october 15, 2019 qcdrs as multi- purpose data the renal ......• presentation • discussion • on...
TRANSCRIPT
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QCDRs as Multi-Purpose Data Platforms: The Renal Physicians Association (RPA) QCDR Experience
October 15, 2019
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Agenda
• Welcome and Housekeeping• Introductions• Presentation • Discussion • On the Horizon
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Housekeeping
• This forum is being recorded• All lines will be muted until the discussion • For the Q&A portion of the webinar, we will open the lines for discussion. Please remain muted unless you are speaking
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Speaker and Moderator
Amy Beckrich, CAEProject Director at Renal Physicians Association
Adam Weinstein, MDVice President, Medical Affairs with Clinical IT Services at DaVita Kidney CareChair, Renal Physicians Association Clinical Data Registry Workgroup
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The Renal Physicians Association’sKidney Quality Improvement Registry
Adam Weinstein, MDChair, RPA Registry Workgroup
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Disclosures
Dr. Weinstein is a volunteer member of the Renal Physicians Association (RPA)Dr. Weinstein is an employee of DaVita, Inc. and a part-time private practice nephrologist in Maryland.
There are no financial conflicts that would bias this talk.Comments and information should not be considered as advice or guidance.
All comments are solely Dr. Weinstein’s. Comments are not reflective of official policy of any of the above organizations.
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Overview Background: About Nephrology and RPA
Origins and Vision: Prior to 2014
Initial Execution: 2014-2015
MACRA-geddon: 2016-2017
Strategic and Tactical Pivots: 2018-2019
Looking forward and next steps: 2020 and beyond
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What is unique about Nephrology?
Nephrology Offices
Dialysis Centers
CommunityHospitals
Other Specialists,3° Hospitals,and SNFs
Kidney care spans multiple venues of care.
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Nephrologists Attempt to Mitigate the Progression towards and Complications of
End Stage Kidney Disease
Stage I, II, IIIa CKD Stage IIIb CKD Stage IV CKD Stage V CKD ESRD & Transplant
Basic NephrologyContact
Increasing RiskFactor
Modification& Monitoring
Education, preparation for Renal Replacement Therapies, increased
monitoring & co-morbidity management
Transplant?, preparation for Renal Replacement Therapies,
increased monitoring & co-morbidity management
Frequent interaction; Intense co-morbidity management
Safe Transition to Dialysis
Pre-emptive Transplant
CKD Risk Mgmt ESRD Education & Prep
Dialysis Management
Increasing costs, complications, hospitalizations, and mortalityIncreasing number of co-managing providers
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And our patient data is everywhere!
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What is the Renal Physician Association (RPA)?
RPA is the professional organization of nephrologists; its goals are to ensure optimal care under the highest standards of medical practice for patients with kidney disease and related disorders. RPA acts as the national representative for physicians engaged in the care of patients with kidney disease.
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RPA’s Role in Measuring Quality - History
• Role of RPA as measure developer• AMA-PCPI• NQF process• Numerous publications and white papers focused on quantifying
quality kidney care
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Prior to 2014
Opportunities
• Continued leadership in quality measures
• Meet the needs of our membership re: PQRS
• Develop a needed capability for the organization
Challenges
• Requires member subscription• Requires member education• Requires EHR interfaces
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What is the RPA registry?
It is a platform for:Data ingestionAnalyticsReporting
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Initial Launch 2014-2015
Opportunities
• Lots of interest• Relationships w/ interventional
nephrology• Growing expertise in measure
development
Challenges
• Labor intensive for onboarding new member-users
• Requires continued member education
• EHR vendors not enthusiastic
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MACRA-geddon: 2016
Opportunities
• New focus on quality measures that were specific, not topped-out and differentiated performance
Challenges
• MIPS: • Needed fewer measures• Low-risk in 1st few years• Quality scoring marginalized
custom measures
• APM bypassed QCDR use• EHR Interfaces needed!
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Strategic and Tactical Pivots – 2017-2019
Opportunities
• Our QCDR is a data platform!• Our QCDR is supported by an
innovative and flexible partner• Many other needs in the
nephrology community
Challenges
• Nephrology EHR landscape consolidation
• We are still funded through member subscriptions
• CMS focusing on outcome measures, harmonizing and removing custom measures
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Pivot #1 – Maintenance of Certification (MOC) Opportunity
• Nephrologists need ABIM/Nephrology certification• ABIM looking for ways to broaden their MOC program• Leverage existing ABIM relationship w/ vendor to aggregate and
report physician quality activities to ABIM
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RPA Dialysis Quality Improvement ABIM MOC Program
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Pivot #2 – Connecting Pharma and Device with Nephrologists
• Real-world use of devices and medications are difficult to ascertain• RPA has an engaged network of physicians and practices• Leverage existing RPA relationships to help Pharma/Device to answer
specific questions and possibly develop quality measures
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RPA Project on Real-World Management of Hyperkalemia
Clinical Care Patterns(via chart review)
Impact of Hyperkalemia on
patient experience(via interview)
11 Practices>300 Patient Interviews
360 Chart Reviews
• Goals: • Gain insight on thresholds of provider action on
hyperkalemia• Gain insight on patient understanding and
perceptions of hyperkalemia
QCDR is the data collection and aggregation tool
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Lessons Learned
• This is a research study• Recruitment is a challenge• Buy-in by practice leadership ≠ buy-in
staff• QCDR can be an excellent data
gathering platform• Survey delivery and prompted workflows
were key• Survey delivery is great, but needs to
accommodate wide range of use cases
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RPA Study on the Real-World Management of Mineral Bone Disease (MBD) in Patients with Advanced CKD
• Develop an understanding of clinical care patterns in real-world clinical actions in the management of CKD-MBD through lab data, medications prescribed, and chart notes, via chart review.
• Develop an understanding of nephrologists’ perception of the practicality of current guidelines and the relative importance of MBD issues in CKD and ESKD via structured interviews.
Project launched Sept 2019 and will conclude Dec 2020.
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Pivot #3 – Focus on Pop-health, Practice Transformation, and Best Practices
• Nephrology is rapidly moving to value-based payment frameworks• Many small and medium practices need help with transformation -
including tools for pop-health and data aggregation• Leverage our QCDR platform and nephrology expertise to:
• Help adopt community-wide, non-CMS approved measures that support nephrologists in these new programs
• Work with private payers to consolidate practice/provider performance
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Epic Smart Form• Exploring the inclusion of CKD process
metrics - not for MIPS/CMS programs
• Data is of interest to private payers/may be negotiating tool for practices
• Relevant to kidney models proposed by Executive Order in July 2019
• Planned for Epic foundation Q1 2020• Planned for RPA QCDR Mid 2020
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Take Away Themes
• QCDRs are undervalued• External pressures on quality measures are increasing• QCDRs are data aggregation and reporting platforms• Specialty societies can leverage the value of their efforts in creative
ways, but there are trade-offs
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Thank [email protected]
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Discussion
Amy Beckrich, CAEProject Director at Renal Physicians Association
Adam Weinstein, MDVice President, Medical Affairs with Clinical IT Services at DaVita Chair, Renal Physicians Association Clinical Data Registry Workgroup
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On the Horizon…
• Webinar: Improving Health Care Quality Through Clinician Level Integrated Performance Measurement with PCPI®
• November 8, 2019, 12:30pm CT• PCPI Conference – November 10-12, 2019• The Quality Landscape: Charting the Course for Success• Register at thepcpi.org
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The slides and recording will be posted at http://thepcpi.orgStay tuned to your email for updates.For any questions please contact us at [email protected]
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