measuring pa- tients’ weight, blood pressure, lipid lev- els, and hemoglobin A1c, to discussing
and educating patients on weight loss and routine dental, eye, and foot care.
“We knew what those processes were be- cause they were part of programs like BTE and NCQA certification for diabetes care.”
Crossing the BTE bridge
There are several pathways for physicians to earn recognition in the Bridges to Excellence (BTE) quality measurement program, each with a different cost. Physicians must demonstrate they have met certain benchmarks for a specific condition and then submit their data in one of four ways:
• Directly from their electronic medical record or registry sys- tem (no charge);
• By uploading data online to the Bridges to Excellence IPRO Direct Submission Portal (
http://pao.ipro.org) ($95 per physi- cian or $295 per group);
• Through the National Committee for Quality Assurance rec- ognition programs (roughly $400); or
• Through the American Board of Internal Medicine (ABIM) maintenance-of-certification modules (ABIM fees plus the $95 IPRO fee).
More information on the BTE performance assessment is
available at
www.hci3.org/?q=node/43/. So far in Texas, Blue Cross and Blue Shield of Texas and
Aetna offer financial bonuses for BTE-recognized physicians in diabetes, cardiac, and asthma care. Once recognized, the health plans will identify members with those conditions that the physician manages and request patients’ biometric information. The Blues and Aetna will then notify the physician of approval to submit a claim with a specific code for reimbursement. To help determine whether BTE is right for your practice, TMA has assembled a toolkit that includes eligibility and return- on-investment calculators and instructional videos (www
.texmed.org/ClinicalQualityTools/). More information on the BTE program can be found at
www.texmed.org/BTE.aspx.
September 2013 TEXAS MEDICINE 61
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