October 16, 2006
MINUTES
Kidney Care Quality Alliance Steering Committee
October 16, 2006
Conference Call
Attendees:
Gail Wick, ANNA
Don Wesson, ASN
Barry Straube, CMS
Kent Thiry, DaVita
Mike Lazarus, FMC
Dolph Chianchiano, NFK
Maureen Michael, NRAA
Alan Kliger, RPA
Ray Hakim/ Ed Jones/Charlie McAllister, Task Group Representative
Kathy Lester/Piper Nieters, Administrative Arm Patton Boggs
Linda Keegan, KCP
Summary The Alliance Steering Committee reviewed the Adult Clinical Measures Task Group Recommendations and discussed modifications to the recommended measures. The group also discussed the balloting process for final approval of the Phase I measures. The staff provided an update on questions related to the National Quality Forum.
Clinical Measures Task Group Recommendations on Phase I Adult Clinical Measures The Steering Committee charged the Task Group with addressing the comments submitted by members of KCP and the Alliance. Based upon its work during the past several weeks, the Task Group recommended a revised starter set of adult clinical measures for physicians and facilities.Dr. McAllister presented the recommendation on behalf of the Task Group and explained its process.
The Task Group meet every week, worked closely with a methodologists, and consulted experts in the kidney care community. It also reached out to the American Medical Association (AMA) to try to harmonize the physician measures with those created by the AMA Physician Consortium.
It also took into consideration the September report on quality measures published by the Institute of Medicine.After summarizing the comments he received, Dr. McAllister described the recommendations. The Task Group recommended a set of starter measures that include both process-based and outcome-based measures.
With the exception of the anemia management and adequacy of dialysis measures, the Task Group recommended that the measures be the same for physicians and facilities. For anemia management and adequacy of dialysis, the Task Group recommended that in addition to the outcome component, the numerator for physicians would include a measure of patients with suboptimal levels who have a plan of care in place.
The Task Group described the reason for this difference and their goal to reach consensus within the community.
The Steering Committee members discussed the measures in great detail. Specifically, members focused on the comments that called for the language of the physician and facility measures to be the same. They also discussed the need for a specific definition for “plan of care.”
Dr. Straube asked about why the definition of facilities/physicians who would be included in these measures centered on facilities or practices with greater than 25 patients He also voiced concern about the use of process measures to gauge quality and cautioned that CMS may not view such measures as valid for purposes of rewarding quality. Dr. Lazarus suggested clarifying the timing of measuring Kt/V in the numerator of the adequacy of hemodialysis measures.
The members agreed to this modification.The members recognized that additional work is needed with a methodologist before measures are submitted for further review. They unanimously agreed to allow the methodologist to continue working with the Task Group to address these issues after the ballot was distributed to the Alliance membership. The Steering Committee agreed that the recommended measures to be approved on this call were a basic set of standards that needed to be moved forward to the Alliance Board.The Steering Committee approved the recommendations from the Task Group, as modified on the call.
Dr. Straube noted that his approval did not constitute a CMS policy or Agency approval. The members approved both the physician and facility measures, with only DaVita abstaining. Dr. Straube again encouraged the Steering Committee to have the Ambulatory Quality Alliance, the Hospital Quality Alliance, and/or the National Quality Forum (NQF) review the measures if they are approved by the Alliance.
Balloting Process
Ms. Lester briefly reviewed the balloting process to move forward with the Phase I recommendations made to the Alliance Board. The measures in a ballot will be distributed to the full Alliance along with the background chart prepared by the Task Group.
Alliance members will have an opportunity to comment on the measures. These comments will be distributed to the full Alliance. The vote will close on Nov. 6.
NQF Update
Ms. Keegan described her conversations with the NQF staff. She noted that NQF is contracting with CMS to engage in quality measure review at the beginning of next year.
At this time, it appears likely that the NQF will develop a technical committee for the review as early as January 2007 and that it could form a Steering Committee by early March 2007.
She suggested that a representative from NQF be invited to the next Steering Committee call to discuss the process in more detail. Finally, she also noted that submission of the quality measures to NQF should not involve a monetary expense for the Alliance given the CMS contract.
Next Steps
The staff indicated that it would prepare the Steering Committee recommendations for submission to the Alliance Board and that they would contact NQF to secure its participation in the next Steering Committee call.
