August 1, 2007
Kidney Care Quality Alliance
Attendees:
| AbbVie Laboratories | Rob Abilez |
| American Health Care Association | Sandy Fitzler |
| American Kidney Fund | LaVarne Burton |
| American Nephrology Nurses Association | Gail Wick |
| American Society of Nephrology | Paul Smedberg |
| American Society of Pediatric Nephrology | Sharon Andreoli |
| Barbara Fivush | |
| Jennifer Shevchek | |
| Amgen, Inc. | Yola Gawlik |
| Baxter Healthcare Corporation | Gary Inglese |
| Centers for Medicare and Medicaid Services | Barry Straube |
| DaVita Healthcare Partners, Inc. | Charles McAllister |
| LeAnne Zumwalt | |
| DaVita Patient Citizens | Chad Lennox |
| Fresenius Medical Care North America | Ray Hakim |
| Kathleen Smith | |
| Genzyme | Greg Madison |
| Kidney Care Council | Margaret Moore |
| National Kidney Foundation | Dolph Chianchiano |
| Jayne Mardock | |
| National Minority Quality Forum | Gary Puckrein |
| National Renal Administrators Association | Maureen Michael |
| Renal Physicians Association | Jim Weiss |
| Roche | Susan Graf |
| Linda Dyson | |
| National Quality Forum | Helen Burstin |
| Summary Dr. Helen Burstin, NQF Senior Vice President of Performance Measures, provided an update to members on the status of the NQF endorsement process for ESRD measures, indicating that the process should conclude in November. Dr. Barry Straube reviewed the CMS reporting and pay-for-performance initiatives and suggested areas where the ESRD community may have a role. Members received a report on Phase II of measure development and a potential partnership with the AMA Consortium from KCQA Steering Committee Co-Chair Dr. Ray Hakim.Update on NQF ESRD-Measure Endorsement ProcessHelen Burstin, MD, MPH, Senior Vice President of Performance Measures at the National Quality Forum (NQF), reported that the NQF received 44 measures from multiple developers including KCQA, the Renal Physician’s Association/Physician Consortium for Performance Improvement (RPA/PCPI), and CMS. She explained that the NQF ESRD Steering Committee reviewed the measures using four criteria, and will meet tomorrow to make its final recommendations on measures to endorse. The recommendations will then be made available for NQF member and public comment. She reported that comments will be considered by the NQF Steering Committee, which can request that measure developers make additional changes. NQF members will then have one month to vote on endorsement of measures. The NQF Board will have a one-week period in which it can weigh-in on endorsement. She explained that based on CMS’ needs, the project will be completed by November. Dr. Burstin noted that difficulties have arisen due to the number of similar measures submitted and intellectual property issues.One Alliance member noted that conclusive scientific evidence does not exists on ESRD and minority populations. He asked how NQF is addressing this deficiency in the underlying science. Dr. Burstin responded that no measures submitted were specific to any race or ethnicity. She explained that in the ambulatory care project, a set of measures has been identified, which were thought to be sensitive to racial and ethnic disparities. She noted that Neil Powe, NQF ESRD Steering Committee Co-Chair, is particularly interested in this issue and that the Steering Committee will likely recommend stratifying endorsed measures.Update on CMS Quality Initiatives and Pay for Performance within ESRD ProgramDr. Barry Straube, Director and Chief Clinical Officer at the CMS Office of Clinical Standards and Quality, provided an overview of settings in which CMS is operating quality and pay-for-performance initiatives.Dr. Strabue explained that the Secretary has announced a Value-Driven Health Care Initiative to focus on health care at the local level. He noted that the Secretary has involved: (1) community leaders; (2) chartered value exchanges, which include local collaboratives focused on quality improvement and use of aggregated data with public reporting; and (3) six communities in six states that are testing data aggregation and public reporting. Dr. Straube noted that the kidney community could focus on quality improvement and public reporting and indicated that large dialysis facilities are already doing this.Dr. Straube explained that CMS is working on its Hospital Quality Initiative report, which is due to Congress in January 2008. He discussed the Premier Hospital Quality Demonstration, and stated that evidence suggests that payments for reporting lead to a better data set as compared to voluntary reporting. He stated that hospitals that participate in public reporting improve more than hospitals that participate in pay-for-performance.Dr. Straube reported that pay-for-performance is currently the focus of Congress in terms of payment reform and predicted that pay-for-performance in ESRD will be implemented. He noted that CMS began the Physician Quality Reporting Initiative in July 2007; however, Congress may eliminate the funding for the bonus payments.Dr. Straube stated that CMS will issue its report to Congress about the feasibility of a bundled composite rate payment system for dialysis in the next few weeks to two months. He explained that before a bundled payment demonstration is considered, CMS will need to present its report.Dr. Straube shared that CMS has made renal CROWNWeb the number one priority for information resources so that conditions for coverage can be released in early 2008. He noted that Congress recommended mandatory data submission through CROWNWeb.Dr. Straube commented that measure development is important in driving quality improvement and transparency. He noted that developing measures will require closer cooperation among CMS, KCQA, RPA, and other organizations. Dr. Straube suggested that additional measures focus on care coordination, efficiency, and episodes of care. He noted that the kidney community could lead in improving care coordination. He reported that CMS is focusing on health disparities.One KCQA member asked Dr. Straube how he conceptualized pay-for-performance measures in relation to exclusions and benchmarks. Dr. Straube responded that all twenty-seven hospital measures are risk-adjusted to an extent and noted that CMS does not want measures that would enable gaming of the system. He added that if risk adjustment does not effectively level the playing field, CMS may want to incentivize providing care to the sickest patients. He noted that rewards should be given to both those providers that are in the top deciles and those that improve from their own baseline.One KCQA member asked Dr. Straube if patients could “opt out” of a demonstration, and another noted that because the ESRD demonstration would not reform the facilities’ payment system, it is not critical that every patient be counted for in the same way. Finally, one member, who noted that physician indicators will be used in the PQRI once NQF endorses ESRD measures, asked how facility-level indicators will be used. Dr. Straube responded that while pay-for-performance on the physician level is feasible because Congress appropriated funds for the program, no funds have been allocated on the facility side for pay-for-performance or pay-for-reporting.Update on Phase II of the Kidney Care Quality InitiativeDr. Hakim reported that at least three other measure developers submitted adult ESRD measures and quality of life measures. He stated that in Phase II of the KCQI, the Steering Committee will form work groups to develop measures and make recommendations for implementation. He shared that CMS may ask for additional ESRD measures and that the KCQA should be prepared.One Alliance member suggested that the Steering Committee form a work group focused on minority populations in the ESRD community. Dr. Hakim noted the suggestion and offered that that Steering Committee may want to integrate this focus into each of the work groups.Dr. Hakim reported that the KCQA and AMA have had discussions regarding a collaboration to develop the next phase of ESRD measures. He noted that the organizations are working to develop ground rules for the partnership and conveyed that a partnership would strengthen the presentation of measures before the NQF. |
