Current Status of PINNACLE Registry TM Eleven Myths and Eleven Facts

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1 Current Status of PINNACLE Registry TM Eleven Myths and Eleven Facts American College of Cardiology Board of Governors William J. Oetgen, MD, MBA, FACC Chair, PINNACLE Registry Steering Committee April 1, 2011

2 What does PINNACLE mean? Practice INNovation And Clinical Excellence

3 Where does the PINNACLE Registry fit into the ACC? Two loci NCDR The PINNACLE Network

4 Where does the PINNACLE Registry fit into the ACC? NCDR The PINNACLE Registry is one of six NCDR clinical registries ACTION-GWTG acute coronary syndromes CATH-PCI diagnostic and interventional procedures CARE carotid artery revascularization ICD implantable cardioverter-defibrillators IMPACT pediatric and adult congenital heart disease PINNACLE outpatient performance improvement

5 Where does the PINNACLE Registry fit into the ACC? PINNACLE Network Community of CV professionals dedicated to: Performance and quality Data and measurement Incentives and rewards

6 Where does the PINNACLE Registry fit into the ACC? PINNACLE Network developing services for members PINNACLE Registry FOCUS Practice Management Program Cardiology Practice Improvement Pathway Performance Improvement Continuing Medical Education ACC Advocacy Program ACC Risk Management Institute Network.aspx

7 Why was the PINNACLE Registry created?

8 Why was the PINNACLE Registry created? Predictions about the future of CV care ca. 2005: the New Reality Medical records will be electronic Quality of care will be paramount Documentation of quality will be mandated Public reporting of individual provider performance will be de rigueur Financial sanctions will be imposed for non-participation Compensation will be based on quality of care and its documentation, not on volume

9 Why was the PINNACLE Registry created? The PINNACLE Registry was created to help participating ACC members to: Document and improve the quality of the care that they provide Benefit from using a trusted source for data analysis and reporting Survive and thrive in the New Reality of health care

10 Review of PINNACLE Registry Functions Conditions of interest CAD, hypertension, HF, atrial fibrillation, cardiac rehabilitation Data consists of ~150 elements from which 27 guidelines-based performance measures are calculated Data are automatically collected from the EHR, analyzed against guidelines-based performance measures, collated, and reported back at the practitioner, site, practice and national benchmark levels Using these data, practitioners create performance improvement plans Results of the improvement plans are evaluated with data from the next report

11 PINNACLE Registry Eleven Myths

12 PINNACLE Myth #1 The PINNACLE Registry is a massive burden to participating practitioners

13 PINNACLE Fact #1 The massive burden is actually the rapidly changing set of societal expectations imposed on ACC members under the New Reality The PINNACLE Registry is not perfect or easy, but it is the ACC s response and potential solution to the New Reality; it is not the problem itself Ten facts support this

14 PINNACLE Myth #2 The PINNACLE Registry severely interferes with the provider s office workflow

15 PINNACLE Fact #2 The PINNACLE Registry was initiated with a 2-page paper collection form which added 5 10 minutes per encounter to the provider s workflow not sustainable Since July 2010, all new PINNACLE participants (except for interested fellowship programs) must have a functioning EHR The current estimated practice time to add the PINNACLE System Integrator to a practice EHR is 10 hours per week for 4 weeks (down from 80 hours; goal is 10 hours) The current estimated additional time per encounter is ~1 minute using SI technology

16 PINNACLE Myth #3 (a and b) The PINNACLE Registry only works for large CV practices (a) The PINNACLE Registry only works for small CV practices (b)

17 Number of practices PINNACLE Registry PINNACLE Fact #3 PINNACLE Registry Practice Sizes >30 Providers per Practice

18 PINNACLE Myth #4 The PINNACLE Registry patient encounter and CV practice uptake has been abysmally slow

19 Unique Records in Data Warehouse PINNACLE Registry PINNACLE Fact #4 PINNACLE Registry Patient Encounter Records 1,491,122 1,400,000 1,200,000 1,000, , ,000 System Integration (SI) Solution 705, , , , , , , ,466 5,722 11,150 0 Sep-08 Dec-08 Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Month

20 Geographic Distribution of PINNACLE Registry Practices March 2011 CA (1;1) OR WA (2;9) NV ID AZ UT MT WY NM (1;5) CO (3;15) ND SD NE (1;1) KS (1;3) OK TX (4;101) MN IA (2;68) MO (2;84) AR (1;17) LA (1;16) WI (1;4) IL (6;95) MS MI (3:24) IN (3;59) TN AL (2;24) OH (2;32) KY (3;31) WV (2;2) GA PA (1;8) VA (3;38) SC (2;33) NY (4;54) NC (2;8) FL (6;42) VT ME NH MA RI (1;7) CT NJ (1;14) DE MD (3;14) DC AK HI Key: (Practices; providers) States = 28 Practices = 58 Providers = 780

21 PINNACLE Myth #5 PINNACLE Registry participation is just not worth it to CV practices

22 PINNACLE Fact #5 PINNACLE Registry participation has many potential benefits Providing optimal care to patients Maintenance of certification credit Pay-for-performance programs of commercial payers Possibly maintenance of licensure credit in the future Possibly fulfillment of meaningful use criteria in the future PQRS proven efficacy

23 PINNACLE Fact #5 PINNACLE Registry PQRS participants practices in 14 states, 172 providers AL, AR, FL, IL, MD, MO, NC, NE, NJ, NY, SC, TX, VA, WA 100% received PQRI payments 13 practices, 171 providers reported results to ACC

24 PINNACLE Fact #5 PINNACLE Registry PQRS participants $1,495,029 received in payments Providers per practice 1 to 50 (mean = 13; median = 7) ~$8,352 received per provider ($3,817 to $21,667) 239,280 total PQRS encounters = additional $6.28 per encounter Or, ~ 130,408 Medicare encounters (54.5%) = additional $11.52 per Medicare patient encounter Additional time per patient encounter < 1 minute PQRS revenue for additional time devoted to PINNACLE = $375/hour PINNACLE-PQRS for 2010 ~500 physicians

25 PINNACLE Myth #6 The PINNACLE Registry is too expensive for the ACC and will require invasion of cash reserves

26 PINNACLE Fact #6 From 2007 to 2010, PINNACLE (R&N) was actually cash flow positive to the ACC PINNACLE Income Statements $3,000,000 $2,000,000 $1,000,000 ACC-Contribution Registry-Contribution Network Contribution Registry Expenses Network Expenses Net Contribution $0 ($1,000,000) ($2,000,000) ($3,000,000) Net Contribution = $1,095,702 or $273,926/year ACC = $1,000,000 or $250,000/year ACC Surplus = $95,702 or $23,926/year

27 PINNACLE Myth #7 (a and b) The PINNACLE Registry is only for research and publication (a) The PINNACLE Registry data are not good enough for research or publication (b)

28 PINNACLE Fact #7a The PINNACLE Registry case created to help participating providers measure and improve performance. Performance improvement, not research, has always been the main purpose of PINNACLE (See fact #1) Nevertheless, it is important to do research and to publish on performance improvement topics and to use our experience to generate new knowledge and new measures

29 PINNACLE Fact #7b PINNACLE Publications and Submissions Chan PS, et al. Am J Med. 2010;123: Chan PS, et al. JACC. 2010;56:8-14. Oetgen WJ, Mullen JB, Mirro MJ. JACC. 2011; 57: Erb BD, et al. US Cardiology. 2011;8(1):12-5. May DC, et al Phys Exec J. In press Arnold SV, et al. Circulation. Submitted Chan PS, et al. Am Heart J. Submitted Oetgen WJ. Circ Cardiovasc Qual Outcomes. In press Oetgen WJ, Mullen JB, Mirro MJ. Arch Int Med In press 2011.

30 PINNACLE Fact #7b PINNACLE Publications and Submissions Chan PS, et al. Am J Med. 2010;123: Chan PS, et al. JACC. 2010;56:8-14.* Oetgen WJ, Mullen JB, Mirro MJ. JACC. 2011; 57: Erb BD, et al. US Cardiology. 2011;8(1):12-5. May DC. Phys Exec J. In press Arnold SV, et al. Circulation. Submitted 2010.* Chan PS, et al. Am Heart J. Submitted 2010.* Oetgen WJ. Circ Cardiovasc Qual Outcomes. In press Oetgen WJ, Mullen JB, Mirro MJ. Arch Int Med In press 2011.» * Data-driven manuscripts

31 PINNACLE Fact #7b PINNACLE Publications and Submissions Chan PS, Oetgen, WJ, Buchanan D, Mitchell K, Fiocchi FF, Tang F, Jones PG, Breeding T, Thrutchley D, Rumsfeld JS, Spertus JA. Performance measure compliance. (JACC. 2010;56:8-14.) 7/1/08 6/30/09 Patients = 14,464 Atrial fibrillation = 2,786 Coronary artery disease = 8,132 Chan PS, Maddox TM, Spinler S, Spertus JA. Warfarin use. (Am Heart J, submitted December 2010) 7/1/08 12/31/09 Patients = 136,796 (>900%) Atrial fibrillation = 18,393 (>600%) Arnold SV, Spertus JA, Tang F, Krumholz HM, Borden WB, Farmer SA, Ting HH, Chan PS. Statin use. (Circulation, submitted December 2010) 7/1/08 6/30/10 Patients = 179,608 (>1200%) Coronary artery disease = 39,601 (~500%)

32 PINNACLE Myth #8 The AHA s GWTG-OP will bury the PINNACLE Registry

33 PINNACLE Fact #8 It is unfortunate that there is any competition between AHA and ACC in outpatient CV quality registries There have been no peer-reviewed publications from GWTG-OP In November 2010, the AHA reported informally on GWTG-OP 2 practices (vs ~35 in PINNACLE) 235 contributing physicians (vs ~450 in PINNACLE) 95,593 patient encounters (vs 961,959 in PINNACLE) Launch planned in January 2011 (vs October 2009)

34 PINNACLE Myth #9 The PINNACLE Registry is incompatible with most EHRs

35 PINNACLE Fact #9 PINNACLE Registry is running on: Nextgen GE Centricity GE Logician GEMMS Allscripts Greenway Medical Misys Medisoft Clinical MIE Soapware gmed Amazing Charts Universal EMR PrimeSuite These represent >60% of CV practices with EHRs

36 PINNACLE Fact #9 PINNACLE Registry team is mapping: MDrec NextTech emd MyWay EPIC Pronto EMR eclinical Works Med Informatics Cerner Infinity Alteer Visionary Health Care Springcharts DigiDMS Athena Intergy / Sage These represent >30% of CV practices with EHRs

37 PINNACLE Myth #10 The PINNACLE Registry does not collect enough data from EHRs to be worthwhile

38 PINNACLE Fact #10 With reasonable, (i.e. cost effective) system integration efforts, the PINNACLE Registry can capture 75% - 80% of the required data for calculation of 27 performance measures for most EHRs (some EHRs are much higher) With these data, 75%-80% of performance measures can actually be calculated and reported Before the PINNACLE Registry and systems integration, zero outpatient CV performance measures were being calculated and reported The PINNACLE Registry is not perfect, but the glass is 75% full, not 25% empty

39 PINNACLE Myth #11 The PINNACLE Registry data are stale when practitioners receive their reports because they only are available quarterly

40 PINNACLE Fact #11 With the ongoing deployment of the PINNACLE Dashboard, providers can instantaneously review their data Custom reports can be created by providers on an ad hoc basis

41 Summary Workflow efficient Practice size Brisk uptake Beneficial to practices Economical to ACC Supports research Competitive EHR agnostic Robust data Timely reports

42 Summary Not perfect

43 Summary Not perfect But functional and useful

44 Summary Not perfect But functional and useful And something to be proud of

45 Contact Information Brendan Mullen Bill Oetgen

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