Orthopedic and Neurological Surgeon Quality Project

Quality Indicators

Below are the best practices for the Ortho & Neuro Surgeon Quality project.

Best Practices for the Ortho & Neuro Surgeon Quality Project
Indicator Expectation Threshold Data source
Activity Prescription Form (APF)

For each surgical claim complete at least:

    • 1 pre-surgery APF, and
    • 1 post-surgery APF
Meet expectation for at least 85% of your state fund injured workers. L&I administrative data
Rehabilitation plan Completed APFs communicate meaningful and actionable items 85% of APF's reviewed have rehab plan complete. L&I administrative data - random review of APF forms.
Dispense as Written (DAW) Prescribe preferred drugs or allow substitution when medically appropriate. Less than 10% of prescriptions are Dispense as Written. L&I administrative data
Timely access to service Worker seen within 7 business days of referral. 70% of new state fund workers seen within 7 business days of referral. Provider report
Timely surgery Worker has surgery within 21 calendar days of claim manager authorization. 80% of workers have surgery within 21 days. L&I administrative data
Occupational health continuing education Receive at least 6 hours of training every two years. 100% completion of 6 hours. L&I administrative data or Provider report (if training not done by/with L&I).

What is the reason, expectation, threshold, and method of measurement for the quality indicators listed below?

Expand or collapse all

  • Expand or collapse. Activity Prescription Form.

    Activity Prescription Form

    This form was developed for the Ortho & Neuro Surgeon Quality project and the COHE project and can be used by project providers without a request from a Claim Manager.

    Reason

    Documentation is essential to prevent delayed recovery.

    • Clear rehabilitation planning,
    • Release for work and
    • Estimated abilities will enable:
      • Employers,
      • Claim managers and
      • Vocational counselors to better coordinate care and return to work planning.

    Providing information at initial and subsequent visits (when the worker's status changes) will reduce the need to complete at least 3 other forms (Time loss notification, Estimate of physical capacities and Supplemental medical report.)

    Expectation

    Bill for at least 1 Activity Prescription Form (APF) for each injured worker. If the injured worker has surgery, at least 1 additional form must be completed following surgery.

    Threshold

    APFs are completed and billed for 85% of the injured workers seen.

    Note: To accurately evaluate the APF, you must bill each time the form is completed. Submit bills within 1 month of the date of service. This ensures that the data is available for analysis.

    Method of measurement

    L&I will analyze all claims seen during the 6 month time frame for the report* using our administrative data. L&I will round all findings to the nearest whole percent.

  • Expand or collapse. Rehabilitation Plan.

    Rehabilitation Plan

    Reason

    Early development and ongoing review of physician-directed rehabilitation reduces disability, recurrent injury and the need for future health care use.

    Expectation

    On each APF indicate the restrictions along with actions being taken to reach maximum medical improvement (MMI).

    Threshold

    At least 85% of randomly selected APFs submitte by the suregeon during the measurement period will reflect worker restrictions and/or meaningful actionable items to reach MMI.

    Note: To accurately evaluate the APF, you must bill each time the form is completed. Submit bills within 1 month of the date of service. This ensures that the data is available for analysis.

    Method of measurement

    For each provider, L&I will review APFs submitted during the 6 month time frame for the report*. Depending on the number of forms submitted L&I will review either all forms or a random sampling.

  • Expand or collapse. Dispense as Written (DAW).

    Dispense as Written (DAW)

    Reason

    Endorsing the WA state preferred drug list (PDL) reduces authorization requirements for providers. Minimizing dispense as written prescriptions enhances the use of cost-effective drugs within specific drug classes (therapeutic interchange program).

    Expectation

    As a project provider, you must endorse the WA state PDL and are expected to prescribe preferred drugs or allow appropriate substitution within the therapeutic interchange program (TIP).

    Threshold

    Less than 10% of the prescriptions written for PDL drug classes in the TIP are for non-preferred drugs.

    Method of measurement

    L&I will analyze all prescriptions subject to TIP written during the 6 month time frame for the report* using our administrative data. L&I will round all findings to the nearest hundredth.

  • Expand or collapse. Timely access to service.

    Timely access to service

    Reason

    Reducing delays in accessing care can enhance recovery, return-to-work and minimize or prevent disability.

    Expectation

    Visit occurs within 7 business days of the referral.

    Threshold

    70% or more first visits occur within 7 business days. Visits by PA-C and ARNP will count as long as an APF is completed and billed by the ortho-neuro project surgeon.

    Method of measurement

    You must provide the following information to L&I on a semi-annual basis:

    • Claimant name,
    • Claim number,
    • Date office received first referral for an appointment,
    • Date visit occurred,
    • Appointment rescheduled by worker and or provider? Y/N
  • Expand or collapse. Timely surgery.

    Timely surgery

    Reason

    Reducing delays in accessing care can enhance recovery and return-to-work as well as minimize or prevent disability.

    Expectation

    Surgery is performed within 3 weeks (21 calendar days) of claim manager authorization.

    Threshold

    Surgery is performed within 3 weeks on 80% of the injured workers who have surgery.

    Method of measurement

    L&I will analyze all injured workers who have had surgery during the 6 month time frame for the report*. They will use their utilization review administrative data. L&I will also round all findings to the nearest whole percent.

    Note: Additional surgery data may be submitted by the provider in cases where the provider performs less than 10 surgeries that go through utilization review (Qualis).

  • Expand or collapse. Occupational health continuing education.

    Occupational health continuing education

    Reason

    Helps physicians understand and recognize the specific medical and management needs that are associated with treating worker's compensation injuries. This knowledge can enhance recovery and reduce long-term disability.

    Expectation

    Receive annual occupational health training every two years. Requirements are met with any of the following:

    • Participate in project provider orientation training (1.5 hours one time only for new providers); or
    • Complete at least 1 of the following CMEs in L&I publications:
    • Participate in Centers of Occupational Health and Education-sponsored course(s); or
    • Participate in L&I sponsored course(s) which can be found by visiting the Courses and Seminars website;
      or
    • Provide verification of continuing education in occupational health topics including, but not limited to:
      • Disability prevention.
      • Assessment tools for occupational health (e.g. pain diagrams, depression inventories, estimating physical capacities).
      • Return-to-work planning.
      • Job modification.
      • Chronic pain management.
    • Provide specific help to L&I in further developing and refining this project.

    Threshold

    When at least 6 continuing education hours are met every two years.

    Method of measurement

    Provide verification of attendance to L&I as follows:

    • Project provider training: L&I will maintain records of attendance.
    • L&I CME publications: L&I will confirm participation using CME self-assessments submitted to L&I's Office of the Medical Director.
    • L&I sponsored courses: L&I will confirm participation.
    • Other occupational health training: Provider submits a Occupational Health CME verification form, that includes:
      • Copy of attendance certificate with numbers of hours attended and
      • Course objectives.

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