Quality Priorities

November 13, 2006

MINUTES
Kidney Care Quality Initiative Steering Committee
November 13, 2006
Conference Call

Attendees
Gail Wick, ANNA
Barry Straube/Pam Frederick, CMS
Kent Thiry, DaVita
Mike Lazarus, FMC
Dolph Chianchiano, NFK
Maureen Michael, NRAA
Allen Nissenson, RPA
Charlie McAllister/Ed Jones, Task Group Representative
Reva Winkler, National Quality Forum
Kathy Lester/Eli Tomar, Facilitator/Administrative Arm Patton Boggs
Linda Keegan, KCP

Summary
Reva Winkler of the National Quality Forum (NQF) described the NQF process and, specifically, the ESRD measure development process.  Following her presentation, the KCQI Steering Committee reviewed the ballot results and discussed next steps.

NQF Presentation
Dr. Winkler provided a quick overview NQF.  Dr. Winkler described that beginning in January 2007, NQF will begin focusing on ESRD measure development.  She said that NQF will strive to achieve consensus around a set of performance measures for CKD and ESRD.  The first step will be to call for a set of candidate measures, which will be open-sourced in the interest of transparency, but not necessarily public domain.  She explained the measures will first be reviewed by the Technical Advisory Panel (TAP) and then the Steering Committee, which will circulate a draft report to all stakeholders in the NQF.  The draft report will have a 30-day public comment period followed by 30-day voting period.  Dr. Winkler stated the measures will need the support of the majority of each of the four councils.

In response to a question from Allen Nissenson, Dr. Winkler explained that while the TAP and Steering Committee may consider a candidate measure’s history, NQF’s guiding principles do not weight the derivation and origin of a candidate measure.

In response to a question from Dolph Chianchiano, Dr. Winkler acknowledged cost is a factor for measuring quality.  The NQF, therefore, favors measures that use existing infrastructure and technology.

Review of Ballot Results
Kathy Lester summarized the ballot results for the Steering Committee.  The Alliance approved
all of the measures with extremely healthy majorities; the closest measure (relating to anemia management in the physician setting) was also approved by more than two-thirds of respondents.  A short summary of the vote tally is attached.  Ms. Lester also discussed the comments submitted with the ballots.  She highlighted that the Alliance needs to address one additional issue around the combined outcomes/process measures for anemia management and adequacy of dialysis.  These comments indicated support for the measures only if there were distinct data collection of the two elements (the outcome piece and the plan of care piece) for each measure.  They want to make sure that there is clear tracking for these measures.  The Steering Committee agreed to move forward with a new Task Group to finalize the measures consistent with NQF submission criteria.

Discussion of Next Steps
Ms. Lester outlined a number of issues the Steering Committee must now address.  Several Alliance members weighed in with comments expressing concern about combined measures and the data collection process.  She suggested that the Task Group work with the methodologist to finalize the recommendations and address the issue of data collection.

Dr. Nissenson inquired about working with an American Medical Association (AMA) methodologist.  Ms. Lester and Dr. McAllister explained that the Alliance employed its own methodologist because the AMA methodologists were not permitted to work with the Alliance directly.  Ms. Lester noted that the Alliance methodologist has continued to work with the AMA methodologists on the physician measures since the October meeting with the Consortium.

Ms. Lester identified the candidates for the task group, and asked if anyone objected.  No one objected; therefore, the Task Group will be:  Ray Hakim, Alan Kliger, Charlie McAllister, Maureen Michael, and Gail Wick.

Because several non-kidney care community Alliance members abstained from voting on certain measures based on a concern about their ability to evaluate the clinical measures from a technical point of view, the staff will reach out to these members of the Alliance to obtain their approval to move forward with the measures based on their understanding and approval of the process used to develop them.

Discussion about Phase IIThe Steering Committee also discussed asking the American Society of Pediatric Nephrology (ASPN) to participate on the Steering Committee during Phase II.  The Steering Committee members agreed that it would be appropriate for a representative from this organization to participate because the incorporation of pediatric measures into the process.

The Steering Committee also agreed to evaluate incorporating an upper limit in the hemoglobin-related measures during phase II.

Phase II will begin as soon as the Steering Committee has finalized the recommendations for adult nephrology.  The goal would be to undertake Phase II in early January 2007.

Brief Summary of KCQA Vote Tally