There are many quality programs occurring in Texas, such as Medicare's Physician Quality Reporting System (PQRS), Blue Cross Blue Shield’s and Aetna’s Bridges to Excellence (BTE), Medical Home, and value based contracting. TMA is helping practices both evaluate the benefits of participating in various quality programs and assisting physicians in quality program implementation.
This webpage will be updated frequently to showcase these new tools as they are created.
TMA has developed tools to assist you. Please see the menu to the left for available resources on clinical effectiveness, patient experience, performance improvement programs, and related topics.
BTE Return on Investment Tool: Estimate If BTE Participation Is Practical for Your PracticeThe ROI calculator asks for inputs to estimate revenue and expenses to generate an estimate of potential incentive dollars available.
First, Determine the number of patients that the payer has attributed to your practice. Then estimate the costs associated with reporting on this BTE condition. The tool will calculate the costs and potential revenue that can be earned from BTE participation and/or NCQA participation (where applicable).
The BTE Return on Investment tool is available for Asthma, Cardiac Care, and Diabetes.
BTE Eligibility Tool: Determine Which Patients Will Meet BTE Eligibility RequirementsBTE eligibility varies slightly by condition, but generally requires 25 established patients who have been initially diagnosed and seen once or more prior to a 12 month period (with at least one visit within the last 12 months).
Enter patient information one at a time, including name (or Patient ID), birth date, relevant diagnosis, diagnosis date, and date of visit. Enter subsequent visits using the same form. As patient data is entered, the calculator will automatically determine patient eligibility. The most recent possible reporting period will be used. The tool will notify you when you have reached the required number of eligible patients.
The BTE Eligibility tool is available for Asthma, Cardiac Care, and Diabetes.
Use this tool to evaluate the care your practice provides against evidence-based guidelines.
Download the flowchart
These include public programs like Medicare as well as commercial insurance programs. These measures were developed from evidence-based guidelines. Practices should understand how well they deliver evidence-based care to their patient populations with these conditions -- even if they aren’t seeking a bonus. Look to your special society for recently released or newly developed measures.
There are a variety of available training and continuing education programs available which address the need for Quality Improvement. TMA has compiled a list of available programs in Texas and nationwide.
Download the list of Quality Improvement programs
The tool asks patients for information to generate a pre-formatted printable document which can be easily folded and carried at all times. This printed record is ideal for patients who do not otherwise carry this information with them by other means such as electronic devices. The tool should be reviewed on a regular basis to ensure accuracy.
Download the Personal Emergency & Medication Record tool
These interactive, but simple calculators serve to educate physicians on the requirements and billing codes associated with each metric. Enter your data on patients seen and contracted rates for each identified code into the calculator. This allows you to see the benefits of providing such care, as well as to analyze the fiscal sustainability of providing this preventive service.
Refer to these portions of the TMA website:
Deadlines for Doctors Continuing Medical Education on Quality Improvement TopicsHITTMA Practice ConsultingPayment AdvocacyCancer Control and Prevention
Or Contact the TMA Knowledge Center:(800) firstname.lastname@example.orgAsk TMA
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