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Leverage the Value of Your Registry Data ? Ginger Biesbrock
As an industry there are many registries available that offer data to improve things like clinical outcomes but there are still missed opportunities to optimize that data. Ginger Biesbrock lists five ways to get additional value from your registry investments. Is your registry data working for you or against you? As an industry, we have access to multiple registries such as the American College of Cardiology/National Cardiovascular Data Registry, Society for Thoracic Surgeons, and American Heart Association/Get With the Guidelines. Each has a data set we are all very familiar with. But as an industry, we leverage only a fraction of it to improve clinical process and outcomes, boost program performance, or demonstrate value. It's been said that organizations spend millions of dollars manually abstracting and validating data from electronic health records (EHRs) and other systems. Many organizations employ a team of nurses, data abstractors, and others to enter, report, and manage their registry data. Yet despite all the resources invested, we see most programs missing opportunities to optimize the use of their data. Here are some ways to get additional value from your registry investments. 1. Designate ownership Having an accountable staff person oversee accurate collection, effective reporting, and the use of data for improving process and outcomes is a well-founded best practice. An integral role we see in programs that manage their data well is what we call a Clinical Quality Specialist (CQS). The person in this role: ? Provides a quality assurance layer: For example, they oversee the work of the abstractors and others who contribute data, to guard against 'garbage in, garbage out,'which is the primary reason registry report data is so often questioned by physicians. It's the CQS' job to scrub and validate that the team is capturing the right information. ? Synthesizes complex data into useful summaries: An effective CQS can distill voluminous registry reports and synthesize them into something easy to read and make decisions from. They know how to tease out the most relevant data points for the physicians and hospital into a one-page summary for end users. ? Monitors and evaluates data trends: The CQS watches for fallout and anomalies and takes a deeper dive into problematic data. For example, if there has been an increase in vascular complications for PCI patients, the CQS can analyze details to figure out what changed to cause the shift. Perhaps they will trace it back to a post procedure site access management change for which the clinical support team doesn't have the right competencies. In such as case, the CQS can then arrange for additional training or other staff improvements. ? Investigates outliers: A CQS can get on top of outliers quickly, pulling records and working within the organization to conduct root cause analyses or other investigations. After core issues are identified, he or she coordinates with the right clinicians and teams to implement system changes. If you think this sounds like a lot of work, you're right. It is. That's exactly why this role is fast becoming common in organizations that want to leverage the value of their data. If you don't have someone in this role, look for ways to budget for and fill it. 2. Choose your focus and goals Most registry reports are data intensive and cumbersome. They have lag times. They contain 50-60 measures that are hard to decipher. That's too overwhelming for anyone, let alone busy clinicians who have little time to digest the data. The role of data management is to synthesize and distill registry data into something useful and actionable. Don't put raw data reports in front of end users. Choose four or five that align with your strategies and goals and report those. Your conversations with clinicians will yield more positive outcomes and less frustration. 3. Tie registry metrics to physician performance and compensation Doing so aligns incentives in a way that benefits patients, physicians, and organizations. For instance, a program in the Midwest developed quality metrics as part of its physician compensation strategy. These quality metrics included PCI, ICD, and several other registry metrics. After designing its compensation model this way, the program had better patient outcomes and a lower vascular complication rate post-PCI. Within 6-12 months, the group dropped its vascular complication rates in half. The strategy worked because physicians were given access to manage their data directly, and incentives that held them accountable for the outcomes. And, it's important to note that a CQS was hired to manage the process. This person ensured that the physicians understood the data and felt confident that it was accurate. When data showed a complication rate higher than desired, the specialist coordinated a root cause analysis and worked with the physicians to develop a strategy for improvement. 4. Use the data in clinical governance We have seen physician leadership engage with registry data above and beyond the performance of their specific program. As the Service Line structure has been developed, leadership committees are responsible for the financial, quality and operational performance of their programs. The subcommittee model can own each of the registries for review and accountability. The information is then shared with the executive committee as part of a dashboard or scorecard. When the registry data is owned and provided in an actionable environment, it's an effective information set for the committees to use as a starting place for accountability standards. 5. Demonstrate value with private payers Another area that may be picking up interest is use of high performing quality data to leverage better payer contracts and relationships within value-based environments. If your registry data demonstrates favorable outcomes and complication rates, your program or clinically integrated network may be in a better position for contract negotiation. Will payers be open to considering registry data as a way to impact the cost of care? I do believe that will be the case. Payers don't have direct access to this level of data and are typically quite interested in reviewing it. It's a good opportunity to show your value and request preferential treatment and better reimbursement if your outcomes warrant that. And as value based care gains traction, the use of registry data to illustrate value will become even more important. Registry participation is mostly voluntary but is mandatory for ICD/LAAO/TAVR. At some point, however, it may be required in other areas as well. It's up to us as an industry to make sure the data is accurate, understood by physicians and end users, and used in a positive way. Add a CQS to your team and use the ideas here to leverage your data for process, performance, and potentially even reimbursement improvement. Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Vice President, MedAxiom Consulting. 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.