AQA Measures and Improvement Workgroup Conference Call Notes Tuesday, October 29, 2013

Transcription

1 AQA Measures and Improvement Workgroup Conference Call Notes Tuesday, October 29, 2013 Participants Andy Baskin, Aetna, Co-Chair Reginald Baugh, American Academy of Otolaryngology Head and Neck Surgery Jean Brereton, American Academy of Otolaryngology-Head and Neck Surgery Foundation Joel Brill, American Gastroenterological Association Gene Cunningham, American Academy of Otolaryngology-Head and Neck Surgery Foundation Kirstin Dawson, AHIP Dave Doman, Johnson & Johnson Liza Greenberg, AQA consultant Scott McKenzie Johnson & Johnson Peter Robinson, American Academy of Ophthalmology Nancy Wilson, AHRQ Invited Speaker Frank Opelka, MD, AMA Physician Consortium for Performance Improvement (PCPI) member Introduction Dr. Andy Baskin welcomed members to the cal and reviewed the agenda: Review/Approval of September 27, 2013 Call Notes Overview of the AQA Fall Meeting Presentation on PCPI Activity Call Schedule o Monday, November 18, 2013, 4:15-5:15 PM ET Review/Approval of Previous Call Notes The September 27, 2013 call notes were approved as written with no corrections or additions. Overview of the AQA Fall Meeting Dr. Baskin presented the following highlights from the AQA Fall Meeting: The AQA Fall meeting was held Monday, October 21. The meeting included updates from the finance committee and the co-chairs for the Measures and Improvement and Reporting workgroups, along with expert presentations. The Measurement and Improvement Workgroup (MIWG) reported that it holds monthly conference calls with presentations on quality improvement strategies in an effort to identify best practices and measure alignment. The Steering Group (SG) suggested that the MIWG engage specialty societies to identify where they are in the measurement and improvement continuum. They also noted that there are variations in terms of adoption of registries and availability of measures. AQA can identify where organizations are along the continuum of measurement and provide feedback if requested, to guide specialty societies in effective measure implementation. 1

2 AQA can also champion their work where they need assistance. Additional definition of this concept will be developed by the workgroup co-chairs and members of the SG. The MIWG will continue to identify potential presenters for upcoming monthly conference calls to showcase successful measurement and improvement efforts. The AQA Reporting Workgroup provided an update on the status of their work focusing on the consumer experience using reports and on how meaningful the information is. The specific target is understanding transparency of information to consumers and tying this to the National Quality Strategy. Panel sessions addressed: o Best Practices to Care Delivery which included a summary of work on measure identification across state and regional measures sets by Gerry Shea, who presented to this workgroup a few months ago; and o Experience and first year results from the Pioneer ACO project. Presenters were Dr Mai Pham from CMMI and Emily Brower from Atrius Health, a Pioneer ACO. Dr. Pham provided a view from CMS stating positive findings in spite of some turnover in the Pioneer ACO participants. There was engaged conversation with the meeting participants and the speakers on the experience of Pioneer ACOs, including Atrius Health, on both positive and negative experiences. CMS staff presented on the role of registries within the CMS and the CMS public reporting strategy through And Dr. Rick Weisblatt from Harvard Pilgrim presented on their experience with Massachusetts Payment Reform and their new consumer transparency tool. This included interesting information on challenges in making information transparent to consumers even in states that have made substantial progress. Dr. Patrick Conway from CMMI presented on the next phase of the Innovation Center and CMS's strategy on quality measurement. His presentation included positive results from their quality programs and future steps for the Innovation center. CMMI is looking for ideas for innovative programs. CMS appears to be willing to go beyond traditional approach in identifying and approving innovative payment and delivery improvements. Presentation on PCPI Activity: Frank Opelka, MD Dr. Baskin welcomed Dr. Opelka and turned the meeting over to him to provide an update on the PCPI effort and their future direction. Dr. Opelka opened the discussion stating that PCPI is undergoing change as part of new direction of the overall American Medical Association (AMA) strategy. The AMA is moving towards a strategy where the PCPI will need to become self-sustaining over time. It appears that PCPI will have a continued relationship with AMA but there will be a transitional process in terms of funding. AMA anticipated continuing support of the PCPI through 2014, with the goal for funding to be 1/3 AMA, 1/3 physician societies, and 1/3 stakeholders and other users in the future. 2

3 Dr. Opelka continued the conversation discussing three priority areas which PCPI intends to use within core business strategy: o Better measures for outcomes o National Quality Registry Network (NQRN) o Performance measurement improvement Better Measures for Outcomes: The AMA has made a $32 million investment over 10 years and anticipates the continued expansion of demand for measures. Going forward PCPI will likely support measure development through validating and testing (a core capability of PCPI) but not end-to-end measure development. The PCPI plans on supporting measures incorporated in current CMS measure sets, e.g. value modifier, PQRS, etc. After 2014, the measure maintenance support will be funded by the specialty societies responsible for measure content. It is anticipated that funding with be through health plans, CMS, and specialty societies. National Quality Registry Network (NQRN): This initiative is a major area of focus of PCPI. The NQRN is a multi-stakeholder collaboration which has gathered input from plans, purchasers and patients and supports an outcomes measurement and performance improvement agenda. The AMA believes that clinical registries may ultimately be more valuable than claims based measures. CMS has recognized registries in the Physician Quality Reporting System (PQRS), and thusly creating more interest in registry development. One caveat is that registries have to be built right - with the right data specifications to ensure value in the output. In working with NQRN, PCPI is seeking to shorten the learning curve for others seeking to develop registries. There will be an NQRN meeting in Boston November 20 th. AMA is developing a 'maturation formula' for registries which includes criteria for different levels of performance at each level of the registry. The criteria will be developed as a step-bystep guide so that registries don t become too ambitious before the right groundwork has been covered. The next activity for NQRN is the development of e-measures and working with electronic health record (EHR) vendors to develop data standards and definitions. This work aims to standardize data output of EHRs and to facilitate measurement using the same criteria. Dr. Opelka voiced concerned that this effort may uncover how poorly designed current EHRs are because the system architecture that is used may not be able to deliver on any of the developed data standards. He also noted that standards may continue to be housed in registries because of these EHR issues. Performance Improvement: The PCPI has convened a new work group to drive quality improvement. The group met for the first time under leadership of Keith Mandell. A major topic of discussion was closing the referral loop. Discussion Several workgroup members commented on the general concern that there isn't a business model for measure development, stating that measure maintenance and development is expensive, and AHRQ and other government programs using measures haven t addressed this specific issue. 3

4 Nancy Wilson, AHRQ, commended AMA/PCPI for its efforts to standardizing data elements and asked about the cycle time for getting information into the registry. Dr. Opelka commented that it depends on the registry. Dr. Opelka noted that at Louisiana State University the clinical data is pulled automatically from the EHRs in almost real time and used for analysis; this may not be true for all registries. For example the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP ) requires that data be entered every day, but the analytics are run every quarter. There is no real time reporting even though there is real time data entry. Nancy Wilson also commented that in the early days of NSQIP had a nurse clinician at every site who was dedicated to data entry (moving paper chart data into registries). She asked if it would be an equally intensive activity in the future. Dr. Opelka noted that we need to get the framework right in the development of registries in order to avert this level of labor intensity going forward. Currently EHR vendors are in the process of developing real time reporting through the use of registry data. Dr. Opelka restated that this project may uncover flaws in the EHR system because EHRs are all built on separate architecture and have different data standards. Epic records may be among the most difficult for standardizing data elements, in spite of Epic being a market leader. There is a lot to be said for setting data standards even if only within the registries. We need to demonstrate interconnectivity in at least one EHR first to show that it can be done. Registries need vendor agreement on where the data sits, how it will fit with other elements, etc. Nancy Wilson commented that neither EHRs nor registries are a magical solution; they are a step forward but it will take work to align all the elements to actually have information management. Dr Opelka commented that there is some retrofitting needed in order to ensure seamless integration of EHR and registry data. Currently there is a competitive environment for EHRs, with non-standard terminology and interoperability of data. Ideally the starting point should have been one EHR standard data set, with competition among vendors being on the basis of applications and functionality, not basic data flow. Dr. Opelka will be meeting with non-epic EHR vendors who will discuss the possibility of making changes to EHR infrastructure that standardize elements without manual input. Dr. Baskin asked if measures coming out of NQRN will go through NQF process. Dr. Opelka responded that PCPI has been very supportive of NQF endorsement and is the parent of NQRN, so it is likely that that will be the path. Dr. Baskin also asked if there would be coordination of maintenance of certification (MOC) activity with the PCPI quality improvement activity as that would reduce barriers to participation. Dr. Baskin noted that MOC and PCPI quality improvement initiatives should be complementary, not additive. Dr. Opelka responded stating that harmonization is a key consideration of that work group, headed by Keith Mandell. Their goal is to reduce the measurement burden and seamlessly put data in front of doctors. The data can t be so complex to manage that it interferes with care. The problem with MOC is that there are 24 societies, and many of them are more focused on measure development rather than MOC. 4

5 Dr. Opelka invited contributions to backstopping current measures and identifying measurement issues that need to be aligned for seamless integration with registries. Dr. Baskin opened the discussion up for other issues or follow up recommendations. Dave Doman (J&J) asked how AQA could support medical specialties in developing and advancing measures. What will be the AQA approach? Andy Baskin noted that there is a lot of variability among specialty societies and the Measurement and Improvement workgroup will investigate the various societies to see where they stand and how we can support them. This will look more concrete after a planning meeting between AQA s MIWG and the Steering Group leadership. The goal is to engage specialty societies. There is a lot to be gained from engaging specialty societies, but we need to define the output. Members were encouraged to contact staff or the workgroup co-chairs with ideas for future workgroup activities or additional questions. Call Schedule Monday, November 18, 2013, 4:15-5:15 PM ET 5