The NCDR Voluntary Public Reporting Program

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The NCDR Voluntary
Public Reporting Program
Combined CathPCI/ICD RSM Call
8/17/2015
Featuring
Ms. Cornelia Anderson: Program Manager - CathPCI Registry
Ms. Christina Koutras: Program Manager - ICD Registry
Mr. Mike Simanowith: Program Manager – Public Reporting
Ms. Kim Kaylor: Communications Lead – Public Reporting
Ms. Atyia Sapp: Quality Improvement Solutions Lead
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What is Public Reporting?
• Bringing the NCDR metrics to the masses
– Clinically valid, meaningful, fair and
understandable
• Why?
– Increase transparency of care quality
– Inform decisions on healthcare choices if possible
– Reassure patients when not
– Ultimately improve patient quality of care
ACC Public Reporting History/Timeline
2011
2008
ACCF PR
Policy
Paper
2012
Public Reporting
Feasibility Workgroup
2013
2014
2015*
FindAHospital
Hospital Profiles
PRAG/ PCI 30 Day
Readmission Pilot
* 2015+ timelines are
estimates as of 8/8/15
Aug
CardioSmart
Profiles
Sep Oct
2016
FindYourHeartAHome
Phase 1 Metrics
Future
Development
Metrics
Metrics on
on NCDR CardioSmart
Phase
Highlights
ACC Public Reporting Policy paper
(2008: JACC Vol. 51, No. 20)
Scientifically valid measures
Appropriate level of accountability
Feasibility Workgroup
Set Ground Rules - Voluntary, Hospital Level, NQF endorsed metrics
Identified Public Reporting measure set, chose vehicle (CMS Hospital Compare)
(2010 – 2012)
PRAG / PCI 30D Readmission Pilot
(2012 – 2013)
FindAHospital:
FindAHospital: Hospital Profiles
(2013 – 2014)
FindYourHeartAHome:
FindYourHeartAHome: Phase 1
Metrics
(2014 - 2015)
Future Development
(2016 +)
PRAG = Public Reporting Advisory Group
Developed in conjunction with physicians
Consideration of unintended impacts
Published 1 CathPCI metric in partnership with Yale-CORE on CMS Hospital
Compare
361 participating sites (22%)
Changed primary vehicle to CardioSmart.org
Engaged HMS-MassDAC for statistical analysis and metric presentation guidance
Launched CardioSmart FindAHospital Site with Profiles for all NCDR sites
Detailed Rules – Yearly data, 4* display, minimum cutoffs
• New public reporting NCDR dashboard (ICD & CathPCI) – 30 days later on CS
• Releasing Phase 1metrics: Discharge medication metrics (ICD & CathPCI)
• Metric posting to Hospital Compare
• Phase 2 metric rollout: Outcomes measures, registry composite (ICD, CathPCI)
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ACC/NCDR Public Reporting
• Voluntary, Voluntary, Voluntary!!!
– (by default you are opted-out)
• Hospital/Site level only (not physician)
• Measures developed by physicians
– Based on clinical data entered into NCDR by you
– NQF endorsed
• No charge (part of registry fee)
NCDR Public Reporting Measures
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NCDR Metrics for Public Reporting
Source
Registry
External
Data
NQF
Endorsed
Registry
OR Line
ICD
No
Yes (0965)
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HF/LVSD: Beta Blocker at Discharge
ICD
No
Yes (1529)
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HF/LVSD: ACE/ARB Therapy at Discharge
ICD
No
Yes (1522)
4
CAD/MI Beta Blocker at Discharge
ICD
No
Yes (1528)
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CathPCI
No
Yes (0964)
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Aspirin at discharge
CathPCI
No
Yes (0964*)
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Thienopyridine (P2Y12 inhibitor) at discharge
CathPCI
No
Yes (0964*)
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Statins at discharge
CathPCI
No
Yes (0964*)
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CathPCI
No
Yes (0133)
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ICD
Yes – CMS
Yes (0694)
CathPCI
Yes – CDC
Yes (0535,0536)
CathPCI
Yes – CMS
Yes (0695)
Measure
Composite discharge meds in ICD patients
(ACE/ARB and Beta Blocker)
Composite discharge meds in PCI patients
(Aspirin, P2Y12 inhibitor, Statin)
PCI inin-hospital risk adj. mortality
(Patients with STEMI and patients without STEMI)
30 or 90 day complication rates after ICD
3030-day all cause risk adj. mortality after PCI
(Patients without STEMI or shock and patients with STEMI or shock)
3030-day risk adj. readmission rates for PCI
*NQF #0964 is currently approved as a composite metric only for all meds.
Phase 1
Sep/Oct
2015
Future
2016?
Detailed Rules of Engagement
• Opt in by registry (not by metric) – ICD and
CathPCI Data Release Consent Form
-
Opt in now, no deadline - ~2 day lag time from DRCF processing
-
Withdraw at any time via email to NCDR
-
Next year DO NOT need to re-sign once you sign up once
• Report and update once per calendar year
-
First report on 2014
• Minimum of 3 quarters (ICD @ Premier level)
of green data in calendar year to report
- Determined at time of report aggregation (~Q4 outcomes report)
• International sites excluded
• 30 day preview of data on NCDR before
public display on CardioSmart
• Did we mention it is VOLUNTARY?
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Participation Display
PR Participation
Status Categories
•
•
•
•
•
•
•
Participating with ACC
Not Participating with ACC
Enrolled: In Registry Less Than 1 Report Year (<3Q of data)
Enrolled: Not Enough Data to Report (<3Q green)
Ineligible: Not Participating in Registry
Ineligible: Does Not Perform Services
Ineligible: Not a US Hospital
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Public Reporting Information
http://cvquality.acc.org/NCDR-Home/About-NCDR/Benefits-of-Participating/ACCPublic-Reporting.aspx
Metric Scoring & Display
Some Key Challenges……………..
How best to display this information so it is understandable by the
PUBLIC, but still clinically meaningful.
How to fairly categorize performance on metrics?
How to assess hospital performance on key metrics and show
comparisons with other NCDR facilities ?
How to account for inherent uncertainty and low volume sites?
Help!!
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Display Performance so it is Understandable
by the Public but Still Clinically Meaningful
Best Practices in Public Reporting
http://archive.ahrq.gov/professionals/quality-patient-safety/qualityresources/tools/pubrptguide1/pubrptguide1.html
• The amount and way that
information is displayed makes a
difference in whether consumers
can actually process it and use it in
decision-making.
• Information displays that help
consumers quickly see the meaning
in the data increase motivation to
use the data and actual use of the
data.
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Metric Display
Assessing
Performance
• Scored on model created from observed data (P value)
Minimum cases/year
to score
• ICD – 11 / year
• CathPCI – 25 / year
• All metrics same cutoff in registry
Grouping / Display of
Performance
• 4 categories of performance set based on P value
• Displayed as 1,2,3,4 star icons - no 0 stars or (½) stars
Defining Star
Categories
• All Phase 1 metrics have same cutoffs
- Pulls low volume hospitals toward mean
- Your P score may not be exactly the same as OR score
- 1* (P<75%), 2* (75 – 89.99%), 3* (90 – 94.99%), 4* (>=95%)
• Categories set based on clinical guidelines (not on
relative performance against other hospitals)
- Possible for all hospitals to be in one star category or no
hospitals to be in a star category
Uncertainty
• Confidence interval estimates on P value will be available
on drilldown only
State score
• In addition to hospital score there will be a state
score/star value that is for all hospitals in the state
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The Great Reveal……
Please note that all slides marked
with WIREFRAME are conceptual
renderings. The actual final
product may be modified due to
technical constraints or other
considerations.
In addition, all data presented is
fictional - for display purposes only.
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NCDR – “Other Reports” Tab
NCDR Public Reporting Dashboard
WIREFRAME
• New NCDR Public Reporting dashboard available from a new ‘Other Reports’ tab
- Reference to Outcomes Reports measures
- Displays exactly how metrics will appear to public on CardioSmart
• Metric table will not display if site is ineligible due to too few submissions/green
quarters
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Public Display on CardioSmart
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Find Your Heart a Home
Find
all NCDR
hospitals
Compare
Services
NCDR Programs
Metrics
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Proposed
NCDR Metric
Display on
CardioSmart
Hospital
Profiles
WIREFRAME
Click for scoring
interpretation guide
[See next 2 slides]
Drill down to details of
metric score
(Model value, 95% CI)
Note: Heartcare Hospital USA
is a fictional example.
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Scoring
Interpretation
Guide
WIREFRAME
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Metric Details on CardioSmart WIREFRAME
• Performance model score and confidence intervals will be displayed only when the
CardioSmart user drills down into the star rating for each metric
- Scoring available at hospital and state level.
Communication Opportunities for
Hospitals
• Ensure patients receive credible
information about your hospital
• Showcase your institution’s quality efforts
to patients and stakeholders
• Distinguish your hospital from other
institutions
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Campaign Concept
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Campaign Strategy
•Geo-Targeted Pilot Program
•Partner and Third-Party Engagement
•Media Outreach and Engagement
•Disseminate Materials via NCDR Hospitals & ACC
Chapters
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Communications Kit
• Communications Kit: Print and digital materials
to help your hospital demonstrate its dedication to
quality and explain the benefits of Find Your Heart a
Home tool
• Sample materials:
– Fact sheet/brochure
– Digital and print ads
– Press release
– Social media messages
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Quality Improvement Tool(s)
• The first set of ACC Public Reporting tools to be
released with the launch of the NCDR Public
Reporting Program is intended to help hospitals
ensure that all steps in their data management
process produce complete, accurate, reliable, and
valid data.
• Future ACC tools will be released to help hospitals
improve specifically on the publicly reported metrics
for the ICD Registry and CathPCI Registry.
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Quality Improvement Tool(s)
• Research
– NCDR abstracts
– Interviews with Program Managers
• Essential Elements
– Process (i.e., task forces, case reviews, QA frequency, validation)
– Education/training (i.e., abstractors, clinicians)
• Initial Tool – Data Quality “Checklist” Overview
–
–
–
–
–
–
Develop a Multidisciplinary Team
Review the Current Data Capture Process
Identify the Problem(s)
Brainstorm with the Team
Use Tools to Implement Solutions
Evaluate Effectiveness of Process
What’s Out There Now?
Federal
Government
• Hospital Compare
• Physician Compare
• CMS physician payment and drug Rx
release
State
Government
• State Public Reporting Programs
• MA, NY, PA, CA, WI, WA, TX, others
Independent
Groups
• HealthGrades, Truven, AnalyticsMD,
ProPublica, Consumer’s Checkbook
• Leapfrog, US News & World Reports
• Others
Insurance
providers
Consumer
Websites
• Aetna, BCBS
• Others, but you don’t know it
• RateMD.com, Angie’s List, Yelp, etc
• Price transparency sites
• (Healthcare Blue Book, Catalyst for
Payment Reform, etc . . . )
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but there are gaps..
• Often based on claims
data only
• Need greater
transparency
• Not all based on
accepted quality
metrics (NQF, NCQA
standards)
• Should be developed
by physicians and have
independent review
• Confusing to
consumers
Why ACC/NCDR Public Reporting?
1.
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Demonstrate commitment to transparency and quality improvement
- Patients are looking for information and will find it (it’s out there).
2.
ACC Public Reporting is entirely voluntary, withdraw at any time.
- 30+ day window to review data privately and decide to opt-in or rescind consent.
3.
4.
You directly affect the quality of the data you report to the public.
ACC Public Reporting uniquely integrates measure reporting and patient
education in one platform (CardioSmart)
-
5.
One site for patients to learn about hospital performance and educate themselves on CV care
Extensive steps taken to report clinically relevant measures and to consider
what is fair and equitable to participating sites.
– Developed in partnership with physicians
– Rely on clinical data and risk-adjusted
6.
- NQF endorsed
- Scored based on clinical guidelines (not tiers)
ACC is committed to supporting your participation in the program and the
communication AND improvement of your results.
-
NCDR site, instructional webinars, and ACC support staff dedicated to answering your questions
Sample messaging to assist you in explaining your results for ALL star categories
Tools to help you improve your performance and ultimately the quality of care you deliver
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Questions?
• Phone: 800-257-4737
• Email: NCDR@acc.org
Please use the subject line “CardioSmart Public Reporting.”
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