January 3, 2006
MINUTES
Kidney Care Quality Initiative Quality of Life Work Group
January 3, 2006
Conference Call
Attendees:
Bill McClellan, Facilitator/Leader
Lori Hartwell
Kathy Lester, Patton Boggs and Kidney Care Partner
Amy Yenyo, Patton Boggs
Julie Black, Patton Boggs
Summary
The Kidney Care Quality Initiative (KCQI) Quality of Life Work Group revised its Phase I recommendation document.
Discussion of Pay for Performance Outlook
Sen. Grassley is likely to push much more comprehensive pay for performance legislation this year. Rep. Thomas, Chairman of the Ways and Means Committee is committed to introducing pay for performance legislation this spring. Ms. Lester noted that the Senate Reconciliation Package no longer contains an ESRD pay for performance provision.
Discussion of Quality of Life
The discussion focused on the concerns raised by the patient representatives on the Work Group. More specifically, the group discussed whether to advocate for inclusion of certain measures in Phase I or if such discussion is more appropriate in Phase II. Compliance with treatment time and modality choice could be among the process measures.
The Work Group liked the idea that the patient community is identifying process measures as important to the quality of life.
Ms. Hartwell noted that the new physician payment system has exacerbated the problem of hours offered for patients to undergo dialysis. No forum existed to discuss this issue at the time the change was made; however, Ms. Hartwell had conversations with Brady Augustine at CMS to share the consequences of the change.
MedPAC is examining the correlation between the change in payment system and access to care. While not a large part of KCP discussions, this issue was addressed in the KCP legislation, which in part, would require the IOM to analyze the effect of changes in payment on patients care.
Specific metrics to consider are modality choice, length of treatment, and patient adherence to treatment. It is unclear how to position the issue as quality of life as opposed to one of the quality of care.
Another fundamental issue is whether to pursue the development of these measures within this Work Group or make a recommendation to the Clinical Measures work group. The work group agreed to consider four quality of life measures during Phase II:
1- Availability of after-hours dialysis options
2- Treatment adherence
3- Modality choice
4- Patient advocacy and self-care
The group noted that the idea behind modality choice is that patients will suffer less depression and anxiety with home dialysis than if they were exposed to the adverse outcomes of other patients in treatment centers. Dr. McClellan mentioned that Nancy Cuther should be involved in the conversation, given her expertise in developing metrics.
Ms. Hartwell mentioned that with regard to patient autonomy, treatments could occur in home or in well-bound facilities, like those of SatelliteHealth.
The group discussed whether the metrics were developed enough to be included in Phase I or whether they are launching points the Phase II conversation. The Work Group agreed that Phase II is an appropriate venue for consideration.
Dr. McClellan recalled comments from a Steering Committee member, who suggested that while a quality of life instrument is a matter of future study, the initial implementation of a pay for performance program should require facilities to note whether quality of life is being measured. The group agreed that during the initial phase, regardless of tool used, facilities should measure quality of life.
The group agreed to amend the Phase I Recommendation Document in several ways. They will add a bullet to recommend ongoing assessment of patient satisfaction and quality of life, without regard to the tool used. In addition, rather than stating that measures will correlate with quality of life, the group will express that measures will correlate with processes of care. The group will expand the goal of vascular access by recommending
a percentage of patients with fistulas, rather than encouraging fistulas.
The work group recommends inclusion of Quality of Life metrics in a pay for performance program. They agreed that processes known to have a correlation should be included. Until better evidence is developed, physicians should measure quality of life with their instrument of choice.
Next Steps
The draft recommendations will be further revised as discussed on the call.
