INTERMACS has a Key Role in Reporting
on Quality Metrics
Robert L Kormos MD FACS, FAHA
FRCS(C)
Director Artificial Heart Program
University of Pittsburgh Medical Center
The Patient Protection and Affordable
Health Care Act
Became law March 23, 2010
Goals of the Act
• Expand coverage
• Reform the delivery system including
insurance.
• Lower the overall costs of providing
care
Treating Heart Failure in the New
Healthcare Environment
Two objectives:
1.QUALITY
2.COST CONTAINMENT
Several strategies:
Meaningful use
Value Based Purchasing (Addressing best practices)
Accountable Care Organizations…
Reduce Avoidable Readmissions
Avoid Adverse Events
Accountability for Outcome
Payment
based upon
actual value
delivered
Incentives
aligned
around shared
definition of
value
Integrated
care organized
around patient
or disease
Value
Based
Healthcare
Specific
measured
outcomes for
every aspect
of care
Coordinated
care delivery
across care
settings
Enabling IT
platform
(infrastructure
, analytics
In what ways can INTERMACS measure adverse
events ?
• Rate of total number of adverse events
• Rate of individual events
• Severity of individual events
• Rate of severe events
• Time to first event
• Relationship of adverse events to survival
• Relationship of adverse events to Quality of Life
• The effect of adverse events on readmission to hospital
In the future the absolute level of events may be less important
than disability resulting from events. This would argue for
identifying the rate of severe/disabling events
New Measure of the Trade-off Between Adverse
Events vs Survival
• Therefore the most significant side effects may be acute
reactions following immediately after LVAD
implantation, but perhaps we should be concerned with
late effects appearing characteristically between 1 and 3
years after implant.
• A new metric could be considered: a time-integrated
measure, possibly the number of adverse event free
life-years, after LVAD implantation.
Value
Quality
What are we measuring?
• Patient Selection
• Death on the Wait List
(BTT)
• Complications
• Length of Stay
• Functional
Improvement
÷
Cost
=
VALUE
Only medical,
pharmacy cost?
• Implant admission
• HF management
pre-implant
• Billed charges
• Paid claims
• Device management
• Quality of life
• Return to Employment
• Survival
© Optum 2013. Used with permission. 130211_V1_DI
7
Quality Measures in Healthcare
• A number of initiatives exist in the Federal
Government that address Quality outcomes in
Healthcare. They work together synergistically.
• These include:
• Physician Quality Reporting System (PQRS)
• National Quality Forum (NQF)
• Measure Application Partnership (MAP)
Physician Quality Reporting System
PQRS
PQRS is a reporting program that uses a combination of incentive
payments and payment adjustments to promote reporting of
quality information by eligible professionals (EPs).
Principles of PQRS
• The program provides an incentive payment to
practices with eligible professionals (Eps) (identified
on claims by their individual National Provider
Identifier [NPI] and Tax Identification Number
[TIN]).
• Beginning in 2015, the program also applies a
payment adjustment to EPs who do not
satisfactorily report data on quality measures for
covered professional services.
Selecting Measures for 2014 PQRS
• At a minimum, the following factors should be
considered when selecting measures for reporting:
• Clinical conditions usually treated
• Types of care typically provided – e.g., preventive,
chronic, acute
• Settings where care is usually delivered – e.g., office,
emergency department (ED), surgical suite
• Quality improvement goals for 2014
• Other quality reporting programs in use or being
considered
What are the National Quality Strategy
Priorities for the use of this data
• Affordable Care
• Effective Communication and Care Coordination
• Health and Well-Being
• Patient Safety
• Person- and Family-Centered Care
• Prevention and Treatment of Cardiovascular
Disease
Endorsed Quality Measures
• There are over 650 NQF endorsed Quality measures being tracked by
CMS at the present time. These are over seen by over 100 Stewards that
include Universities, Insurance companies, National Societies or CMS.
• Examples of Stewards include AHRQ (> 40), ACC (23), AMA (>80), CMS
>100), NCQA (>100), Joint Commission (>20), STS (30).
• Many of these measures are grouped into over 75 Portfolios of
measures. For example in the Quality of Life, Functional Status & Health
Outcomes portfolio owned by the NQF there are 35 measures with
different Stewards.
• An example includes a measure of the percentage of heart failure
patients with documentation in the hospital record that left ventricular
systolic (LVS) function was evaluated before arrival, during
hospitalization, or is planned for after discharge. This resides within a
Portfolio of 35 measures sponsored by the Kansas City Quality
Improvement Consortium and is owned by CMS.
http://www.qualityforum.org/Home.aspx
CALL FOR MEASURES AND MEASURE
CONCEPTS: Criteria for Adoption of measure
Measure Applications Partnership (MAP)
• MAP is a public-private partnership that:
• Reviews performance measures for potential use in
federal public reporting and performance-based
payment programs
• Works to align measures being used in public- and
private-sector programs.
• MAP is the first group of its kind to provide upstream,
pre-rulemaking input to the federal government on the
selection of measures.
• Identifies “measures that matter” to those who are
affected by the more than 20 federal programs that use
performance measures
Advises NQF on Outcome Measures to adopt into the NQF standards
Measure Applications Partnership (MAP)
• MAP makes recommendations to 4 inter-related
Clinician Performance Measurement programs:
• The Physician Quality Reporting System (PQRS)
• The Medicare and Medicaid EHR Incentive Program for
Eligible Professionals (Meaningful Use):
• Provide performance information for Physician Compare
• And the Value-Based Payment Modifier (VBPM).
Measure Applications Partnership (MAP)
Key Initiatives
•
•
•
•
•
•
•
•
•
•
•
Stroke Outcome Measures
Hospital-Acquired Condition Measures
Hospital Inpatient Quality Reporting (PQRS)
Hospital Value-Based Purchasing
Hospital Readmissions Reduction Program
Hospital-Acquired Condition Reduction Program
Inpatient Psychiatric Facility Quality Reporting
Hospital Outpatient Quality Reporting
Rehabilitation Facility Quality Reporting
Long-term Care Quality Reporting
Ambulatory Surgical Center Quality Reporting
INTERMACS is Positioned to Develop a Plan
for Utilizing Quality Measures with the NQF
• Some potential examples could include:
• Strategies for data completeness and how specific data
leads to process or quality improvement in individual
hospitals.
• Reduction of all cause hospital readmission rates as well
as specific causes.
• Examining specific quality of life, and patient reported
outcome measures including functional status.
• Reduction of LOS.
• Optimization of perioperative antibiotic use
• Device thrombosis protocols of management
• Quality of Life measure free of serious AE.
• Relationship of all of the above to hospital charge data