Emergency Department Utilization
Primary care physicians (PCP) whose patients exhibited low utilization of the Emergency Department over a 12-month period, after adjusting for severity of illness represented by the MDs average RAF/HCC score. Nationally,16 percent of Medicare beneficiaries utilize the ED an average of 2.9 times annually. Fifty-three percent of MDX Hawai`i PCPs had higher patient ED utilization rates than the national average. A 2012 study by Kaiser Health News cited nearly 60% of Medicare emergency room visits as “potentially preventable.” Healthcare experts say hospitalizations can have a detrimental impact on seniors. In fact, research shows nearly one in four seniors will lose the ability to live independently after a hospitalization MDX Hawai`i recognizes Excellence in Kupuna Care Winners: PCPs whose patients have the lowest ED utilization rates.
Completion of Annual Wellness Visits & Annual Health Assessments
Primary care physicians who provide quality health care are known for taking time to consult with their patients. These appointments should include reviewing required screenings, understanding changes in a patient’s daily activities and lifestyle and documenting a patient’s full co-morbid make-up. In a recent survey, more than 80 percent of MDX Hawai`i PCPs reported that an annual wellness visit/annual health assessment is important, very important or extremely important to high quality care. Many PCPS also encourage chronically ill patients to see their healthcare team every three months. MDX Hawai`i recognizes Excellence in Kupuna Care Winners: PCPs who have completed an Annual Health Assessment for the majority of their patients over a 12-month period
Compliance with Chronic Disease Quality Measures
Medicare Advantage plans across the country are rated based upon a prescribed set of quality measures. And there are very stringent guidelines primary care physicians should follow when caring for patients with chronic diseases. For example, regular heart checks and screenings are necessary for patients with congestive heart failure. Controlling blood pressure and sugar levels are important for diabetic patients, according to the Centers for Medicare Services (CMS). MDX Hawai`i honors those PCPs who have achieved four stars within their patient populations as Excellence in Kupuna Care Winners.
Access to Care/Frequency of Primary Care Visits
PCPs who see all their patients at least one time a year are following best practices for good clinical care. It’s important that physicians consult with and examine patients with chronic health conditions even more frequently – three to four times a year. MDX Hawai`i recognizes those PCPs who have seen 80% of their patient’s at least one time in the last twelve months as Excellence in Kupuna Care Winners.
Low Frequency of Hospital Re-Admissions
Ensuring that patients who leave a hospital are not re-admitted has been a focus of the health care system for many years. One of the best practices in ensuring patients are not re-admitted is a visit with the patient’s PCP within seven days post-discharge. MDX Hawai`i recognizes PCPs who routinely see their hospitalized patients within seven days post-discharge as Excellence in Kupuna Care winners.
Compliance with Preventative Care Quality Measures
Medicare Advantage plans across the country rate their plans based upon a prescribed set of quality measures. Breast cancer and colon cancer screenings and annual flu shots are among those quality measures that target comprehensive preventative care for Medicare Advantage members. MDX Hawai`i will honor those Excellence in Kupuna Care Winners: PCPs who have achieved 4 Stars within their patient populations for these metrics.