Quality Measures and Reimbursement

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The HCPLive Peer Exchange: Optimizing Outcomes in HIV Treatment features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of Health Services at Ursinus College, also in Collegeville, PA.

The panelists are:

• Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
• Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
• Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

In this segment, the panelists discuss several aspects of the quality measures that are becoming an increasingly prevalent feature in health care, including in HIV medicine.

Measurements of quality have been used to help improve patient outcomes and attainment of quality measures is increasingly linked with reimbursement. Dr. Doghramji observed that “everybody is looking at our metrics and at how well we’re doing” nowadays, and asked the panelists what quality and performance measures are currently in place to evaluate care provided for their patients who have HIV infections?

Dr. DeLuca said there are quite a few quality measurements and core measures, “and a whole lexicon of regulatory speech and things we’ve been doing anyway.” Most physicians now use EMRs which can track quality measures such as when patients’ prescription renewal frequency and timeliness, the number of office visits that they’ve attended, the percentage of patients that have undetectable viral loads, etc.

Dr. Sax mentioned that the quality metrics that most HIV care providers are familiar with are those that were put in place by the Ryan White program, which is a federally funded but administered on a statewide basis collection of community-based and hospital-based HIV provider set-ups in clinics. “They have very, very strict reporting requirements,” said Dr. Sax. These include measures like viral suppression rate, immunizations, proper administration of prophylaxis, screening for STIs, pap smears, tuberculosis screening, dental visits, etc.