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Rami Doukky, MD, MSc, FACC, FASNC Professor of Medicine, Preventive Medicine & Radiology
Chief, Division of Cardiology John Stroger, Jr. Hospital of Cook County
Director, Stress Testing Laboratory Rush University Medical Center
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Astellas Pharma - Research Grants
- Advisory Board
ASNC - Board of Directors
- ImageGuideTM Registry Oversight Committee
Disclosures
Slides Curtesy of Peter Tilkemeier and ASNC
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Evidence Application Outcome
Registry
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Concept
Outcomes
Clinical
Evidence
Guidelines
Decision Support
+ QI Initiatives
Measurement + Feedback
Clinical Registries
Adapted from Califf RM, Peterson ED
et al. JACC 2002;40:1895-901
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What is ImageGuideTM?
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The ImageGuide Registry is the first cardiovascular registry of its kind, focusing on SPECT and PET imaging
studies.
The primary purpose of the registry is quality improvement, and it provides a fully integrated platform to seamlessly collect data in nuclear imaging labs to measure
quality, safety, and efficiency.
What is ImageGuide?
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To support nuclear cardiology specialists and laboratories in their efforts to enhance the quality,
safety, and value of nuclear cardiology in clinical care locally, nationally, and across the globe.
ImageGuide Mission
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1. To provide timely data feedback and tools for nuclear cardiology practices
2. To facilitate fulfillment of regulatory and other reporting requirements
3. To inform health policy and reimbursement advocacy
4. To demonstrate the value of nuclear cardiology
5. To serve as a platform for research and education
ImageGuide Goals
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ImageGuide provides the operational framework to support a community of practices committed to
patient centered imaging, practice
transformation, and innovation through
ongoing data collection and quality
improvement.
Data Collection
Practice
Payment
Quality
Research
Background
Accreditation
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ImageGuide Purpose
ImageGuide enables
providers to track data for
each study
Captures standardized data across all practices
Providers can benchmark
performance on location,
practice, and national
levels
Quality is ever-evolving
Improves Value of Nuclear
Cardiology
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Data Structure
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Permissible Values
Structured and standardized sources
• DICOM (Digital Imaging and Communications in Medicine)
- Distribution and viewing of medical images
• SNOMED-CT (Systematized Nomenclature of Medicine - Clinical Terms )
- Reference set of terminology
• HL-7 communications standard
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Use of Structured Data
1. Complies with guidelines for interpretation & reporting
2. Insures utilization of a single “language”
3. Allows comparison of data from multiple sites
4. Facilitates data flow
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Data Submission Methods
Web-based Data Collection Tool Web-based data collection tool to manually enter imaging study data directly into the registry.
ASNC Certified Reporting Vendor ASNC has partnered with reporting vendors to collect and submit all required data elements to the registry.
EHR/EMR/Imaging System It may be possible to automatically extract and submit data from EHR/EMR/Imaging System.
Future integration in major structured reporting software is key
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Automated Data Entry
- Studies will automatically be added to the registry file when the physician signed the report.
- Prevents “cherry-picking”
- There is work involved at the onset of the project, once it is in place there will be little maintenance.
- This pathway provides “real-time” feedback to physicians, allowing for meaningful, targeted, QI programs and ultimately improve the quality of care for patients.
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• Study referral information
• Patient demographics
• Clinical information
• Stress testing data
• Resting ECG data
• Imaging parameters
• Radiation dosing
• LV perfusion
• LV perfusion quantification
• Stress LV function parameters
• Resting LV function parameters
• Study quality
• RV parameters
• Signature date/time
Data Element Categories
Hundreds of data elements
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Nuclear Cardiology Study Workflow in the Future
Patient Assessment
Stress Imaging Study
Interpretation
Signed Report
Extract Data to ImageGuide
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What is for me in it?
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Why Participate in a Registry?
• Advance clinical practice
• Enhance patient care
• Justify services to payers and policymakers
In the current evolving healthcare
environment, in which reimbursement is
increasingly tied to performance, it is
essential that medical professionals take part in quality improvement
initiatives to:
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Physicians are required to participate in mandatory quality tiering under the Value-Based Modifier Program (VM)
Upward and downward payment adjustments based on participation Physician Quality Reporting System (PQRS)
2016 Value-based Payment Modifier Program
PQRS, Physician Quality Reporting System
ImageGuide is a CMS-designated Qualified Clinical Data Registry (QCDR), through which one can receive credit under Physician Quality Reporting System (PQRS).
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Regulatory Update
What is a Qualified Clinical Data Registry
(QCDR)?
• QCDRs are a CMS reporting mechanism that allow registries to
develop their own performance measures
Providers who report via QCDR can receive credit under
Physician Quality Reporting System (PQRS)
• Providers must satisfactorily report on 9 measures in 2016 or
receive penalties
QCDR, Qualified Clinical Data Registry PQRS, Physician Quality Reporting System
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ImageGuide & MIPS
The traditional PQRS & VM programs will sunset on December 31st, 2018 and will be replaced by
the Merit Based Incentive Payment System (MIPS)
Providers who do not successfully report on
quality measures will be subject to higher negative payment adjustments in
subsequent reporting years:
Participation in a QCDR can aid in achieving
successful and meaningful quality reporting
2019
-4%
2020
-5%
2021
-7%
2022
-9%
MIPS, Merit Based Incentive Payment System
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Sample Penalties Under PQRS/VM & MIPS
$-
$10,000.00
$20,000.00
$30,000.00
$40,000.00
$50,000.00
Annual Per-Physician Penalties Based on $500,000 in CMS Receivables
Penalty (USD)
-2% (PQRS) + -4%* (VM)
-4% (MIPS) -5% (MIPS) -7% (MIPS) -9% (MIPS)
*Physicians in groups of 1-9 will receive a -2% penalty for
unsatisfactory PQRS participation under the VM
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ImageGuide vs. Other CV Registries
• In office practice, ImageGuide requires entry only nuclear imaging tests rather than every patient encounter
• Hospital-based registries (NCDR) may not apply to physicians not performing invasive procedures
• NCDR is labor intensive vs ImageGuide which can be automated
• Good choice for imaging physicians
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Performance Measures
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ASNC 1 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Preoperative
Evaluation in Low-Risk Surgery Patients
ASNC 2 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Routine Testing
After Percutaneous Coronary Intervention (PCI)
ASNC 3 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Testing in
Asymptomatic, Low-Risk Patients
ASNC 4 Utilization of Standardized Nomenclature and Reporting for Nuclear Cardiology Imaging
Studies
ASNC 5 Single-Photon Emission Computed Tomography (SPECT) Myocardial Perfusion
Imaging (MPI) study report turnaround time 24 hours
ASNC 6 Positron Emission Tomography (PET) Imaging Study Report Turnaround time < 24 h
ASNC 7 Nuclear Cardiac Stress Imaging Not Meeting Appropriate Use Criteria
ASNC 8 Laboratory Accreditation for Nuclear Cardiology Imaging Studies
ASNC 9 Physician Reader is CBNC or Nuclear Medicine Certified
ASNC 10 Nuclear cardiology Imaging Studies Terminated Due to Technical Problems
ASNC 11 Overall Study Quality
2015 QCDR CMS Approved Quality Measures
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First Year as a QCDR
• As a QCDR, ImageGuide submits data to CMS on 11 measures.
• This information is not publicly reported in the first year.
• As measures evolve and mature they will be publicly reported.
• 2016 measures were just completed and submitted to CMS for approval
- Radiation exposure
- Use of stress only protocol
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ImageGuide Benefits
Fulfil Reporting Requirements
Avoid negative payment adjustments on all services
billed under Medicare Part B by successfully participating
in PQRS via QCDR
Report on performance measures developed by and
for nuclear cardiologists
Demonstrate Value
Gain access to standardized data to present to all payers
that demonstrates appropriate use of nuclear imaging tests in a practice
setting
Participate in a community of providers dedicated to
improving patient care and demonstrating the value of
the profession
Proactively Contribute to Shaping
Healthcare Reform
Contribute to a system that gives Nuclear Cardiologists a
voice in how they are measured
Succeed in a market of quality-based reimbursement
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Short Falls
No outcome data
ImageGuide is a diagnostic procedure registry
• The relationship between the test and the outcome is indirect, dependent upon changes in management by the overseeing physician
Limited ability to integrate ImageGuide with older reporting and imaging systems in current use
• Will improve going forward
Data represents only performance of voluntarily participating sites
• Quality practices, Preaching to the quire?
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Physicians
Industry
Payers
Federal
CMS Value-based purchasing
FDA post market surveillance, NIH/AHRQ research
State
State-level reporting and mandates
Government
Cardiovascular Imagers Leading Publications: JNC, JACC, JACC Imaging Payment Dominant membership position Negotiations Clinical Team Technologists Primary Care Improved referrals Informed clinical decision-making
Innovation and Growth
Clinical Credibility
Data Queries
Informed Payer Coverage
Inform Payers and CMS
Drive Core Measurement of the Field
Defined Value of Technology
Nuclear Lab Report Card
Incentivizing high quality CV care
Centers of Excellence
Promoting Appropriate Use Criteria
Links with ACO, PCMH, ICNAL, CBNC, ABIM
VALUE
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Summary
• ImageGuide is a CMS designated QCDR helps in fulfilling regulatory requirement
•Provide feedback and facilitates quality improvement and better patient care
•Support practices in providing high value, safe practice
• Inform health policy and payment strategies
• Inform research and education efforts
•A resource for laboratory accreditation
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Thank You!
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Additional Information
email [email protected] with any questions.
Visit http://www.asnc.org/imageguide Web portal demonstration Complete data element list Sign-up portal access & requirements FAQs
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Imaging Registry: Laboratory driven
ASNC ImageGuideTM
CMS Qualified Clinical Data Registry Reporting (QCDR)
Objectives:
• Improve overall lab performance and patient safety
• Increase value
•Create a community
•Provide tools and resources
•Provide feedback / benchmarks
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ImageGuide 2016 QCDR Status
ImageGuide was recognized as a QCDR in 2015
Self-nomination applications must be submitted annually
ASNC submitted Self-Nomination & Data Validation Plan on January 31, 2015
Approval of 20 proposed performance measures anticipated in March
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How Does ImageGuide Differ From Other Registries?
Representation of Nuclear Cardiology
Other hospital-based registries may not apply to physicians not performing invasive procedures
ImageGuide captures a greater level of granularity on nuclear imaging studies
Efficient Quality Improvement
Other office based registries require data submission for every patient encounter
ImageGuide requires data collection only on nuclear imaging tests
ImageGuide is an effective solution for imaging physicians
ImageGuide does not duplicate any existing system Data collection is focused on SPECT and PET studies
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Sample Penalty Illustrated
Medicare 2% Penalty
Penalty applies to TOTAL Medicare receivables NOT only nuclear cardiology related CPT codes
• 2018 Total receivables for one physician
- $500,000
• In 2018 Medicare will apply 2% penalty if not in compliance with Merit-based Incentive Program (MIPS)
- $10,000
Medicare 9% Penalty
Penalty applies to TOTAL Medicare receivables NOT only nuclear cardiology related CPT codes
• 2022 Total receivables for one physician
- $500,000
• In 2022 Medicare will apply 9% penalty if not in compliance with Merit-based Incentive Program (MIPS)
- $45,000
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Enrollment
Practice administrators can enroll via ImageGuide’s online Sign up portal
• Information is collected on the site and participating providers
• Participation agreements with sites must be executed to complete enrollment
The first 100 members to enroll before May 1st will participate in ImageGuide for free in 2016
• Annual per-provider participation fees for 2016 are $500/ASNC member and $750/nonmember
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What does it offer the providers
• Real-time feedback reporting - Allows practices to monitor and improve nuclear imaging
- Quality Improvement & Radiation Safety
• Meet regulatory challenges - Eases accreditation
- Platform for Physician Quality Reporting System (PQRS)
• Provides report card and testament for quality, “Bragging rights”
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QCDRs & 2016 PQRS Reporting
• QCDRs are a CMS reporting mechanism that allow registries
to develop their own performance measures that satisfy PQRS requirements
What is a Qualified
Clinical Data Registry?
• Providers must satisfactorily report on 9 quality measures for 50% of patients
• Providers who fail to meet reporting requirements in 2016 will receive a 2%
penalty on all CMS Part B receivables in 2018
Providers who report via QCDR can receive
credit under PQRS
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Physicians are required to participate in mandatory quality tiering under the Value-Based Modifier Program (VM) program
Upward and downward payment adjustments based on participation Physician Quality Reporting System (PQRS)
The maximum downward adjustment is up to -4%* in addition to the 2% PQRS penalty
2016 Value-based Payment Modifier Program
2016 Penalties for Unsatisfactory PQRS Participation
PQRS VM Total
1-9 Providers
-2% -2% -4% (in 2018)
10+ Providers
-2% -4% -6% (in 2018)
*In 2016, providers will receive upward, neutral, or downward payment adjustments based on quality
tiering results
PQRS, Physician Quality Reporting System