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Prime registry

  • 1.  Prime registry

    Posted 04-21-2018 11:09
    I'm hoping Lynn Ho and John Brady and any others might weigh in.

    I took advantage of the offer for free Prime Registry and am now to place of having to do the work to get interface set up.
    As I think with all of us, even straight forward work has to be prioritized. So I'm wondering how much and if any real benefit to me and my clinic of Prime Registry. I'd appreciate hearing others experiences and compelling reasons for or against moving forward with it. 

    It's hard as we're all so different in who we serve and the payers of our area.  Most independents in my area (the NW)  are not involved with any greater groups- ACO/ IPA or anything requiring a registry. Gwen Hanson is the exception that I've found. Most of us in the NW are DPC or just participate in which ever insurers we each choose and as a group we all seem to be doing overall well. We are strong insurance based community with a large variety of private insurers still in the game (Aetna, Premera, Molina, Regence, BCBS, Cigna, Kaiser Permenante).

    My particular clinic chooses to see everyone regardless ability to pay.  We have a sliding scale for those still without insurance and help them to get insured.  My medicare group is a small percent of my panel panel but it is growing as we all age. I don't have to do MIPs/ MACRA given the small number. And thus I haven't paid attention to the details so I don't know what is needed at this point if I opted to voluntarily participate. I have a small medicare penalty now as my most recent PQRS didn't qualify for reasons I don't understand.  Prior years we got through fine but I got a letter I haven't followed up on that we are now being penalized.

    I'm not currently part of an ACO/ IPA and haven't felt the need in our neck of the woods.  However 2018 marketplace plans were all ACO related and so for the first time we all felt some pain of not having joined with anyone. I have a tentative meeting set up with the biggest ACO we might eligible to join, but here too, I'm still not sure worth my time and effort.

    We also have a large medicaid population and have to figure out their particular registry that we may this year be required to participate in. We got a waiver last year after I loudly fussed. So this is on my list to figure out.

    I admire the nature of some folks on the forum who are seemingly more tech savy and less adverse to the work with registries, contracts and risk management work.  I prefer to spend my time on program development, community collaboration and advocacy. So having to think about registries, interfaces and contracts is a necessary evil for me. I find my clinic is successful because I'm very deliberate in what I take on and what I refuse to take on.

    I'm hopeful IMP members can help me sort out if I should move forward with Prime Registry. 
    And if any local folks or any IMP members have further wisdom about making the effort to join the local ACO I'd like to hear all perspectives.

    Within all of this we're thinking of a voluntary membership fee just because we think our patients would be willing to pay it given the services we provide.  We've for 11 years done just fine billing insurers with a mix of creative collaborations, grants and one time projects here and there that boost our revenue.  I just can't decide right now how important to jump on the bandwagon to not be left out in the cold vs it is all a passing fad that if we just hold tight will save us unwanted time and energy doing work that I can't see how improves my quality of care.

    Melissa









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    Melissa Weakland MD
    Ballard Neighborhood Doctors
    Seattle WA
    IMP since 2007
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  • 2.  RE: Prime registry

    Posted 04-22-2018 08:50
    Melissa:

    The Prime Registry sounds interesting. I wonder if AAFP is still giving away the first 3 years. I have enjoyed getting measured. I've found I was usually not doing as well as I thought and even the good items can deteriorate quickly without attention.  Let us know how the data mining from your EMR goes. 





  • 3.  RE: Prime registry

    Posted 04-23-2018 05:31
    Melissa I think many of us  have the same  questions
     I do not think anyone has any idea what is going on or what is going to happen
     I do think it may be tough to go it alone and suggest an IPA or ACO if available     I  am  in an ACo     It is worthless as they all are  in terms of care or costs savings, that was just another experiment that will go away  but they  negotiate contracts and tell me things. I did MIPS this yr but will now be exempt     I do give the ACo some data      I cannot get prime with practice fusion but sending the data to the ACo isn't too bad
     so I think many people will write in and they will all tell you different things becasue everyone has a differnet situation   If you are fine financially keep your head down and you r chin up and hang in    If an ACO/ IPA thing would help you  then join one  AS for MIPS and data etc its is all going to change again soon and  no one has  any idea what things will look like    MIPS is  under attack.

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    Jean Antonucci
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  • 4.  RE: Prime registry

    Posted 04-23-2018 08:13
    HI Melissa
    using Prime Registry for a few years ago, I think last year I used it  to submit PQRS data to CMS so they wouldn't penalize me for that,  but now they are penalizing me anyway this year for not submitting Meaningless Use.  One can't win with the bureaucrats!

    So at last count on the prime registry I have 24 green bars ( meaning those items are passing for MIPS) so more than enough needed for that program, and for TCPI.
    the question would be what are your local quality groups or insurers demanding for you as quality measurements ? those metrics may or may not be in prime and you may or may not pass on those particular metrics

    for example my local quality organization requires 5 metrics:
    what Prime pulls is controlling blood pressure is % of people <85 with blood pressure <140/90(68%)  , but the local metric is for people 18-60 with blood pressure < 140/90 and 61-85 with blood pressure < 150/90 (82%)
    so I do it manually via putting a tracking element on the superbills
    I'm not sure if I would pass the local quality metric bar with a score or 68%
    devil is in the details

    and depression screening with follow up via prime (51%)  but manually (96%)
    hard to catch both the screening and the follow up  though I am working with them on fixing this via their mapping process
    ( they write a program that goes into the database and checks off the screening when it sees keywords like "HYH" , "counseling"  etc)
    I am currently working with them on this so that they will be able to pull this metric for me

    for actual clinical utility for items you want to track
    you could use prime for quality tracking but it tends to over count what has been done
    for example it says I have a 96% mammogram screening rate
    actually when we track it by hand it is 82%
    ditto same falsely high rate for colonoscopy pap
    so I am working with them on cutting out the false positives, because it would be so nice to run the registry and simply be able to pull up people actually due for mammogram, colonoscopy, pap, diabetic eye exam etc.
    if it actually turns out that it will function for these issues, then I will be dancing a jig !

    because it is cheap, easy to set up and theoretically SHOULD work well as a registry once all items are mapped correctly .
    the main problems being falsely high results ( making it not actually useful for clinical work) and falsely low results ( putting you at risk full for not meeting your quality thresholds)
    so - currently working on mapping again, I had stopped for a while because ... just because.

    I got it free through TCPI initiative  -
    but I think there is a nominal charge per year ? $300  if you dont have the free access .

    hope that helps you decide .

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    Lynn Ho
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  • 5.  RE: Prime registry

    Posted 04-23-2018 14:00
    I tried to use PRIME a couple years ago, but as mentioned, Prime and PF do not play nicely together.  I think, at the time, there were only a couple of EMRS that were not interfacing with PRIME.    I am not sure who is the bad child, but I have my suspicion.   I reached out to AAFP and Prime and PF a couple of years ago, but I am not aware of any progress on that front.

    I am not eligible for MIPS / MACRA nor am I in an ACO.

    On a separate matter, is anyone aware of any ACOs that are not regional based,   ie: a doctor in NYS can join and be on a panel with doctors from across the country?   I will ask again on a new thread.



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    Michael S. MD
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  • 6.  RE: Prime registry

    Posted 04-25-2018 07:55
    Thanks everyone. Most helpful.

    If other members out there are using Prime Registry, hope you'll take a moment to speak up.

    Lynn- when possible can you say a bit more.  I'm impressed by the time you seem to be devoting to getting the system to work for you. I'm unclear however what benefit you and/or your patients get?

    Can you give a quick snap shot of why you're working with the Prime Registry?
    ie,
    Who is your local quality group and what benefit do you get from them?
    Are you hopeful the time needed to get it set up will pay off as a true clinical utility to you?
    Does your TCPI require data and there too- what do you get from them?

    No one requires anything from me locally.That's my current dilemma as no overt benefit nor demand is clearly at my doorstep. But there might be benefit out there for me that I'm unaware of if i join a group and provide them data.  I just don't know if worth my time exploring or, as Jean says, if I should just keep my head down and chin up and continue as I've been doing as working so far.

    Thanks!
    Melissa


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    Melissa Weakland MD
    Ballard Neighborhood Doctors
    Seattle WA
    IMP since 2007
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  • 7.  RE: Prime registry

    Posted 04-26-2018 08:02
    Good questions!
    I have decided that the system does not work for me and does not seem to improve patient care and so by the end of the year I am scrapping it and going direct.

    The local quality system I am talking about is an administrative boondoggle called the Care Transformation Collaborative (CTC-RI)  which as far as i can tell, takes the 10% of the insurance spend mandated by the insurance commissioner and supposedly redistributes it to PCMH practices in the state ( with it seems a hefty portion of that money going to administration and then mostly to the behemoth ACO and hospital based and large group practices in the state)  .  You have to jump through useless hoops to apply and then continue to qualify .  After they finally let us small practices in to  the drink from the trough ( in 2014, about 4 years after the program started), after all the big groups had taken as much as they could, our group of micropractices joined.
    Certification requirements are 3 fold: NCQA medical home certification and recert, HEDIS measures reported quarterly and a CAHPS survey and meeting certain thresholds or improving from where you are.  Additionally you are required to hire a nurse care manager for x hours per week ( supposedly 45% of whatever moneys they give you) and do reporting around that.  Payment is $5.50 PMPM for attributed non medicare non medicaid patients - for my pop of 750 works out to about $24K per year.
    You can use PRIME to respond to HEDIS numbers and for NCQA recognition, they will be accepted (if meeting thresholds)

    I am hoping to use prime as an actual functioning registry for colon cancer screening, mammogram screening diabetic eye screening, pap screening.  As far as I can tell, the native registry in Amazing Charts does not work .  The PRIME registry lets you  drill down to patient level so if it pulls an ACCURATE ( or even relatively close)  list of the haves and have nots  then it will be much easier than the excel sheets we pull manually. Problem is it is not accurate yet with both false positives and negs for screenings :-(
     I have hopes that with correct mapping though we can make it work !




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    Lynn Ho
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  • 8.  RE: Prime registry

    Posted 04-26-2018 08:17
    RE no one is asking you for data!
    WA state must be run by totally enlightened primary care people, because that kind of data is useless for judging the quality of primary care.   Resist any powers that are moving down that faulty quality data path ! Push back !  that type of data is useless!  If no one is asking you for it then by all means I would NOT bother to collect it. HEDIS numbers especially process are just a matter of box checking and fudging data.

    As we pretty much know in this enlightened group:
    Starfield says:  primary care is comprised of 4 things - access, continuity, comprehensiveness and coordination
    When those are measured through the eyes of the people receiving that care, then that should give you a true measurement of primary care quality.  Measuring other items whether outcome or process, are ancillary to the measurement of what primary care is.
    And additionally: when primary care as above is provided to a population, ( with access to a trusted source of continuous care), then those outcome numbers ( htn, diabetes control, etc)  will be as good as they can be for that population- outcome numbers also in large part are quite dependent on the intrinsic resources of that population.  Then -  you are measuring the socioeconomic determinants of health and not the quality of the primary care.
    Pop registries are helpful, but again not as a metric for measuring primary care quality.  AND not paid for by FFS.

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    Lynn Ho
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