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Cardiovascular PracticeRecognition Program
May 14, 2008
Michael Mirro, MD, FACC
Janet Wright, MD, FACC
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What is the CVRP?
Practice-level recognition program designed to identify quality in cardiovascular practice
Standardize the methodology for how cardiovascular practices are assessed and recognized
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Why a CVRP from the ACC?
We have a strong history of advocating for quality
We are recognized as a leader in the development of clinical guidelines, appropriateness criteria, and performance measures
We are committed to supporting and enhancing professionalism while implementing strategies that promote and foster practice innovation
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Who Better than the ACC?
We have a responsibility to our members and to the public to characterize quality cardiovascular care and to determine acceptable levels of performance.
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How Did the CVRP Evolve?
Consumers want to know:
“How do I
choose a quality cardiologist?”
Payers want to know:
“Are the cardiologists
in our network providing
quality care?”
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Who Did the Work?
The PAR4 Task Force accepted the charge in July 2007
A small working group of the PAR4,
including subspecialty society representation, produced multiple iterations for review and feedback from internal and external stakeholders
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Underlying Premises:
Be clear that the entity of interest is the practice
The CVRP is not an all or none program; it is a menu of quality indicators from which a practice can choose based on their interests and capabilities
All practices should have a reasonable ability to participate in year one
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Four Domains of Practice Recognition:
Commitment to Quality Commitment to Professionalism Commitment to Lifelong Learning Commitment to Patient-Centered
Care
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Commitment to Quality1. IAC or ACR Diagnostic Imaging Laboratory
Accreditation2. NCQA Physician Practice Connections
Recognition3. CMS Physician Quality Reporting Initiative
(PQRI)4. Participation in ABIM or ABP Maintenance of
Certification5. PCPI/ACC/AHA Performance Measure
Implementation6. Active Participation in a Recognized PCI Data
Registry7. Active Participation in a Recognized ICD Data
Registry
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Commitment to Professionalism
1. Current ABIM Cardiovascular Disease Board Certification or Current ABP Pediatric Cardiology Board Certification
2. Cardiovascular Subspecialty Board Certification (ABIM): Clinical Cardiac Electrophysiology
3. Cardiovascular Subspecialty Board Certification (ABIM): Interventional Cardiology
4. F.A.C.C. or F.A.H.A. Designation
5. Fellowship in Cardiovascular Subspecialty Designation
6. Cardiovascular Subspecialty Certification
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Commitment to Lifelong Learning
1. Documentation of Continuing Medical Education
2. Participation in Interactive Educational Activities
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Commitment to Patient-Centered Care
1. HIT: Use of CCHIT approved EMR
2. Patient Safety: E-Prescribing
3. Team-Based Care: Heart Failure Management Program
4. Team-Based Care: Anticoagulation Management Program
5. Team-Based Care: Device Management Program
6. Survey of Patient Experience
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Criteria and Thresholds
Q1. Non-Invasive Diagnostic Imaging Lab Accreditation
All individuals in practice perform tests and procedures in labs accredited or pending accreditation by IAC or ACR (hospital-based labs excluded)
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Criteria and Thresholds
Q2. NCQA Physician Practice Connections PPC (2006)
Active Recognition
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Criteria and Thresholds
Q3. CMS Physician Quality Reporting Initiative (PQRI)
Any individuals in practice participate in PQRI between July 2007 and December 2008
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Criteria and Thresholds
Q4. Maintenance of Board Certification
All cardiologists in practice holding time-limited certificates from ABIM and ABP are participating in Maintenance of Certification.
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Criteria and Thresholds
Q5. PCPI/ACC/AHA Measure Implementation
Participation NCDR IC3 and engagement in Data Quality Review for QI
OR
Practice submits Cat II codes to health plans per PQRI technical specifications and reporting thresholds for 2008 Measures 5, 6, 7, 8, and 118
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Criteria and Thresholds
Q6. Active Participation in PCI Registry
At least 50% of the PCI cases performed by each individual operator within the practice are reported to a recognized PCI data registry
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Criteria and Thresholds
Q7. Active Participation in ICD Registry
At least 50% of the ICD cases performed by each individual operator within the practice are reported to a recognized ICD data registry
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Criteria and Thresholds
P1. CV Board (ABIM or ABP) Certification
At least 90% of cardiologists in practice hold current ABIM Cardiovascular Disease Board Certification or ABP Pediatric Cardiology Board Certification.
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Criteria and Thresholds
P2. CV Subspecialty Board (ABIM) Certification: Electrophysiology
At least 50% of electrophysiologists in practice hold current ABIM Subspecialty Board Certification in Clinical Cardiac Electrophysiology
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Criteria and Thresholds
P3. CV Subspecialty Board (ABIM) Certification: Interventional Cardiology
At least 50%% of interventionalists in practice hold current ABIM Subspecialty Board Certification in Interventional Cardiology
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Criteria and Thresholds
P4. FACC or FAHA Designation
At least 80% of cardiologists in practice hold FACC or FAHA designation
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Criteria and Thresholds
P5. Cardiovascular Subspecialty Designation
Up to 50% of sub-specialists in practice hold fellowship designation in up to two cardiovascular subspecialty organizations
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Criteria and Thresholds
P6. Cardiovascular Subspecialty Certification:
At least 50% of nuclear cardiologists in practice are Diplomates of the Certification Board of Nuclear Cardiology
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Criteria and Thresholds
P6. Cardiovascular Subspecialty Certification:
At least 50% of electrophysiologists in practice who do not hold CV Subspecialty Board Certification in Electrophysiology are Certified Cardiac Rhythm Device Specialist (CCDS)
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Criteria and Thresholds
P6. Cardiovascular Subspecialty Certification:
At least 50% of cardiologists performing CCT in practice are Diplomates of the Certification Board of Cardiovascular Computed Tomography
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Criteria and Thresholds
P6. Cardiovascular Subspecialty Certification:
At least 50% of cardiologists performing echocardiographic services (Trans-thoracic, Stress, Trans-esophageal) in practice are certified by the National Board of Echocardiography
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Criteria and Thresholds
L1. Documentation of Continuing Medical Education
At least 80% of cardiologists in practice have documented 100 Category CME hours with at least ½ in CV disease in prior 2 years
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Criteria and Thresholds
L2. Participation in Interactive Educational Activities
At least 80% of cardiologists in practice are actively engaged in educational activities that focus on quality improvement, such as the ACCF Learning Portfolio or the HRS e-Learning Platform
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Criteria and Thresholds
PC1. HIT: Use of CCHIT-approved EMR
Practice documents use of CCHIT-approved EMR
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Criteria and Thresholds
PC2. Patient Safety: E-Prescribing
Practice documents implementation of Medicare Part D e-prescribing standards released by CMS in April 2008.
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Criteria and Thresholds
PC3. Team-Based Care: Heart Failure Management Program
PC4. Team-Based Care: Anticoagulation Management Program
PC5. Team-Based Care: Device Management Program
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Team-Based Carework in progress
Practice provides a multidisciplinary care process that aims to manage activities across sources and sites of care to ensure that the physician-guided, patient-centered treatment plan is occurring as agreed and adapted as needed.
Practice measures and reports Program effectiveness at least annually..….(We hope to identify at least three metrics per program for implementation)
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Criteria and Thresholds
PC6. Survey of Patient Experience
Practice documents the use of a standardized method for collecting, reviewing, and using patient experience data.
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Future Versions of CVRP
• May add indicators within domains over time
• May move from participation and reporting thresholds to performance thresholds
• May add domains such as “Commitment to Efficiency” or “Commitment to Outcomes”
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Next Steps Assign points to each of the criterion
within each domain using a Delphi process.
Each domain will be worth a certain number of points to comprise a total score.
Practices will need to achieve a certain number of points in order to achieve recognition status.
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Next Steps
30-day member comment period Determine best approach for
administration of CVRP Get feedback from Health Plans Develop a toolkit for practices,
including clear instructions and methods for achieving indicators based on practice preference
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In Summary…the CVRP
Is a practice-level recognition program designed to identify quality in cardiovascular practice
Standardizes the methodology for how cardiovascular practices are assessed and recognized
Provides a menu of quality indicators from which a practice can choose based on their interests and capabilities
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Questions?
Comments?