QCDRs as Multi-Purpose Data Platforms: The Renal Physicians Association (RPA) QCDR Experience

October 15, 2019

Agenda

• Welcome and Housekeeping• Introductions• Presentation • Discussion • On the Horizon

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Housekeeping

• This forum is being recorded• All lines will be muted until the discussion • For the Q&A portion of the webinar, we will open the lines for discussion. Please remain muted unless you are speaking

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Speaker and Moderator

Amy Beckrich, CAEProject Director at Renal Physicians Association

Adam Weinstein, MDVice President, Medical Affairs with Clinical IT Services at DaVita Kidney CareChair, Renal Physicians Association Clinical Data Registry Workgroup

The Renal Physicians Association’sKidney Quality Improvement Registry

Adam Weinstein, MDChair, RPA Registry Workgroup

Disclosures

Dr. Weinstein is a volunteer member of the Renal Physicians Association (RPA)Dr. Weinstein is an employee of DaVita, Inc. and a part-time private practice nephrologist in Maryland.

There are no financial conflicts that would bias this talk.Comments and information should not be considered as advice or guidance.

All comments are solely Dr. Weinstein’s. Comments are not reflective of official policy of any of the above organizations.

Overview Background: About Nephrology and RPA

Origins and Vision: Prior to 2014

Initial Execution: 2014-2015

MACRA-geddon: 2016-2017

Strategic and Tactical Pivots: 2018-2019

Looking forward and next steps: 2020 and beyond

What is unique about Nephrology?

Nephrology Offices

Dialysis Centers

CommunityHospitals

Other Specialists,3° Hospitals,and SNFs

Kidney care spans multiple venues of care.

Nephrologists Attempt to Mitigate the Progression towards and Complications of

End Stage Kidney Disease

Stage I, II, IIIa CKD Stage IIIb CKD Stage IV CKD Stage V CKD ESRD & Transplant

Basic NephrologyContact

Increasing RiskFactor

Modification& Monitoring

Education, preparation for Renal Replacement Therapies, increased

monitoring & co-morbidity management

Transplant?, preparation for Renal Replacement Therapies,

increased monitoring & co-morbidity management

Frequent interaction; Intense co-morbidity management

Safe Transition to Dialysis

Pre-emptive Transplant

CKD Risk Mgmt ESRD Education & Prep

Dialysis Management

Increasing costs, complications, hospitalizations, and mortalityIncreasing number of co-managing providers

And our patient data is everywhere!

What is the Renal Physician Association (RPA)?

RPA is the professional organization of nephrologists; its goals are to ensure optimal care under the highest standards of medical practice for patients with kidney disease and related disorders. RPA acts as the national representative for physicians engaged in the care of patients with kidney disease.

RPA’s Role in Measuring Quality - History

• Role of RPA as measure developer• AMA-PCPI• NQF process• Numerous publications and white papers focused on quantifying

quality kidney care

Prior to 2014

Opportunities

• Continued leadership in quality measures

• Meet the needs of our membership re: PQRS

• Develop a needed capability for the organization

Challenges

• Requires member subscription• Requires member education• Requires EHR interfaces

What is the RPA registry?

It is a platform for:Data ingestionAnalyticsReporting

Initial Launch 2014-2015

Opportunities

• Lots of interest• Relationships w/ interventional

nephrology• Growing expertise in measure

development

Challenges

• Labor intensive for onboarding new member-users

• Requires continued member education

• EHR vendors not enthusiastic

MACRA-geddon: 2016

Opportunities

• New focus on quality measures that were specific, not topped-out and differentiated performance

Challenges

• MIPS: • Needed fewer measures• Low-risk in 1st few years• Quality scoring marginalized

custom measures

• APM bypassed QCDR use• EHR Interfaces needed!

Strategic and Tactical Pivots – 2017-2019

Opportunities

• Our QCDR is a data platform!• Our QCDR is supported by an

innovative and flexible partner• Many other needs in the

nephrology community

Challenges

• Nephrology EHR landscape consolidation

• We are still funded through member subscriptions

• CMS focusing on outcome measures, harmonizing and removing custom measures

Pivot #1 – Maintenance of Certification (MOC) Opportunity

• Nephrologists need ABIM/Nephrology certification• ABIM looking for ways to broaden their MOC program• Leverage existing ABIM relationship w/ vendor to aggregate and

report physician quality activities to ABIM

RPA Dialysis Quality Improvement ABIM MOC Program

Pivot #2 – Connecting Pharma and Device with Nephrologists

• Real-world use of devices and medications are difficult to ascertain• RPA has an engaged network of physicians and practices• Leverage existing RPA relationships to help Pharma/Device to answer

specific questions and possibly develop quality measures

RPA Project on Real-World Management of Hyperkalemia

Clinical Care Patterns(via chart review)

Impact of Hyperkalemia on

patient experience(via interview)

11 Practices>300 Patient Interviews

360 Chart Reviews

• Goals: • Gain insight on thresholds of provider action on

hyperkalemia• Gain insight on patient understanding and

perceptions of hyperkalemia

QCDR is the data collection and aggregation tool

Lessons Learned

• This is a research study• Recruitment is a challenge• Buy-in by practice leadership ≠ buy-in

staff• QCDR can be an excellent data

gathering platform• Survey delivery and prompted workflows

were key• Survey delivery is great, but needs to

accommodate wide range of use cases

RPA Study on the Real-World Management of Mineral Bone Disease (MBD) in Patients with Advanced CKD

• Develop an understanding of clinical care patterns in real-world clinical actions in the management of CKD-MBD through lab data, medications prescribed, and chart notes, via chart review.

• Develop an understanding of nephrologists’ perception of the practicality of current guidelines and the relative importance of MBD issues in CKD and ESKD via structured interviews.

Project launched Sept 2019 and will conclude Dec 2020.

Pivot #3 – Focus on Pop-health, Practice Transformation, and Best Practices

• Nephrology is rapidly moving to value-based payment frameworks• Many small and medium practices need help with transformation -

including tools for pop-health and data aggregation• Leverage our QCDR platform and nephrology expertise to:

• Help adopt community-wide, non-CMS approved measures that support nephrologists in these new programs

• Work with private payers to consolidate practice/provider performance

Epic Smart Form• Exploring the inclusion of CKD process

metrics - not for MIPS/CMS programs

• Data is of interest to private payers/may be negotiating tool for practices

• Relevant to kidney models proposed by Executive Order in July 2019

• Planned for Epic foundation Q1 2020• Planned for RPA QCDR Mid 2020

Take Away Themes

• QCDRs are undervalued• External pressures on quality measures are increasing• QCDRs are data aggregation and reporting platforms• Specialty societies can leverage the value of their efforts in creative

ways, but there are trade-offs

Thank you!ajwein@gmail.com

Discussion

Amy Beckrich, CAEProject Director at Renal Physicians Association

Adam Weinstein, MDVice President, Medical Affairs with Clinical IT Services at DaVita Chair, Renal Physicians Association Clinical Data Registry Workgroup

On the Horizon…

• Webinar: Improving Health Care Quality Through Clinician Level Integrated Performance Measurement with PCPI®

• November 8, 2019, 12:30pm CT• PCPI Conference – November 10-12, 2019• The Quality Landscape: Charting the Course for Success• Register at thepcpi.org

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The slides and recording will be posted at http://thepcpi.orgStay tuned to your email for updates.For any questions please contact us at info@thepcpi.org

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