Medicare pilot project offers CME for quality improvement

Physicians can earn up to 30 credits by working to enhance the quality of patient care.

By Markian Hawryluk, amednews staff. April 28, 2003.

Washington -- Medicare has sweetened the pot for physicians to engage in quality improvement projects.

The Centers for Medicare & Medicaid Services announced a national pilot program to award continuing medical education credits to physicians who participate in quality improvement projects with Medicare's Quality Improvement Organizations.

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To qualify for credits, physicians must implement a quality improvement intervention in one of three areas -- diabetes management, influenza and pneumococcal immunization, and breast cancer screening. Then physicians must use performance measures to track the success of their programs and adjust their interventions if no improvement occurs.

"The program provides an opportunity for physicians to build their quality improvement capacity while earning CME credit for their efforts to improve care," CMS Administrator Tom Scully said.

The pilot project aims to boost the number of physicians in outpatient and office settings participating in quality improvement efforts.

Medicare officials also want to develop quality improvement skills among primary care physicians that later could be applied to other patient populations.

QIOs can provide physicians with specific interventions and measures for use in the project, or doctors can develop their own.

Participants will earn 5.5 credits in the first quarter after implementation because of the preliminary work needed to implement the intervention, and then an additional 1.5 credits for each subsequent quarter of the project. If they implement interventions in each of the three topic areas, physicians can earn up to 30 credits in the first year.

The American Medical Association will award AMA Physician's Recognition Award category 1 credits to participating physicians. The program is also part of an American Academy of Family Physicians pilot.

Building on success

The CME incentive project builds upon a highly successful program developed by the Iowa QIO.

The Iowa Foundation for Medical Care launched the program two years ago as part of its local quality improvement efforts and has since exported it to a number of neighboring states.

Offering the credits has made it much easier to convince physicians to participate, said Mike Speight, director of partnership development for the Iowa Foundation.

"Typically it would take several months for them to make the commitment to participate," he said. "With CME, we found that sometimes we were able to get physicians to sign up with just a single visit."

The quality improvement interventions also have been very successful. Iowa has boosted performance on all of the clinical measures used in the state over the last three years.

"CME's contribution has been that it has drawn more physicians into the projects so we have more physicians participating than we would have otherwise, and therefore, more patients are benefiting from improved performance," Speight said.

One of the interventions used in Iowa was a structured diabetes care flow sheet that helped physicians track standard care measures for patients with diabetes.

Research has indicated that providing those patients with screening tests and services, such as lipids tests, eye exams, blood pressure monitoring and hemoglobin tests, helped reduce diabetes-related problems.

While physicians were generally aware of the benefit of these services, without a systematic approach to scheduling such tests, patients often fell through the cracks.

The flow sheets helped remind physicians when patients should have tests and services.

The QIOs even developed electronic flow sheets that could be incorporated in electronic medical records or other office automation systems.

All QIOs except those in Alabama, Puerto Rico and the Virgin Islands are participating in the national CME program.