December 8, 2005
MINUTES
Kidney Care Quality Initiative Quality of Life Work Group
December 8, 2005
Conference Call
Attendees:
Bill Peckham
Lori Hartwell
Richard Goldman
Kathy Lester, Patton Boggs and Kidney Care Partners
Julie Black, Patton Boggs
Not in Attendance:
Bill McClellan
Lynda Szczech
Mycha Naftalin
Summary
The Kidney Care Quality Initiative (KCQI) Quality of Life/Patient Perspective Work Group reached consensus on using clinical outcome measures as surrogates for Quality of Life measures. The group also agreed to adopt “RPA’s third guideline,” expanding it to encourage ongoing educational efforts. Rather than immediately implement a survey tool, the group agreed that Quality of Life instruments should be evaluated for a number of years prior to being linked to payment.
The Work Group specified that MedPAC, IOM, or AHRQ should conduct the study.
Discussion of Quality of Life Tools
The group noted that process measures do not have the level of evidence or literature for support as outcome measures may.
The Steering Committee encourages the work group to present process measures at the Board meeting.
The Work Group noted that the list of clinical measures previously agreed to will serve as surrogates for Quality of Life outcome measures. Noting the importance of educating patients about their treatment options, the group agreed to adopt the “RPA third guideline” in an amended form to reflect the necessity of ongoing education.
The group would not support immediately adopting a particular survey tool without an evaluation period.
The members do not want to risk changing behavior in a negative way at the expense of patients. An instrument like CAHPS® may be useful to an individual facility, but not enough is known about the responses and their meanings to link it to pay for performance. The group cited MedPAC, IOM, and AHRQ as appropriate agencies to conduct a study on quality of life tools.
Discussion of Political Environment
Ms. Lester explained the political environment in which KCQA will work to implement a pay for performance program. She noted that that a pay for performance system would likely be tied to the creation of an update mechanism. The Work Group on Pay for Performance has incorporated gain-sharing into its recommendation. Physician payments would be tied to fixing the problems with the physician fee schedule. The withhold model is the most popular option on the Hill; however, the CMS bundling demonstration includes a “savings sharing” approach.
Next Steps
Ms. Lester will circulate a draft of the Quality of Life Recommendations for the group to edit.
