July 5, 2006
MINUTES
Steering Committee
July 5, 2006
Conference Call
Participants
Charlie McAllister, DaVita Inc.
Alan Kliger, Renal Physicians Association (RPA)
Ed Jones, RPA and Kidney Care Partners (KCP) Chairman-elect
Michael Lazarus, Fresenius Medical Care North America (FMC)
Maureen Michael, National Renal Administrators Association (NRAA)
Kent Thiry, DaVita Inc. and KCP Chairman
David Warnock, National Kidney Foundation (NKF)
Sandra Watkins, American Society of Pediatric Nephrology (ASPN)
Gail Wick, American Nephrology Nurses Association (ANNA)
Linda Keegan, KCP
Caitlin McCormick, Patton Boggs
Kathleen Strottman, Patton Boggs
Eli Tomar, Patton Boggs
SummaryThe Kidney Care Quality Alliance (the Alliance) Steering Committee (the Committee) discussed the clinical measures which the Work Group recently completed.
Several suggestions were made as to possible modifications and additions. The Committee voted to approve the clinical measures with the understanding that their suggested changes will be incorporated into the final document.
Opening Statements
The Committee discussed voting procedure for organizations with a seat on both the Committee and the KCP Board of Directors and the possibility those two individuals vote differently. The KCP guiding principles state that a Member of the KCP Board is free to vote in any manner they chose regardless of previous action by the member organization.
Status of the Clinical MeasuresDr. McAllister summarized the process the Work Group undertook in reaching a consensus on the clinical measures. He discussed the political environment and noted that, despite the likelihood that certain groups may not be completely satisfied, the group feels the measures are supported by hard science as well as the vast majority of the kidney care community. Dr. McAllister noted that the group discussed the area of bone and mineral metabolism and found that it was a controversial area with little hope for agreement among experts.
Thus, they concluded it was not the proper time to adopt a measure. The group also considered including a measure addressing diabetes management and hemoglobin-C, but chose not to include measures for these areas due to lack of fully-developed of measures in the field.
In the area of transplant referral, the group felt there was little area for improvement and consequentially did not include any measures for this field.
Dr. McAllister explained that the Work Group decided to aggregate the measures across two domains; a domain for dialysis facilities and one for individual physicians.
He walked through the measures for each domain, highlighting the group’s recognition of the inherent difficulties on the physician level that result from the absence of a formal system for collecting data.
Dr. McAllister described the Work Group’s struggle with the wording of the influenza vaccination measures.
Dr. Jones expressed concern that the exclusion of patients who refuse the vaccine contradicts language referring to patients who are “offered” vaccination rather than patients who “receive” it.
He also suggested including a definition of patients with permanent catheters in the measures. Dr. McAllister proposed an amendment to the recommendations to address these issues.
Dr. McAllister reintroduced the recurring debate over process versus outcomes-based measures, emphasizing the spirited debate over the application in physician measures.
Dr. Jones inquired about obtaining physician data.
Dr. McAllister acknowledged the difficulties associated with reporting, but suggested using medical records, order sheets, lab records, and other paper records.
Dr. Lazarus stated that nursing staffs would not and could not collect physician data, and suggested clear specification as to what can and cannot be abstracted since a general records review is impracticable. Dr. McAllister reminded participants that the group developed specific recommendations for kinetics.
Ms. Michael advised against placing the burden of gathering physician data on the facilities.
She also recommended clarifying the definition of a change in modality.
Dr. Lazarus warned that while reporting is quarterly, the MCA payment is monthly, so the measures should specify that the physician receives the majority of the MCA payment for the month.
Dr. Kliger proposed three recommendation to the group. First, the Work Group clearly define permanent catheters; second, the influenza vaccination measure be based on vaccinations administered, not recommended; third, reporting should include what actions physicians take when hemoglobin is below 11, in addition to a plan of correction.
After Steering Committee members had the opportunity to voice their concerns and offer recommendations, Dr. McAllister outlined the options available to the Committee.
No members of the Committee voted to pass the clinical measures document as written and no members voted to reject the document.
The Steering Committee unanimously agreed to accept the document with the Committees recommendations, which include:
Recommendation 1: It should be made clear that the facilities are not responsible for data collection.
Recommendation 2:
Provide more clarity as to what is meant by “same modality,” particularly as it relates to home dialysis.
Recommendation 3:
Define what is meant by permanent catheter
Recommendation 4:
Change vaccination measure from “offered or recommended” to “received”
Recommendation 5:
Change the aggregate level for physicians from “for whom they receive the MCP” to “for whom they receive the majority of the MCP” because MCP is reported monthly
Recommendation 6:
Add a process measure to the HgB measure to better monitor what actions a physician takes when hemoglobin level is below 11.
Next Steps:
Once the Work Group incorporates the Committee’s recommendations, the document will be presented to the KCP Board by Dr. McAllister and Dr. Kliger. The KCP Board will convene a conference call to review the clinical measures on July 10 at 5pm and hold follow up calls on July 14 and July 24 with the opportunity for questions and comments.
The KCP Board will vote on July 24 at 5pm. On July 26 from 1 to 5pm, there will be an in-person meeting of the Alliance in Washington, DC.
Several Committee members expressed concern with the tight schedule, highlighting the need to provide the document to participants in the Alliance ahead of time.
Dr. Kliger mentioned his upcoming meeting with the American College of Physicians (ACP) and asked if there was still an interest in bringing the ACP into the Alliance. The group supported the idea and Mr. Thiry offered to have CMS officials contact the ACP to encourage their participation.
Staff was tasked with incorporating the recommendation in the clinical measures document and circulating it to the members of the Work Group and the Steering Committee for final approval.
