December 20, 2005
MINUTES
Kidney Care Quality Initiative Pediatrics Work Group
December 20, 2005
Conference Call
Attendees:
Barbara Fivush, Facilitator/Leader
Brad Warady
Cindy Richards
Craig Langman
Eileen Brewer
Joseph Flynn
Sharon Andreoli
Kathy Lester, Patton Boggs and Kidney Care Partner
Amy Yenyo, Patton Boggs
Julie Black, Patton Boggs
Summary
The Kidney Care Quality Initiative (KCQI) Pediatrics Work Group reached consensus on recommendations and revisions to the Quality of Life and Pay for Performance guidance documents. Clinical Measures areas were divided among the group for the purpose of drafting recommendations. A revised document, including the clinical measures table, will be circulated to the group.
Approval of Minutes
The Work Group approved the minutes.
Review of Budget Reconciliation Package
Ms. Lester noted that the Senate Reconciliation Package no longer contains a pay for performance provision. Nonetheless, she reminded the group of the tight timeframe influenced by Chairman Thomas’ goal to introduce pay for performance legislation in March. Work Group members commented that this allows time for input, especially to indicate the lack of evidence in pediatrics.
Review of the Steering Committee Recommendations
Dr. Fivush informed members that the other groups each presented a document with recommendations to the Steering Committee. Relaying information from the Steering Committee, she stated that the Work Group does not have to generate a separate Pediatric specific document, but may if it wishes. She presented two approaches by which they could proceed. Members could insert pediatric-specific language into the three documents; alternatively, the Work Group could insert bullets or a paragraph as a separate pediatric section within each document. She also noted that a different approach may be taken for each document. Work Group members were concerned that these approaches would not fully highlight that pediatric issues were considered separately.
In addition, several expressed concern that integrated recommendations without a separate document would create an accessibility issue within the pediatric community. Ms. Lester reminded the group that the guidance document that the Work Group has been charged to create is intended for Congress and CMS. The group reached consensus to incorporate and modify language or add a separate pediatric section as appropriate. Ms. Lester informed the group that she drafted the Pediatric Work Group Phase I Recommendation Document.
Discussion of Quality of Life
In reviewing the recommendations of the Quality of Life/Patient Perspective Work Group, the Pediatrics Work Group suggested adding a recommendation to clarify that different surrogate markers exist for children than for adults. The first recommendation is to note this difference.
The members also agreed to acknowledge that the document now addresses pediatric issues.
The members approved the recommendations on process measures and a pilot program. To address the differences in proven surrogates and to convey the need for a pilot program, the Work Group recommended inserting language addressing the ongoing work within CMS to develop appropriate measures.
Discussion of Pay for Performance
The members agreed that any pediatric specific recommendations would follow the Pay for Performance Work Group recommendations in the guidance document. The recommended including language stressing the differences between pediatric and adult facilities/providers, as well as language indicating the need for additional time for implementing pay for performance in pediatric settings. The members emphasized the need for a three-year window during which appropriate measures and evaluation tools could be developed.
Discussion of Clinical Measures
The work group agreed to address Vascular Access, Adequacy of Hemodialysis, Adequacy of Peritoneal Dialysis, Anemia Management, Immunization, Bone, and Nutrition measures.
Not all members were able to review the 2006 K/DOQI guidelines. The group agreed to divide the measures and email Dr. Fivush with recommendations within 48 hours. In reviewing the advCKD measures recommended by the Clinical Measures Work Group, the Pediatrics group agreed to examine transplant measures.
Next Steps
Work Group members will email clinical measure recommendations to Dr. Fivush within 48 hours. A follow-up call will be scheduled to review the modifications and recommendations.
