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

Goals of the Act

• Expand coverage • Reform the delivery system including

insurance. • Lower the overall costs of providing

care

The Patient Protection and Affordable Health Care Act

Became law March 23, 2010

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

Value Based

Healthcare

Payment based upon actual value

delivered

Integrated care organized around patient

or disease

Coordinated care delivery across care

settings

Enabling IT platform

(infrastructure, analytics

Specific measured

outcomes for every aspect

of care

Incentives aligned

around shared definition of

value

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.

© Optum 2013. Used with permission. 130211_V1_DI 7

Value = ÷

What are we measuring?

• Patient Selection

• Death on the Wait List (BTT)

• Complications

• Length of Stay

• Functional Improvement

• Quality of life

• Return to Employment

• Survival

Quality VALUE

Only medical, pharmacy cost?

• Implant admission

• HF management pre-implant

• Billed charges

• Paid claims

• Device management

Cost

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

• 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.

Endorsed Quality Measures

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