AOA Clinical Assessment Program (CAP)

The Clinical Assessment Program (CAP) for Physicians is a Web-based performance measurement program developed by the American Osteopathic Association that analyzes data abstracted directly from patient medical records. Originally designed to measure clinical practice in residency training programs, CAP was extended to the physician’s office in December 2005. Three measure sets, including Diabetes, Coronary Artery Disease and Women’s Health Screening, were developed using evidence-based guidelines that represent state-of-the-art professional standards of care. These guidelines track patient outcomes in order to improve the quality of care and are comparable to other ambulatory care measure sets.

In September 2006, the AOA signed a memorandum of understanding with Aetna, Inc., regarding a pilot project in which Aetna will use the AOA Clinical Assessment Program (CAP) diabetes measure set as an incentive for Aetna participating physicians in southern New Jersey, southeastern Pennsylvania, and Delaware. If 50% of the physicians in a practice complete the CAP (or the ABIM program if other physicians in the practice are MDs), they will be considered to have the highest rating on their diabetes log and therefore will be eligible to get an increased per patient per month capitation payment for all of their patients. Approximately 2,000 physicians in these areas are estimated to be eligible to participate in this pilot project. The press release can be read online.

As more private health insurance plans, as well as the Centers for Medicare and Medicaid Services recommend and employ internal methods of measuring physician’s care, physicians will need to prepare for pay-for-performance. The CAP provides the experience that will ease the transition to pay-for-performance by using clinically relevant methods that are not claims-based. In addition, physicians who participate in CAP receive 20 hours of AOA Category 1-B CME credit for each measure set.

The CAP is HIPAA compliant. It has been developed to collect no identifiable patient information and meets the HIPAA privacy regulation for “de-identification of protected information” set forth in 45 CFR Sec. 164.514(b)(2). All physician-specific data is confidential and will only be made available to the physician or their delegate.

About CAP for Physicians

The CAP for Physicians measures current clinical practices in the physician’s office and compares the physician's outcomes measures to their peers and national measures.

Goals

• To provide a structure for quantitative evaluation of current osteopathic care provided individually and in the aggregate by osteopathic physicians.
• To identify where quality-of-care improvements can be made in osteopathic physician's offices and provide educational interventions.
• To provide osteopathic physicians with information on how they are treating their populations.

Measure sets

Performance in CAP is measured by abstraction of required data elements from patient's medical records by the physician. Data elements include demographic information and clinical information. Clinical indicators selected for measurement represent evidence-based clinical practice standards derived from large randomized controlled clinical trials, single controlled observational studies, or expert consensus. Each data dictionary includes a measurement on the completion of an osteopathic structural examination. The measure sets will include Coronary Artery Disease, Diabetes Mellitus, and Women's Health Screening.

How the CAP works

• Physicians who decide to participate go to www.DO-Online.org, enter their AOA ID number and password, and then click on CAP for Physicians.
• Participants select one to three measurement sets.
• Medical records are selected based on specific patient parameters such as diagnostic criteria, patient inclusion and exclusion criteria, and sampling technique.
• Participants abstract data from 20 patient records for chart review.
• Data is entered online through the Web site.
• Participants receive a performance analysis report, comparing their performance with other participants and national benchmarks (e.g., NCQA’s HEDIS measures).
• An educational intervention(s) designed to improve performance s selected by the physician for implementation.
• 20 additional charts are abstracted and entered into the database to generate a comparison report.
• Physicians receive 20 hours of AOA Category 1-B CME credit for participation. Each of the three measure sets will be eligible for an additional 20 CME hours.

More information

CAP Pilot Study
The findings of an analysis of osteopathic family practice residency programs that participated in the first CAP initiative.

CAP: The First Academic Year 2003-2004 (PDF format)
A report on the Clinical Assessment Program for Residency programs

Hats Off to CAP: AOA's Clinical Assessment Program puts DOs in a league of their own (PDF format) An article from the April 2005 issue of The DO magazine

CAP for Physicians now up and running (PDF format)
An article from the February 2006 issue of The DO magazine

CAP for Physicians adds measure sets (PDF format)
An article from the July 2006 issue of The DO magazine

For more information about participating in CAP for Physicians, please contact:
Sharon McGill
American Osteopathic Association
(800) 621-1773, ext. 8150
smcgill@osteopathic.org