Quality Priorities

November 7, 2007

MINUTES
Kidney Care Quality Alliance Steering Committee
November 7, 2007
Conference Call

Attendees

Summary
The Steering Committee determined the next steps for implementing the test plan for the five KCQA measures endorsed by the NQF Consensus Standards Approval Committee (CSAC).

Approval of Minutes
The approval of the October 10, 2007, meeting minutes is pending.

Report on NQF Consensus Standards Approval Committee (CSAC) Meeting
Dr. Hakim reported that all five of KCQA’s measures were approved for time-limited endorsement by the NQF CSAC.  Within seven days of November 7, 2007, the NQF Board will provide final endorsement of the ESRD measures.

Karen Thiel attended the CSAC meeting and discussed CPT licensing and AMA committee approval of existing CPT codes with Karen Pace prior to the vote on the KCQA measures.  During the CSAC discussion, Ms. Pace indicated that KCQA was following through on all of these issues and that KCQA had a representative present if NQF had questions or concerns.  Ms. Thiel stated that no CSAC members shared concern.  Ms. Thiel noted that Ms. Pace would provide KCQA with the contact at AMA who raised the CPT issues.

Ms. Thiel reported that CMS’ Facility Patient Survival Classification (based on Standardized Mortality Ratio), Conservative Method was the only measure that did not receive endorsement.  The CSAC did approve 10 measures for time-limited testing; 5 from KCQA, 3 from RPA/PCPI, 1 from the Society for Vascular Surgeons (SVS), and 1 from CMS.  Following the meeting, Ms. Thiel spoke with the AMA’s RPA/PCPI representative, Greg Wozniak, who is the AMA’s clinical performance evaluation person for measure testing.  Mr. Wozniak suggested that the three organizations (KCQA, AMA and SVS) could jointly test their time-limited measures.  Ms. Thiel also reported that Tim Ferris, the Medical Director of Massachusetts General’s Physician’s Organization, wants to test the entire set of measures at his hospital.

NQF mentioned that KCQA will need to change the denominator in KCQA’s Influenza Vaccination in the ESRD Population – Facilities measure to reflect the numerator description indicating that the measure is for patients aged 18 years and older.  Ms. Thiel reported that NQF will look for this clarification in the KCQA testing plan.

Finally, Ms. Thiel mentioned that NQF approved revised guidelines for testing proposals.  NQF decided not to review previously submitted testing plans in light of these new criteria, but rather requested that measure developers adhere to the components of the newly approved plan.  Ms. Pace will provide a copy of the NQF measure testing document that was approved.

Discussion of Proposal to Implement the Test Plan
Kathy Lester indicated that due to the expense involved, the KCQA Steering Committee will need to present the implementation proposals and the committee’s recommendation to the KCP Operations Committee.  Dr. Hakim agreed that the KCQA Steering Committee needs to solicit additional proposals to inform the Operations Committee.  The Steering Committee agreed to the below process to implement its test plan:

1. Discuss jointly testing the time-limited measures with the RPA/PCPI and SVS
2. Review and revise, as needed, KCQA’s test plan in light of the revised NQF guidance document on testing proposals
3. Review and revise the RPF and circulate with the KCQA test plan to possible principle investigators (The Weinberg Group; Bob Rubin – Georgetown University; David Zimmerman – University of Wisconsin; Arbor Research Collaborative for Health; Vanderbilt University; Dan Mendelson – Avalere; Duke Outcomes Research Group; Tufts New England Medical Center; Neil Powe – Johns Hopkins University)
4. Evaluate responses and make a recommendation to the KCP Operations Committee

Report on Pediatric Measures
Barbara Fivush updated the Steering Committee that the ASPN submitted a pediatric adequacy measure to the AMA Consortium.  Dr. Fivush indicated that AQA would also review the measure.  Dr. Hakim relayed that the NQF is interested in pediatric ESRD measures.

Next Steps
Patton Boggs staff, along with Drs. Hakim and Nissenson, will have conversations with the RPA/PCPI and SVS staff to determine the feasibility of jointly testing the time-limited measures.  If the other organizations are interested, Patton Boggs will prepare a side-by-side comparison of each of the testing proposals to inform the shape of the overarching test plan.  Should the KCQA need to test its measures independently, Steering Committee members will review the RPF to identify areas where KCQA might be able to achieve efficiency by implementing portions of the test plan without a principle investigator.  Upon revising the RPF, Patton Boggs staff will circulate the document to the above named possible principle investigators.  The Steering Committee will convene via teleconference on Wednesday, December 5, from 10-11 am EDT.