RPA s s Kidney Quality Improvement Registry

RPA s s Kidney Quality Improvement Registry

Disclosures/Conflicts Co-Owner at Kidney Health Center of Maryland Part-time VP Medical Affairs at Shore Regional Health/University of Maryland Medical System Medical Director for 2 Dialysis Units and an ACO Consulting work for DaVita/Falcon EHR Maryland Health Care Commission RPA Board of Directors

Background 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 is no longer sponsoring measure development Healthcare is increasingly dependent upon measurements for state and national guidelines, reimbursement, and performance ratings The PQRS measures are increasingly important in CMS incentive programs

RPA Registry Workgroup Adam Weinstein, MD (Chair) Kidney Health Center of Maryland Stevensville, MD John Ducker, MD Nephrology Associates of Northern Indiana Fort Wayne, IN Alan Kliger, MD Yale New Haven Health System New Haven, CT Evan Norfolk, MD Geisinger Medical Center Nephrology Danville, PA Paul Palevsky, MD University of Pittsburgh School of Medicine VA Pittsburgh Healthcare System Pittsburgh, PA Suzanne Przybyla Mid-Atlantic Nephrology Associates, P.A. Baltimore, MD Rebecca Schmidt, DO WVU School of Medicine Morgantown, WV Lisa Simonton Partners in Nephrology & Endocrinology Pittsburgh, PA

Do I provide better care? How do I define better? How do I monitor? How do I improve?

Vortex of Quality Reporting Demonstrating High Quality Care = More discrete data collection and scrubbing = More time and overhead doing data management = less time caring for patients = More time defending less revenue

CMS makes the rules Realities Incentives = penalty avoidance There is overhead costs to penalty avoidance Penalty avoidance demonstrating quality Still need to demonstrate quality for non-cms payers and for other reasons

The VBM Black Box

VBM facts of concern Based on PQRS -> >50% of eligible providers must submit on 50% of Medicare eligible Part B patients Therefore you can cherry-pick the best performing patients Everyone will get 100% on quality measures VBM distribution will largely be based on COST Nephrologists are high cost

Value Based Modifier Quality and Cost scoring groups providers into tiers by which money is redistributed Low Avg High Quality Quality Quality Low Cost 0 +2x* +4x* Avg Cost -2.0% 0 +2x* High Cost -4.0% -2.0% 0 Physicians treating frailest patients more likely to incur penalty CMS contractor found that a third of groups with sickest patients fell into high cost category compared to 8% of all groups

The Real Problem Feedback? Improvement? Real Life Patients EHRs and other clinical data sources

A More Ideal Framework for Quality Improvement Single repository to collect, store, analyze and report on your clinical quality data Allows for the same collected data to be used for a variety of activities benchmarking and comparison of data between providers and groups of providers BEFORE submission Links data to educational resources for improvement submission/reporting of data to a variety of programs/entities, as the emerge and evolve

RPA Registry What is it? RPA s Registry is a collection of related databases working as a clinical quality improvement platform.

RPA Registry What is it? A clinical quality improvement platform.

RPA Registry What is going on? A clinical quality improvement platform.

In-Depth Review of Functions The Technology Certification Portfolio Registry and PQRS/VBM Peer comparison MOC

The Technology CE City and the MedConcert Platform Improvement Platform Secure Mature In use Social Networking features

Certification Portfolio Functions

Registry Functions

What is a registry? A database that collects clinical and other data for a specified population. Typically defined by a particular disease or condition and serves to answer complex scientific, quality, clinical, or policy questions as related to. Increasingly the basis for measures of performance to best practices. (example STS data sets on coronary artery reperfusion)

What is a QCDR? (Quality Clinical Data Registry) Registry owned and operated by a specialty society Must be approved by CMS Satisfies MU2 registry requirements May contain existing PQRS measures May contain NON-PQRS measures All measures in the QCDR can count toward meeting PQRS requirements Thus all measures will help define quality in the VBM program

Wait! You mean RPA can make its own PQRS measures? (And CMS will accept them?) YES

RPA s Kidney Quality Improvement Registry The ONLY nephrology specific, CMS-approved Qualified Clinical Data Registry (QCDR) Aggregates data from outside clinical data sources needed Not limited to only CMS-defined PQRS measures. Only way to report on RPA s metrics for quality renal care Provides a platform to develop quality indicators. One of the functions of this Clinical Quality Improvement Platform

How does the RPA s registry work? Web-based, subscription service Related databases of patients and clinical events linked to a provider (you, the registry user). Entered data can be used to participate in multiple professional (e.g. MOC) and incentive reporting programs (e.g. PQRS, MU2). Data is connected to performance improvement tools including peer comparison, outlier analysis, as well as guidelines and educational resources from the RPA. Hosted in the secure MedConcert platform.

Registry Dashboard

How do I get my data in? Manual Entry Structured Report (like Excel files) CCD sent per encounter Interface

Registry Getting Data In

Getting Data In

What data do I want in there? Professional Certification and Credential Data A master list of patients you care for SOME clinical data for those patients on your master list Diagnosis codes Dates of service Key lab or other clinical data

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

RPA Kidney Quality Improvement Registry: Non-PQRS Measures (10) 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

In depth with one measure Q: I want to know what % of my hypertensive, proteinuric patients are on an ACE or ARB in 2014. What you need: 1.List of patients 2.List of their ICD-9/10 problems 3.Date of encounter 4.ACE/ARB status? (or list of medications)

Data Analysis Functions

Measure Performance Scores Measure Name Performance Trending Provider Score Fixed Benchmarks and Program Goals How do we improve? Links to Interventions Can be configured to aggregate measure scores at the practice, location, department, and TIN level, etc.

38 Monitor Patient Outliers Identify at-risk patients or patients falling outside of the measure numerator

Improvement Interventions Access links and tools from the RPA and other professional societies, and national experts in quality improvement to help you and your team learn and improve

MOC: Maintenance of Certification - Collect, perform, and report Part IV MOC credit. -Established relationship with ABIM -Will help keep up with keeping up

Let s Review RPA Clinical Quality Improvement Platform

Business Case Registry participation empowers subscribers with better control over VBPM PQRS submission is not continuous PQRS allows for cherry picking of the best data Without real time monitoring of PQRS data points it is unclear how to optimize chances at demonstrating quality care under PQRS system Registry participation gives more control over MOC/MOL Re-use entered PQRS/VBPM data Ease the performance improvement MOC with interventions linked directly to the data Help return medicine to caring for patients (not entering data)

Business Case Registry participation gives control over incenting quality real time monitoring and comparison of performance improvement gives practices a means to reward quality Registry participation gives data to use in contract negotiations real time monitoring and comparison of performance improvement gives practices data for private insurance contracting without taking risk Registry participation gives practices and providers benchmarking data and gap analysis real time benchmarking against nephrology peers and identification of patient outliers allows practices to close performance gaps before payment is affected

Business Case Registry participation opens opportunity to monitor cost/reimbursement data (think real-time benchmarking survey) Registry participation opens options to link Pharma and device manufacturers to clinical care 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.)

Questions? Is it secure? Do you have sponsors or partners? What does it mean to be a sponsor or partner? What are your data management policies? What else can we do with this platform?

http://www.renalmd.org/rpa-kidney-quality-improvement-registry Member and non-member pricing $499 RPA Member (annually) $699 Non RPA member (annually) Range of fees depending on registry features selected PQRS reporting included in annual fee Integration of EHR for Meaningful Use may incur additional fees