Quality Measures for Primary Care Physicians - UPMC Health Plan

Understanding and properly implementing QI is essential to a well-functioning practice, and is necessary for any practice interested in improving efficiency, patient safety, or clinical outcomes.

Often, primary care physicians are unaware of the quality measures and how they reflect health care services.  This course is designed to give the a "101" on quality measures.

Target Audience

Faculty, residents, fellows, and physician assistants.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Explain the concept of quality and value and how it applies to health care
  • Identify the components of a quality measure
  • Describe HEDIS®, CAHPS®, and NCQA roles in quality measures

Suggested Additional Reading:

  1. Panzer, Gitomer, Greene, Webster, Landry, Riccobono. Increasing demands for quality measurement. JAMA. 2013; 310(18):1971-1980.
  2. Schuster, Onorato and Meltzer. Measuring the Cost of Quality Management. JAMA. 2017; 318(13): 1219-1220. 3Rotenstein, Huckman, Wagle. Making Patients and Doctors Happier-The Potential of Patient-Reported Outcomes. N Engl J Med. 2017; 377(14): 1309-1312.
  3. Quality Measures. American Academy of Family Physicians. No date. Accessed June 14, 2021. aafp.org/practice-management/improvement/measures.html
  4. Health Care Cost. Wikimedia Commons. Oct. 8. 2017. commons.wikimedia.org/wiki/File:Health_care_cost_rise.svg; Data from: Health expenditure and financing. Organization for Economic Co-operation and Development. No date.
  5. AMA Health System Science Learning Series: “What are the components of Value-Based Care? November 14, 2019. Available at: https://edhub.ama-assn.org/health-systems-science/interactive/18028223#
  6. Brown B, Crapo J. The Key Transitioning from Fee-For-Service to Value-Based Reimbursement. Value Based Care. 2014. Accessed June 14, 2021. healthcatalyst.com/insights/hospital-transitioning-fee-for-service-value-based-reimbursements
  7. What are the value-based programs?. Centers for Medicare and Medicaid Services. cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
  8. Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual Saf. 2015;24(10):608-610. doi:10.1136/bmjqs-2015-004160
  9. Quality Measures. Centers for Medicare and Medicaid Services. Updated Feb. 11, 2020. Accessed June 14, 2021. https://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index
  10. Quality Performance Measures, Methodology Document. American Academy of Orthopedic Surgeons. aaos.org/uploadedFiles/PreProduction/Quality/Clinical_Quality_and_Value/Additional_Resources/PM_Methods_v2.pdf
  11. About NCQA. National Committee for Quality Assurance. No date. Accessed June 14, 2021. https://ncqa.org/about-ncqa/
  12. The CAHPS Program. Agency for Healthcare Quality and Research. Jan. 2012. Updated Oct. 2018. Accessed June 15, 2021. ahrq.gov/cahps/about-cahps/cahps-program/index.html
  13. CAHPS Health Plan Survey. Agency for Healthcare Quality and Research. Oct. 2011. Updated Oct. 2020. Accessed June 15, 2021. ahrq.gov/cahps/surveys-guidance/hp/index.html
  14. HPA 2020: Updates to Scoring, Accreditation Statuses and Report Cards. National Committee for Quality Assurance. No date. Accessed June 14, 2021. ncqa.org/programs/health-plans/health-plan-accreditation-hpa/current-customers/hpa2020/scoring-updates
  15. NIDA Drug Screening Tool: NIDA-Modified ASSIST (NM ASSIST). National Institute of Drug Abuse. No date. Accessed June 15, 2021. archives.drugabuse.gov/nmassist
Course summary
Available credit: 
  • 1.00 AAPA Category I CME
  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 Attendance
Course opens: 
12/01/2021
Course expires: 
12/01/2024
Part of: 
UPMC Health Plan - Provider CE Courses

Barbara Kevish, MD - Physician, Renaissance Family Practice, UPMC Penn Hills. Medical Director, Practice Transformation and Provider Relations, Quality and Value-Based Programs

Alin Severance, MD - Medical Director, Behavioral Health Services, UPMC Insurance Services Division, Associate Medical Director, Community Care Behavioral Health Organization

Johanna Vidal-Phelan, MD, MBC, FAAP - Senior Medical Director, Quality and Pediatrics, UPMC Insurance Services Division.

Debra Zeh, RN, BSN - Senior Director Quality Improvement, Provider Performance at UPMC Health Plan.

Karen Rogers, MMS PA- C - Physician Assistant, UPMC Pinnacle West Shore.

No relationships with industry relevant to the content of this educational activity have been disclosed.

Authors disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above. No other planners, members of the planning committee, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above. No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The University of Pittsburgh has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0  AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

 

Available Credit

  • 1.00 AAPA Category I CME
  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 Attendance
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