Table 1.
Plurality Provider Algorithm (PPA) | Diabetes Care Home (DCH) Method* | |
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Current implementation | Medicare’s Physician Group Practice (PGP) Demonstration |
Wisconsin Collaborative for Healthcare Quality (WCHQ), a voluntary statewide consortium of health care organizations engaged in a public reporting initiative |
Medicare’s Group Practice Reporting Option (GPRO) of the Physician Quality Reporting Initiative (PQRI) | ||
Proposed for use when extending the Medicare PGP Demonstration to Accountable Care Organizations (ACOs)3 |
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Description of methodology | Patient is assigned to the single provider group that accounts for the greatest number of his/her E&M visits in the year. Ties are assigned to the group with more total charges.7 |
The provider group is responsible for a patient’s diabetes care during the measurement year if s/he had 1) ≥2 diabetes-coded E&M visits with any provider in the group regardless of specialty during the measurement year and prior year, and 2) ≥2 E&M visits (any diagnosis) to a primary care provider (PCP), or at least 1 visit to a PCP and 1 to an endocrinologist within the group over the same period, with at least 1 visit occurring during the measurement year. |
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Conceptual definition | The group delivering the most outpatient E&M services to a patient is solely responsible for the quality of all types of care the patient receives, including diabetes care. |
A group is responsible for a patient’s diabetes care – but not necessarily other types of care – if it delivers diabetes-specific AND primary care services (or a mix of primary and endocrinology care) to the patient on more than 1 occasion. |
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Comments | Requires complete visit information across all provider groups used; therefore, feasible for use by health plans but not individual provider groups. Also difficult to apply to uninsured patients |
Requires visit information only from the provider group in question, making it feasible for use by provider groups to self-monitor performance; allows inclusion of uninsured patients |
Assigns a patient to a single provider group, eliminating ambiguity in determining who is responsible for the patient’s care |
Can result in multiple groups simultaneously considering themselves responsible for the same patient’s care, which may better reflect the patient’s reality |
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Assignment is not condition-specific | Assignment is specific to measuring diabetes performance; WCHQ has developed similar methods of patient selection for measuring quality of care for other conditions and services |
Abbreviations: PGP = Physician Group Practice; E&M = Evaluation and Management; PCP = Primary Care Provider; WCHQ = Wisconsin Collaborative for Healthcare Quality
This method is property of WCHQ and is used herein with their permission.