Friday, May 31, 2019 | Ginger Biesbrock
A common challenge in CV programs today is the cost/resource requirements of quality registry involvement such as NCDR-PCI and others. Due to several payer requirements for registry utilization, I’ve not yet been to a program that has not engaged with at least one registry in the CV program or service line. The challenge typically lies in the resource requirements for abstraction and registry data management. Although this is an important and real challenge, the bigger challenge I see is the utilization of the registry data in a meaningful way. Whether the registry is STS, NCDR-PCI, ICD, Action or others, there is a wealth of quality data that can provide feedback on patient outcomes, processes, clinical decision making and patient throughput. All of these can be tied to clinical outcomes, patient experience and the economics of your CV program. The key is using the data in a meaningful way to drive and support quality and process improvement within your organization. There are three areas that need to be managed in order to promote effective utilization of quality data - abstraction, data management, and program performance.
One of the common concerns related to registry data is the accuracy. Certainly, garbage in does equal garbage out. In addition, the more cumbersome it is to get the data abstracted, the higher the cost of the resource as relates to time and even licensure requirements. There are three key principles to effective abstraction. They are standardization, interface functionality and thinking creatively. Standardization for procedure documentation, E/M visit notes and other clinical documents is key to minimizing abstraction time. I have seen single encounter abstraction times as little as 15 minutes or as much as 3 hours. The difference is the ease in which the required information is available and the use of interface to manage patient demographics and other mappable data fields. The abstractor-operator relationship is very valuable to develop standards for both the documentation and the abstraction processes. If your abstractors do not interface with the procedural physicians on a regular basis, then I would suggest you have opportunity. Getting creative means looking at clinical resources that have bandwidth to assist with abstraction. For instance, the use of perfusionists to assist with STS data abstraction between cases on or slow days. The use of cath lab team members that require limited duty assignments or abbreviated schedules may be an option for cath lab registry abstraction. Some programs do outsource or use other software platforms for abstraction as well.
Even good, clean data is only as good as how it is used. The registry reports can be long and cumbersome making them a bit challenging to navigate. Understanding the data reports, the data lag time and how the data highlights opportunities is essential in managing the data and then allowing the data to work for you. By ‘work’ for you, I mean the ability to review reports in a timely fashion, identify areas of opportunities and pulling those out to create action items and initiatives. In addition, deciding how to report the data is important. The reporting can occur at the group or individual physician level, blinded or unblinded. Often it starts at the group level and the moves to individual level blinded followed by individual level unblinded. The evolution requires confidence in the data, leadership and trust. Developing CV service line scorecards focusing on the key metrics will allow for better engagement than trying to review entire reports that can create distraction. It is important to choose only several areas to focus on. Too many areas with too few resources creates an environment in which it is very difficult to succeed.
The ultimate benefit of registry engagement for the individual organization is performance management. Understanding patient outcomes and always striving for improvement are the ultimate goals. Registries provide insights of how you compare to other organizations with similar patients. In addition, you are able to monitor trends and fall-outs. Choosing the appropriate number of initiatives based on opportunities and resources available is key to assuring success. Physician and administrative leadership need to come together to agree on key opportunities and develop plans for improvement, monitoring and sustaining. The CVSL structure noted in Figure 1 is a great way to provide leadership and accountability.
Finally, the role of the quality coordinator/specialist is invaluable for tying abstraction, data management and performance management together. The coordinator should be in charge of quality assurance of the data, synthesis of the data into score cards, monitoring of trends, root cause analysis for fall-outs and event review. Without this role, programs utilize team members with ‘day jobs’ and the quality work and registry management tend to fall by the wayside.
In summary, most programs across the country are involved in registries. That being said, I see significant opportunity in many programs for true, effective utilization of registry data and benchmarks. The reasons are variable, but most are related to lack of effective abstraction creating clean, accurate data, data management creating actionable data that is transparent and monitored, or leadership that is required for true performance management. Quality improvement requires dedication, good data, governance/leadership and the right resources to manage and direct the initiatives. Without, these many programs are spending a lot of money on a valuable tool that is going unused.
One more thought to leave you with – many of you have allowed certain measures of your NCDR-PCI, ICD and Action registry data to be publicly available. When is the last time you looked at what is being reported? Also, states such as Massachusetts have had mandatory report of NCDR-PCI data for several years. It is also likely that APM programs such as BPCI-A will begin to utilize registry data to monitor quality and incentivize or penalize based on performance. Are you ready? If what is voluntary suddenly became involuntary or you had an opportunity to take part in an APM would you be happy with what is being reported? If the answer is ‘no’ or ‘I am not sure’ then I would suggest now is the time to look deeper to assure that your answer is ‘yes’. Our patients, physicians, and care teams deserve this.
Illustration: Lee Sauer
Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Executive Vice President, Care Transformation. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.
Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care.
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