April 19, 2006
MINUTES
Kidney Care Quality Initiative Steering Committee
April 19, 2006
Conference Call
Attendees:
Mike Lazarus, Fresenius Medical Care North America (FMC)
Gail Wick, American Nephrology Nurses Association (ANNA)
Sandy Watkins, American Society of Pediatric Nephrology ASPN)
Alan Kliger, Renal Physicians Association (RPA)
Linda Keegan, Kidney Care Partners (KCP)
Maureen Michael, National Renal Administrators Association (NRAA)
Kathy Lester, Patton Boggs and Kidney Care Partners
Amy Yenyo, Patton Boggs
Summary The Kidney Care Quality Initiative (KCQI) Steering Committee discussed the March KCP Board Meeting and status of the Phase I recommendations. The Steering Committee agreed to a four-part charge to assist the Clinical Measures Work Group in revising and finalizing the Phase I Final Recommendations. The staff provided a Congressional and CMS update on pay-for-performance initiatives and the formation of ESRD measures. Lastly, the Steering Committee discussed the recruitment of additional members for the Kidney Care Quality Alliance (Alliance).
Next Steering Committee Meeting The Steering Committee agreed to participate in a conference call to discuss Phase II at 3:00 EDT on May 5, 2006. Kathy Lester will distribute an agenda and the call-in information to the Steering Committee prior to the call.
Discussion of March KCP Board Meeting
The KCP Board approved with consensus the Pay-for-Performance (P4P), Quality of Life, and Pediatric Work Group Phase I Final Recommendations. While a majority of the KCP Board approved the Clinical Measures Work Group Phase I Final Recommendations, there was not sufficient support to establish true consensus among the members. Various Board members raised the following concerns:
(1) the proposed anemia management domain is process-based, rather than outcomes-based;
(2) the recommendations lacked a unique peritoneal dialysis measure;
(3) the recommendations did not address bone and mineral measures; and (4) the domains did not distinguish between facilities and physicians.
Dr. Bill Haley, the Facilitator of the Clinical Measures Work Group, is awaiting specific instructions from the Steering Committee before reconvening the Work Group to address the Board’s concerns and revise the Clinical Measures accordingly.
Dr. Kliger said that some members of the kidney care community are recommending that KCP endorse AMA Consortium measures, and he recommended that the Steering Committee instruct the Clinical Measures Work Group to review the AMA Consortium measures and to the extent possible and appropriate endorse or incorporate them into the Kidney Care Quality Initiative (KCQI) measures.
Congressional and CMS Update on P4P initiatives and ESRD Measures In response to requests for updates, staff has met with Centers for Medicare and Medicaid Services (CMS) officials, as well as staff of key Congressional committees. Both CMS and Congressional staff were pleased with the progress and the direction of the recommendations. CMS expressed an interest in participating in the Alliance. In terms of the clinical measure recommendations, CMS emphasize the need to introduce new measures (such as immunization and vascular access) and to focus on outcomes-based measures. Given that the KCP did not reach consensus on the clinical measure recommendations, KCQI staff did not focus on the measures in detail.
Congressional staff remains interested in passing P4P legislation this year. House Republican leadership has indicated an interest, as has the Committee on Ways & Means and Senate Finance. Congressional proposals would likely address the elements of a P4P program, but not include specific clinical or quality of life measures.
Discussion of Clinical Measures Work Group Recommendations The Steering Committee agreed to a four-point charge requesting the Clinical Measures Work Group to:
(1) develop process and outcome based measures that to the extent possible, aggregate data at both the physician and facility levels;
(2) review the AMA Consortium measures and to the extent possible and appropriate endorse them and/or incorporate them in the Phase I final Work Group recommendations;
(3) ensure that the final recommendations include appropriately defined and robust measures by working with a methodologist; and
(4) address the three concerns raised by the Board (which will be summarized and provided to the Work Group).
The Steering Committee asked the staff to work with KCP Board members to provide summaries and detailed descriptions/scientific basis for the suggested changes to the measures presented on March 16, which will then be shared with the Clinical Measures Work Group. The Steering Committee recommended hiring a methodologist to assist in measure development and consulting with Dr. Haley to identify an appropriate person and determine proposed costs. The Steering Committee will need to approve the methodologist and the costs before submitting the proposal to the KCP Ops Committee.
Staff will give one month’s notice of the next Clinical Measures Work Group meeting. The Steering Committee recommended that the Work Group meet in person, if possible. Dr. Kliger and Dr. McAllister (already a Work Group member) will assist the Work Group in understanding the direction from the Steering Committee. Work Group members will be asked if they want to continue to participate in the Work Group before the meeting, so that, if necessary, additional members can be recruited.
Discussion of Alliance MembersIn addition to the KCP members, the following organizations have agreed to join:
- America’s Health Insurance Plans
- American Federation of Hospitals
- National Medical Association
- National Partnership for Women and Families (pending)
- Society of General Internal Medicine
To help increase the profile of the Alliance, it is important that KCP try to obtain the participation of other organizations as well. Steering Committee members agreed to reach out to their contacts in the following organizations:
- American Association of Retired Persons (AARP)
- American College of Physicians (said no, but may be worth asking again)
- National Association for the Advancement of Colored People (NAACP)
- National Association of Hispanic Nurses (NAHN)
- National Black Nurses Association, Inc. (NBNA)
- National Council of La Raza
- National Hispanic Medical Association (NHMA)
- National Urban League
MiscellaneousThe Steering Committee agreed to discuss the development of efficiency measures in Phase II during the May 5, 2006 call.
Next Steps The next Steering Committee meeting will be a call on May 5, 2006. The staff will provide a copy of the AMA’s consortium measures to the Steering Committee as well and a list of organizations targeted to participate in the Alliance for the Steering Committee members to approach.
