California Physician Performance Initiative (CPPI)

The California Physician Performance Initiative (CPPI, www.cchri.org/cppi), started in 2006 by the California Cooperative Healthcare Reporting Initiative (CCHRI, www.cchri.org), is developing an approach to measure and report quality and cost of healthcare provided by physicians. The goal is to improve the delivery of quality care while moderating costs. CPPI received federal funding in 2006 to develop a system to measure and report on the quality of healthcare provided by physicians. Three California commercial health plans joined with Medicare to pool their medical claims data to measure quality of care as part of a national effort to establish physician performance standards.

CPPI BQI (CMS-funded Better Quality Information to Improve Care for Medicare Beneficiaries) Measures for Cycle 1, 2, 3

CANCER:

MEASURE: Breast Cancer Screening
CYCLE 1 — COMPLETED MARCH 2008: 1
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Colorectal Cancer Screening
CYCLE 1 — COMPLETED MARCH 2008: 1
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Cervical Cancer Screening
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

DIABETES:

MEASURE: LDL Testing
CYCLE 1 — COMPLETED MARCH 2008: 1
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: HbA1c Testing
CYCLE 1 — COMPLETED MARCH 2008: 1
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Diabetes Nephropathy Testing
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Diabetes Eye Exam Screening
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

HEART DISEASE:

MEASURE: Cardiovascular — LDL Testing
CYCLE 1 — COMPLETED MARCH 2008: 1
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: CAD Patients Receiving Lipid-lowering Therapy
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Post MI Post Discharge Beta-blocking Therapy
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Persistence of Beta Blocker Therapy — Post MI
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Annual Monitoring for Patients on Persistent Medications: Ace Inhibitors, Digoxin, Diuretics, Statins
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Percent of Patients After AMI, CABG, or PCI Receiving at Least One LDL-C Screening
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

HEART FAILURE:

MEASURE: HF: LVF Testing
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

MEASURE: Warfarin for Patients With CHF and Atrial Fibrillation
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008: 2
CYCLE 3 — COMPLETED OCT. 31, 2008: 3

RESPIRATORY DISEASE:

MEASURE: Pharmacology Management of COPD Patients (PCE)
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

MEASURE: Inappropriate Treatment of Adults With Acute Bronchitis
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

MEASURE: Appropriate Medications for Asthma Patients
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

MEASURE: Spirometry Testing for COPD Patients to Confirm Diagnosis
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

CARE FOR OLDER ADULTS:

MEASURE: Percent of Patients 65 or Older That Had Glaucoma Eye Exam
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

MEASURE: Women With Osteoporosis Age 67 and Older Who Have Had a Fracture Bone Density/Medication
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

RHEUMATOLOGY / ORTHOPEDICS:

MEASURE: Rheumatoid Arthritis Patients Prescribed a DMARD Drug
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

MEASURE: Low Back Pain Patients Who Receive an Imaging Study
CYCLE 1 — COMPLETED MARCH 2008:
CYCLE 2 — COMPLETED JULY 2008:
CYCLE 3 — COMPLETED OCT. 31, 2008:

CCHRI began soliciting feedback from affected physicians as part of CPPI in October when they were notified via mail. The quality measure scores were based on claims data from patient care provided in 2007. Physicians were provided with a percentile rank compared to their physician peers, performance scores by measure, and performance scores by patient group.

Physician-specific Medicare scores will not at any time be released to the public by either Medicare or CCHRI. Although CCHRI has no plans to publicly release physician-specific quality scores related to the treatment of private PPO patients, it is possible that the private health plans could use this information in the future. However, the private health plans would only be provided the scores of their network physicians. The California Medical Association (CMA) continues to work closely with CCHRI to vigilantly protect the use of physician information.

CMA and SDCMS urge physicians to verify the accuracy of the data used to calculate their scores; physicians can request their private PPO patient lists at the CCHRI website (www.cchri.org/cppi) where they can download and complete the “Request for Patient List and Appropriate Data Use” form. The completed forms will be sent to Thomson Reuters (the vendor contracted to collect, standardize, and score the data in strict compliance with HIPAA regulations). Requests must be submitted no later than December 5, 2008, and will be processed within five business days of receipt. Additional information about CPPI, including the scoring methodology, can be found at www.cchri.org/cppi.

Physicians who review their patient lists and believe their scores to be in error can submit correction requests (with supporting data) within 30 days. Thomson Reuters will log the physician’s request and tabulate the frequency and nature of corrections. A letter acknowledging receipt of the correction request will be mailed to each physician. At the end of the comment period, CCHRI will review the nature of corrections with its Physician Advisory Group and Steering Committee to determine appropriate use of the physician scores.