Good News for HBOT

There is big news for wound care and hyperbaric medicine professionals and, for once, the news is good. The Benchmarks for Measures Included in the Performance Year 2016 Quality and Resource Use Reports document is now available from the Centers for Medicare & Medicaid Services (CMS) for the measures included in the Quality and Resource Use Reports (QRURs). The big news is that there are wound care-relevant quality measures that have national benchmarks! Why is this important? Quality reporting works like the exams we had in college that were graded on a curve. I remember scoring a 46 on a college calculus exam, assuming that I had failed. However, that particularly difficult test was graded on a curve so that a score of 50 was an “A,” making my score of 46 a “B+”! Similarly, depending on the quality measure, a score of 50% could put a practitioner in the bottom decile or the top decile, because the score is calculated in relation to the scores of everyone who’s reporting that measure. (Use the link below to review the benchmark rate for each measure that can be used in 2016 as part of a QRUR.¹) For a practitioner to have a chance at a bonus payment under the Merit-Based Incentive Payment System (MIPS), he or she must score in the top decile of all the practitioners reporting that measure because “quality performance” comprises 60% of the MIPS score. If there is no national rate for a measure, it can’t contribute to one’s quality score. That is why the U.S. Wound Registry (USWR) has been working hard for the past two years to get as many practitioners as possible to report as many qualified clinical data registry (QCDR) wound care measures as possible, so that benchmark rates could be set. If a QCDR measure has no data reported at all in this report, it means one of two things: 1) it has not been reported by any provider ever or 2) it has not been reported by enough providers to achieve a benchmark. The document in the link below¹ lists quality measures by measure name, in alphabetical order. That means the USWR hyperbaric and wound care measures are spread out in several different places (links also included below).

Here are a few of the USWR quality measures that now have national benchmark rates recognized by CMS:

• Vascular assessment of patients living with leg ulcers: mean rate 52.91% (chronic disease registry [CDR] 10; https://www.uswoundregistry.com/content/docs/cdr/cdr10/spec10.pdf)
• Adequate offloading of diabetic foot ulcers (DFUs): mean rate 56.96% (CDR 1; www.uswoundregistry.com/content/docs/cdr/cdr1/spec1.pdf)
• Adequate compression of venous leg ulcers (VLUs) at each visit: mean rate 88.65% (CDR 5; https://uswoundregistry.com/content/docs/cdr/cdr5/cdr5_v4_6_.html)
• Wound bed prep through debridement: mean rate 69.80% (CDR 11; https://uswoundregistry.com/content/docs/cdr/cdr11/cdr11_v4_6_.html)

If these performance rates don’t seem very good, consider that when the USWR looked at registry data in 2010 we found that only about 6% of DFU patients received adequate offloading at each visit and only 17% of VLU patients received adequate compression. We now know that the gap in practice has been significantly reduced among the practitioners who reported these measures, providing evidence that the “Do the Right Thing” program is working.^2,3 While improved patient care is something to be excited about, the big news story is that in 2017, practitioners can report these measures for quality measure credit under MIPS. And, because the benchmark rate has been set, the rate that has to be beaten in order to have a chance at bonus payments is well known!

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READ MORE: FROM THE EDITOR
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Ten years ago, I set out with the help of Marcia Nusgart, R.Ph, and the Alliance of Wound Care Stakeholders (she serves as executive director) to have CMS recognize quality measures for wound care practitioners. It seemed an impossible dream at the time. However, a decade later, here we are celebrating benchmark rates for several measures. I would like to say an official “thank you” to the Alliance and those who were on the conference calls about measure development in 2013. Most of the participants were from the Association for the Advancement of Wound Care and the American Professional Wound Care Association (with the Alliance facilitating the calls). This has been expensive. In 2014, the USWR, a 501 (c)(3) nonprofit organization, received some small financial donations from a few manufacturers. These funds were incredibly helpful. However, since that first year, the USWR has had no ongoing financial support from any of the clinical wound care associations whose members it serves, or from any segment of the wound care industry. The lack of support for vital quality work continues to baffle me, but that’s a topic for another day. Despite uphill odds, the USWR has managed to create benchmark rates for the most basic processes in wound care, just in time for the beginning of an entirely new physician payment system linked to quality reporting. To the wound care practitioners who reported this measure and whose commitment to quality reporting made benchmark rates possible, the entire industry owes you a debt of thanks. (If I were allowed to list you by name in Today’s Wound Clinic, I would do so). Lots of people talk about quality, but only a handful of clinicians have made the personal and professional commitment to “Do The Right Thing” presently. You know who you are. Thank you. 

Caroline E. Fife is chief medical officer at Intellicure Inc.; executive director of the U.S. Wound Registry; medical director of St. Luke’s Wound Clinic, The Woodlands, TX; and co-chair of the Alliance of Wound Care Stakeholders.

References

1. Benchmarks for Measures Included in the Performance Year 2016 Quality and Resource Use Reports. CMS. Accessed online: www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/downloads/py2016-prior-year-benchmarks.pdf

2. Do the Right Thing. U.S. Wound Registry. Accessed online: https://uswoundregistry.com/dotherightthing

3. Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound care? Wound Repair Regen. 2010;18(2):154–8.