Appendix F - Medicare Care Management Performance (mcmp) Demonstration Physician Survey�demonstration Physicians

APPENDIX F

MEDICARE CARE MANAGEMENT PERFORMANCE (MCMP)

DEMONSTRATION PHYSICIAN SURVEY—DEMONSTRATION PHYSICIANS

OMB Approval No.: xxxx-xxxx

Expiration Date: xx/xx/xxxx

Medicare Care

Management Performance (MCMP) Demonstration

Physician Survey

Demonstration Physicians

Draft

ABOUT THIS SURVEY

This survey is being conducted by Mathematica Policy Research, Inc. (MPR) on behalf of the Centers for Medicare & Medicaid Services (CMS) as part of the Medicare Care Management Performance (MCMP) Demonstration project.

These questions are about your use of electronic medical records (EMRs) and the primary care services you provide to Medicare patients with chronic illnesses.

Most of the questions can be answered by simply marking a box. A few ask you to write in your answer. If you do not know an answer, please write “DK” next to the question.

We estimate that it will take about 10 minutes to complete the questionnaire.

All of your answers will be treated confidentially to the extent allowable by law. Your responses will not affect your Medicare compensation.

If you have questions about this survey or your participation in it, please call Julita Milliner‑Waddell, MPR’s survey director, at 1-609-275-2206.

If you would prefer to complete the survey by telephone, please call 1-xxx-xxx-xxx toll free and ask for Melanie Costas.

When you have completed the questionnaire, please return it in the enclosed, postage-paid envelope.

Thank you for your time and participation.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-XXXX. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Prepared by Mathematica Policy Research, Inc. F.3

The first questions are about your use of health information technology. If you work out of multiple locations, please answer these questions for your primary ambulatory care location.

A1. Electronic Medical Records (EMRs) are clinical information systems for tracking patient health information. EMRs allow you to document office visits, transmit prescription and laboratory test orders electronically, and perform other functions.

Does your practice currently have an EMR system? Please include both full and partial EMR systems.

1  Yes

0  No GO TO B1

A2. How long ago did your practice acquire an EMR system?

YEARS | | | MONTHS | | |

A3. Do you use the EMR system to record and manage the care for any or all of your patients?

1  Yes

0  No GO TO A5

A4. When did you start using your practice’s EMR system?

| | | | | | | |

MONTH YEAR

A5. The following is a list of functions that may be available on your EMR system. Please indicate how often you use each of the functions or whether you plan to use the function within the next 12 months. If the function is not available on your system, please mark the last box in the row.

	MARK ONE ANSWER PER ROW
How often do you use your EMR system to perform the following functions?	Routinely	Occasionally	Not at All But Plan To	Not at All and NO Plans To	Function Not Available
a. Document office visits and patient medical history?	1 	2 	3 	4 	5 
b. Document patient medications?	1 	2 	3 	4 	5 
c. Document communication with other health care providers, such as referrals to specialists or responses from pharmacists?	1 	2 	3 	4 	5 
d. Enter orders for prescriptions?	1 	2 	3 	4 	5 
e. Enter orders for laboratory, radiology, or diagnostic tests?	1 	2 	3 	4 	5 
f. Review test results?	1 	2 	3 	4 	5 
g. Issue alerts for possible drug interactions?	1 	2 	3 	4 	5 
h. Issue reminders to schedule preventive services?	1 	2 	3 	4 	5 
i. Issue reminders to patients?	1 	2 	3 	4 	5 
j. Generate reports (for example, to identify patients overdue for services)?	1 	2 	3 	4 	5 

A6. How satisfied are you with the training you received on proper use of your EMR system?

MARK ONE ANSWER

1  Very satisfied

2  Somewhat satisfied

3  Somewhat dissatisfied

4  Very dissatisfied

5  No training received

A7. How satisfied are you with your EMR system’s ability to meet your needs?

MARK ONE ANSWER

1  Very satisfied

2  Somewhat satisfied

3  Somewhat dissatisfied

4  Very dissatisfied

5  Not applicable, have not used the system

B1. In the past 12 months, to what extent have the following factors been a barrier to adopting or expanding the use of EMRs in your practice?	MARK ONE ANSWER PER ROW
	Not a Barrier	Minor Barrier	Major Barrier
a. Start-up costs	1 	2 	3 
b. Maintenance costs	1 	2 	3 
c. Lack of time to acquire or set up the system	1 	2 	3 
d. Lack of computer skills among clinical or other staff	1 	2 	3 
e. Skepticism about effectiveness or usefulness of EMRs	1 	2 	3 
f. Reluctance to change processes already working well	1 	2 	3 
g. Lack of training or technical support	1 	2 	3 
h. Patient privacy concerns	1 	2 	3 
i. The amount of time necessary to use the system	1 	2 	3 
j. The time and ability to incorporate old records into the new system	1 	2 	3 
k. Lack of a leader who has both clinical and technical knowledge to spearhead the project of adopting an EMR system	1 	2 	3 
l. Gathering consensus among physicians	1 	2 	3 
m. Poor return on investment	1 	2 	3 
n. Opposition to this style of practicing medicine	1 	2 	3 
o. Limited or no interoperability—that is, other providers with whom you communicate do not have EMR systems	1 	2 	3 

B2. During the past 12 months, have you been involved in efforts to assess your practice’s technology needs?

1  Yes

0  No

To answer the questions in this section, please think about experiences you have had in the past 12 months while caring for Medicare patients who have chronic illnesses including congestive heart failure, coronary artery disease, diabetes, and other chronic conditions.

C1. How do you currently issue reminders to Medicare patients about routine preventive care?

MARK ONE ANSWER

1  Reminders are issued using a computerized system

2  Reminders are issued using a manual system

3  Reminders are not currently issued; plan to implement in the next year

4  Reminders are not currently issued; no plan to implement in the next year

C2. Compared to previous years, did you have more, fewer, or about the same number of office visits with each Medicare patient on average during the past 12 months?

MARK ONE ANSWER

1  More visits

2  Fewer visits

3  About the same number of visits

C3. Compared to previous years, has the average number of telephone conversations with your Medicare patients changed during the past 12 months?

MARK ONE ANSWER

1  More telephone conversations now

2  Fewer telephone conversations now

3  No change; about the same number of telephone conversations

C4. Compared to previous years, has the average number of email exchanges with your Medicare patients changed during the past 12 months?

MARK ONE ANSWER

1  More email exchanges now

2  Fewer email exchanges now

3  No change, about the same number of email exchanges

n  Do not exchange email with patients

C5. In the past 12 months, how often have you encountered the following situations involving your Medicare patients with chronic illnesses who see other providers?	MARK ONE ANSWER PER ROW
	More Than 10 Times	5 to 9 Times	1 to 4 Times	Never
a. Patients received the wrong drug, wrong dosage, or had a drug-drug interaction	1 	2 	3 	4 
b. Patients underwent unnecessary or duplicate tests	1 	2 	3 	4 
c. Other providers did not notify you of new or modified prescriptions	1 	2 	3 	4 
d. Other providers did not give you timely feedback after referrals	1 	2 	3 	4 
e. You did not receive timely information after a hospitalization	1 	2 	3 	4 
f. You did not have ready access to patient information during office visits or other encounters	1 	2 	3 	4 

C6. Still thinking about your Medicare patients with chronic illnesses, how satisfied are you with the following aspects of their care?	MARK ONE ANSWER PER ROW
	Very Satisfied	Somewhat Satisfied	Somewhat Dissatisfied	Very Dissatisfied
a. The overall quality of care they receive?	1 	2 	3 	4 
b. Their receipt of recommended preventive services?	1 	2 	3 	4 
c. How well their care is coordinated across providers?	1 	2 	3 	4 
d. Your knowledge of their conditions and recommended preventive care?	1 	2 	3 	4 
e. Patients’ knowledge of their conditions and recommended self‑care?	1 	2 	3 	4 
f. Patients’ adherence to recommended self-care?	1 	2 	3 	4 
g. The amount of time you spend with patients in an average office visit?	1 	2 	3 	4 
h. Your Medicare reimbursement?	1 	2 	3 	4 

C7. Compared to a year ago, how often do you do each of the following.	MARK ONE ANSWER PER ROW
	More Often	Less Often	About the Same	Don’t Do At All
a. Produce data or reports on the number or percentage of your Medicare patients who are receiving guideline-recommended services?	1 	2 	3 	4 
b. Identify your Medicare patients who have not received guideline-recommended services and encourage them to get the services?	1 	2 	3 	4 
c. Have ready access to information about Medicare patients’ medical history, health conditions, and care plan during office visits and other encounters?	1 	2 	3 	4 
d. Review patient charts prior to office visits to flag any conditions or topics needing attention?	1 	2 	3 	4 

D1. Thinking about your participation in the MCMP demonstration during the past 12 months, please indicate whether you agree or disagree with the following statements about the MCMP demonstration.

	MARK ONE ANSWER PER ROW
	Strongly Agree	Agree	Disagree	Strongly Disagree
a. The MCMP Demonstration targets important medical conditions?	1 	2 	3 	4 
b. The MCMP Demonstration uses well-accepted, appropriate measures of care quality?	1 	2 	3 	4 
c. The MCMP Demonstration encourages adoption and use of EMRs?	1 	2 	3 	4 
d. The MCMP Demonstration required a reasonable level of effort to begin reporting quality data?	1 	2 	3 	4 
e. The MCMP Demonstration requires a reasonable level of effort to report annual quality data?	1 	2 	3 	4 
f. The MCMP Demonstration has easy-to-understand rules for rewarding quality care?	1 	2 	3 	4 
g. The MCMP Demonstration provides sufficient financial rewards?	1 	2 	3 	4 

D2. During the past 12 months, how did MCMP affect the amount of time you spent educating Medicare patients with chronic illnesses about taking care of themselves?

MARK ONE ANSWER

1  Increased the amount of time

2  Decreased the amount of time

3  No change

D3. During the past 12 months, how did MCMP affect the amount of time you spent communicating with other health care providers about your Medicare patients with chronic illnesses?

MARK ONE ANSWER

1  Increased the amount of time

2  Decreased the amount of time

3  No change

D4. Please indicate how the following aspects of patient care have changed under MCMP.

	MARK ONE ANSWER PER ROW
	Made Better	Made Worse	No Change
a. The quality of your relationships with patients.	1 	2 	3 
b. The overall health of your patients.	1 	2 	3 
c. Your patients’ satisfaction with their health care.	1 	2 	3 
d. Your adherence to recommended clinical practice guidelines or evidence-based medicine.	1 	2 	3 
e. Your clinical decision making.	1 	2 	3 

D5. If your clinical decision making has been affected by your participation in the MCMP demonstration, please explain below.

D6. During the past six months, how has participation in the MCMP demonstration affected the number of office visits made by your chronically ill Medicare patients?

MARK ONE ANSWER

1  Visits have increased

2  Visits have decreased

3  No change GO TO D8

D7. Was this increase or decrease in office visits medically appropriate?

1  Yes

0  No

D8. Which of the following staff from your practice attended the kick-off meetings for MCMP in May or June 2007?

MARK ALL THAT APPLY

1  Physicians

2  Physician Assistants

3  Nurse Practitioners

4  Registered Nurses

5  Administrators

6  Business Managers

7  Office Managers

8  Other (Please specify)

n  No one attended

D9. Did you or anyone from your office participate in training calls hosted by CMS or the QIO (Lumetra, Health Insight, Masspro or Arkansas Foundation for Medical Care)?

1  Yes

0  No

D10. Would you recommend the MCMP demonstration to your colleagues?

1  Yes

0  No

D11. Please list the names of other pay-for-performance programs with which you have experience.

n  No experience with other pay-for-performance programs GO TO E1

D12. How does MCMP compare to the other programs with which you have experience?

1  Better

2  Worse

3  Neither better nor worse

Please explain why:

E1. In an average week, about how many different Medicare patients do you see who have chronic illnesses?

| | | | NUMBER OF MEDICARE PATIENTS

WITH CHRONIC ILLNESSES

E2. Are you able to speak with patients in a language other than English if the patient prefers?

1  Yes (Please specify the languages

you speak)

0  No

E3. In what year did you begin medical practice?

| | | | | YEAR

E4. Are you male or female?

1  Male

2  Female

E5. Are you Board Certified?

1  Yes

0  No

E6. Are you of Hispanic or Latino origin?

1  Yes

0  No

E7. Which of the following categories best describes your race?

MARK ONE OR MORE

1  American Indian or Alaskan Native

2  Asian

3  Black or African-American

4  Native Hawaiian or other Pacific Islander

5  White

Thank you for taking the time to complete this questionnaire. Please mail your completed questionnaire in the pre-paid envelope provided. If you have misplaced your envelope, please mail it to:

Julita Milliner-Waddell , Survey Director

Medicare Care Management Performance

(MCMP) Demonstration

Mathematica Policy Research, Inc.

600 Alexander Park

Princeton, NJ 08543