Renal Physicians Association s Kidney Quality Improvement Registry

Transcription

1 Renal Physicians Association s Kidney Quality Improvement Registry

2 State of the World Generating RVUs is not enough Providers are incentivized to manage their population of patients Existing tools practice management systems, electronic health systems are not enough. Community case management and large analytics packages (like for ACOs and insurance companies) are not realistically available. Measures of excellent nephrology care are not available

3 State of the World - II

4 State of the World - III PQRS is the basis of quality reporting for physicians PQRS measures feed the value based modifier (VBM) PQRS measures will feed the MIPS and Shared Risk Models of reimbursement after 2018

5 Medicare Part B Income At-Risk Year Max VBM + PQRS Penalties Max P4P Bonuses % of MIPS from PQRS % of MIPS from Clinical Improvement % 1.5% XX XX % 2% XX XX % 4% XX XX % or more 4-5% XX XX 2018 XX XX 30% 15% What about commercial contracts? What about other shared risk entities?

6 Coping with the state of the world Continuous monitoring and performance improvement of measured data is the best strategy to protect at-risk income, improve quality, and demonstrate value. Improve Performance Change Behavior Analyze Data Capture Data RPA Registry Aggregate Data

7 What is the RPA Registry? Web-based, subscription service that is a database of clinical events for entered patients. Data can be used to participate in multiple professional (e.g. MOC) and incentive reporting programs (e.g. PQRS, MU2/MU3). Incorporates performance improvement tools including peer comparison, gap analysis, and improvement resources from the RPA. Contained in a secure, online community with social networking and communication tools. Is a CMS-approved QCDR (quality clinical data registry)!

8 State of the Registry Launched in March demos a month 6 practices submitting data for 65+ physicians 28 PQRS measures, 10 non-pqrs measures, and numerous nonmeasure questions Adding interventional nephrology measures for 2016 Developed and hosted by CE City CE City now owned by Premier future opportunities?? #1 barrier is EHR interface, which is a resolving issue

9 EHRs Connecting to CE City Athena Clinical Allscripts NextGen CompuGroup Medical etransmedia Meditab Module MD STI Computer Services Others coming soon

10 Ongoing Partnership Opportunities Measure development Non-measure questions (understand prevalence) Focused research questions or problems Data sharing*

11 Vision for the future Long-term project users by end of 2016 Continue to evolve measures for the spectrum of kidney diseases Continue to evolve data use scenarios and possibilities without loosing sight of the mission tool for providers and practices Ride the waves generated by MIPS, APM, and the increasingly complex world of value-based payments

12 Where do measures come from? RPA has been the lead nephrology organization responsible for developing and testing physician performance measures. RPA represented nephrology at the AMA Physician Consortium for Performance Improvement (PCPI). AMA PCPI is no longer sponsoring measure development. The RPA must now find innovative ways to develop and test quality measures

13 What is a QCDR? A CMS- approved, specialty society owned registry *Must* be owned by a specialty society May include the published PQRS measures May include society developed measures that count toward PQRS scoring ONLY those submitting data through the approved registry can have the society-developed measures count toward PQRS QCDRs are the future of quality reporting July 2015 CMS fee schedule update call QCDRs are mentioned 31 times in 76 slides!

14 A specialty Registry fosters an Alignment of Interests Clinician Practice Nephrology Community Patients Healthcare Industry

15 Impact - Clinician The ONLY nephrology specific, CMS-approved QCDR Collects data for the purpose of tracking how we monitor and care for patients Fosters improvement in the quality of care gap analysis, peer comparison Not limited to PQRS measures. Registry participation gives more control over data and data reporting Maximizes use of EHR collected data - Help return to the work of caring for patients (not capturing and analyzing data)

16 Impact - Practice Registry participation gives control over incenting quality at the practice level real time monitoring and comparison of performance improvement gives practices a means to reward quality Helps lay the foundation for demonstrating value-based care for other organizations (e.g. insurance). Registry participation gives data to use in contract negotiations Registry participation allows practice greater control over PQRS data real time monitoring of PQRS data optimizes chances at demonstrating the highest quality care Allows for ease of picking of the best data for PQRS submission Real time benchmarking against nephrology peers and identification of patient outliers allows practices to close performance gaps before payment is affected Registry participation opens opportunity to monitor cost/reimbursement data and other demographic-specific reporting

17 Impact Patient Care Electronic Health Records recapitulates the paper chart, with very focused analytics and reporting Focused on Meaningful use Limited analytics set Limited population health tools Registry can draw data from ANY location you care for patients Registry use allows for identifying outliers for performance improvement in processes of care and outcomes.

18 Impact Healthcare Industry Help support performance improvement for clinicians Gain from the increasingly aligning interest in data collection and analytics Opportunity to ask clinical questions without the time, energy and expense of measure development Opportunity to learn about prevalence or other existent trends/clinical concerns in a quantified fashion Opportunity to ask more specific research questions or develop specific data sets with a wider range of providers Opportunity to access de-identified data from the registry* *With IRB-approved Data Use Agreement

19 Impact Nephrology Community Serves as the focus of to report nephrology-specific PQRS data. The RPA defines the measures thus painting a more accurate picture of quality care. Help develop the measures beyond PQRS measures and collect the data to better understand how the renal community provides quality care now and in the future. Enables the RPA to define reportable metrics for quality renal care in the US Provides a platform to develop and test renal-specific measures. Registry participation becomes a platform to quickly iterate measures of quality over time Aggregated registry data puts future incentive payment determinants in the hands of the specialty (as opposed to the payers - CMS, etc.)

20 $499 RPA Member per year (and FSN members too!) $699 Non RPA member per year (Interface and other technical Fees May Apply)

21 Registry Dashboard Registry data entry: Manual entry Upload Interface CECity can help optimize the data upload

22 Patient Data

23 Measure Performance Dashboard Display of measures and quality score performance. Measure performance gaps and lists of patient outliers, and link to interventions and improvement tools. Can aggregate measure scores at the practice, location, department, and TIN level, etc.

24 Continuous Performance Management Measure(s) Score & Trending Gaps, Benchmarks and Goals Links to Interventions

25 Monitor Patient Outliers Manage quality measure compliance & Identify at-risk patients or patients falling outside of the measure numerator

26 Improvement Interventions View Improvement Tools and Resources by Measure Access links and tools from the RPA and others, to learn and improve

27 Currently 28 Included Measures Diabetes: Hemoglobin A1c Poor Control Adult Kidney Disease: Blood Pressure Management Adult Kidney Disease Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Diabetes: Low Density Lipoprotein (LDL-C) Control (<100 mg/dl) Medication Reconciliation Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol Radiology: Exposure Time Reported for Procedures Using Fluoroscopy Pediatric Kidney Disease: Adequacy of Volume Management Surgical Site Infection (SSI) Adult Kidney Disease: Laboratory Testing (Lipid Profile) Adult Kidney Disease: Hemodialysis Adequacy: Solute Adult Kidney Disease: Peritoneal Dialysis Adequacy: Solute Preventive Care and Screening: Influenza Immunization Pneumonia Vaccination Status for Older Adults Adult Kidney Disease: Patients On Erythropoiesis- Stimulating Agent (ESA) - Hemoglobin Level > 12.0 g/dl Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy Neurological Evaluation Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention Evaluation of Footwear Preventive Care and Screening: Body Mass Index (BMI) Screen and Follow up Documentation of Current Medications in the Medical Record Pediatric Kidney Disease: ESRD Patients Receiving Dialysis Hemoglobin Level < 10g/dL Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days Falls: Screening for Future Fall Risk Controlling High Blood Pressure Diabetes: Medical Attention for Nephropathy Falls: Risk Assessment Advance Care Plan Falls: Plan of Care

28 Current Non-PQRS Measures (10) CMS-approved, RPA-only QCDR measures that count for PQRS Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy Adequacy of Volume Management ESRD Patients Receiving Dialysis: Hemoglobin Level <9g/dL Arteriovenous Fistula Rate Transplant Referral Advance Care Planning Advance Directives Completed Referral to Hospice Advance Care Planning (Pediatric Kidney Disease) NHSN Bloodstream Infection in Hemodialysis Outpatients

29 Non-Measure Questions Has the patient had a kidney transplant? yes/no - If yes, transplant date In patients with egfr <20, does the patient have a working kidney transplant? (yes,/no; if yes, date) -if no, has the patient been listed for a kidney transplant (yes/no) -if no; has the patient been referred for a kidney transplant (yes/no) -if no [to referral], why not (patient choice/medical exclusion/other) -if yes, was the patient deemed medically unsuitable for transplant - (yes/no) Is there documentation of patient education about renal replacement therapy (home, in center, PD, HD or transplant)? (yes/no) Is there a documented discussion about the patient s prognosis, including end of life planning? (yes/no) Has the patient received a transfusion due to anemia? (yes/no) - If yes, was the patient was receiving an ESA? (yes/no) Has the patient experienced episodes of hyperkalemia requiring medical intervention? (yes/no) Was there past acute kidney injury (AKI)* in the patient? (yes/no ) [*AKI to be determined by clinician judgment based on history or labs.] Was there a precipitating cause of dialysis? yes/no - If yes, is there a relationship or predictable event? [text box please explain]

30 MU2: Specialized Registry Reporting Successful enrollment and submission of data to the RPA Quality Improvement Registry for the purpose of satisfying the MU2 Menu Measure #6 (Specialized Registry Reporting) is contingent upon submission of data directly from Certified EHR Technology (CEHRT) to the registry. Providers who would like achieve the MU2 Menu Measure #6 will need to connect their EHR directly to the RPA Kidney Quality Improvement Registry.

31 MOC: Maintenance of Certification Maintenance of Certification (MOC) is an ABIM-run program in which clinicians perform a number of tasks to demonstrate on-going learning. Part IV, practice improvement, involves the collection and action based on data from the clinical environment. The Data collected for the RPA registry can be used to satisfy an MOC Part IV project

32 Questions? Adam Weinstein, MD - ajwein@gmail.com RPA Registry Committee Chair Amy Beckrich- abeckrich@renalmd.org RPA Registry Project Manager