ACC: Take responsibility for data or pay the price
CHICAGO—Ownership of data in a cardiovascular practice is everyone’s responsibility, said Cathleen Biga, RN, CEO of Cardiovascular Management of Illinois in Woodridge, Ill., at the American College of Cardiology’s 61st annual scientific session. Failure to meet that responsibility may result in lost opportunities to improve care—and revenue, too.

“How do you get your arms around this massive amount of data?” Biga asked, referring to patient data collected and analyzed to measure outcomes and quality of care, in a March 24 session focused on the challenges of daily practice.  

To illustrate the disconnect between the data and the doctors, she asked audience members to raise their hands if they had ever been shown their facility’s National Cardiovascular Data Registry (NCDR) data. The ACC registry, which has more than 2,200 hospital participants, is used to report clinical outcomes with the goal of improving patient care. She noted that while a bit less than half showed a hand, that was nonetheless better than results that found only a third of institutions share the data with physicians.

“Who interprets your inclusion-exclusion [data]? Does everybody interpret it the same way? I guarantee you not,” she said. “Who validates your data? Do you take the same chart and give it to another abstractor and see what they come up with? If not, it is a very important part of your internal quality process, to make sure you are validating and auditing your data.”

She encouraged physicians to understand data sources and coding. That lack of understanding can lead to inappropriate categorization that not only muddies the results but also may hurt the bottom line. She offered the example of a patient with chest pain who received an implantable cardiover-defibrillator. The discharge diagnosis was chest pain, which was reimbursed at $3,000.

 “The ICD device was never paid for because it was an inaccurate coding situation,” Biga said.

Every facility should name a physician champion who can talk to his or her peers, provide guidance and ensure there are no gaps in the data collected, she recommended. Facilities can then use this data to measure quality and identify opportunities to improve care.

But data collection and analyses carry costs, too, she warned. A project using the ACC registries CathPCI, ACTION and ICD totaled 7,420 full-time equivalent hours. “That is three full-time people just to collect and abstract the data,” she said.

Choose a measure, build a multidisciplinary team, validate the data and report the results, she said. “And then celebrate the successes you can achieve,” she added.

She concluded with these pointers:
  • A hospital or a physician cannot do this kind of project alone; form a team.
  • Have a process in place.
  • Physicians must own the data.
  • Choose a first project that will be a success. Keep it simple.
  • Close the loop.

“Inspect what you expect,” Biga said. “Gather the data and use the data, because that information is out in the public for everyone to see.”