ACCA: Sustainability improved by participating in CV registries
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Currently, more than 2,500 hospitals and 1,000 practices are participating in the National Cardiovascular Disease Registry (NCDR), which helps to track provider performance and is used by the FDA for post-marketing assessments.
“The earth is changing under our feet,” Hewitt said. One of the goals of the undertaking is to create a “holistic registry” that will be expanded internationally, to help both improve data and move post-market assessments forward.
“We have an opportunity to streamline registry definitions and technology though software vendors,” she added. EHRs aid this growth. "It will be interesting to see when the tides shift, how these two things [registries and health IT] will come together.”
Currently, registry data are being used for analytics, quality improvement and research and publications.
“Science tells us what we can do, guidelines tell us what we should do, and registries tell us where we should be headed,” Hewitt said. “Registries play a critical role in cardiovascular care.”
She added that the real-world data stemming from these registries help shape the future of guidelines more than clinical trials because of their focus on smaller, more specialized subsets of patients.
To make registries successful though, she said that physicians must be involved in the decision-making process.
Hewitt noted that an estimated $800,000 in reimbursements already has been received from participation in the PINNACLE registry (average PQRS payment is $8,400).
However, there is an Achilles heel to setting up these registries, and that is attempting to link the NCDR to Centers for Medicare & Medicaid Services (CMS) data. “We have some major concerns,” she added. “The results for some measures are so low that sometimes the samples jump.”
Currently, CMS is re-evaluating benchmark measures and is developing new measures using registry data. “CMS is asking ACC to make core measures so they can retire the old,” Hewitt said. And while she said these measures are set to change, they will not be completed within the next six months.
“In terms of healthcare reform, are we seeing clearly toward the summit?” Hewitt asked. “It still seems foggy to me," she added. In fact, she offered that there is not 100 percent agreement that quality actually cuts costs.
However, she noted that some have reported seeing up to 30 percent in lower costs by decreasing complication rates and length of stay.
“While quality is going to save money, it will not drastically affect care,” Hewitt speculated. However, she said that preventing medical errors may be one of the most effective strategies out there for enhancing care and cutting costs. "It still remains to be seen which measures will save money and which ones will not," she added.
“The day of pay for reporting is dead,” Hewitt said, “It is now pay for performance.” Because she said it is assumed that hospitals are collecting and reporting data publicly, the times have shifted toward getting paid for performance.
“There are many problems within healthcare and we need more transparency and consistency," Hewitt summed. "It is not just about being cost-effective, it is about making quality-based measures publicly available to improve patient care.”