Real-time Tool: As Demand for Value Grows, Societies Expand Registry Offerings

The healthcare delivery environment continues to evolve, requiring clinicians and practice executives to seek solutions that will lead to a pathway of success.

Practices under pressure 

The demand for increased focus on value in healthcare is real, and clinicians will need to incorporate tools to support better quality and appropriate cost. This trend is driving a shift toward consumerism as well as to reimbursement models that demand cost and quality information. In practice, this translates to a growing need to monitor, improve and demonstrate quality in practice.

Part of the mounting demand for value is coming from the commercial health insurance market. More and more, beneficiaries are covered through high-deductible health plans (HDHPs). According to America’s Health Insurance Plans (AHIP), 20.2 million beneficiaries were covered through HDHPs in 2016, up from 19.7 million in 2015. The result is increased cost sharing by patients. 

For patients, the bump in out-of-pocket spending is typically related to testing and diagnostic services, emergency care and other nonpreventive care. As patients and their families become more cognizant of high deductibles as a pain point in their budgets, many will insist on receiving care with confirmed value plus information to inform their healthcare decision making. In a recent AHIP survey of 52 health plans, 75 percent said they are already sharing cost data with beneficiaries and 60 percent are providing physicians’ quality data.  

Medicare is moving along the same trajectory. The Centers for Medicare & Medicaid Services (CMS) is finalizing how it will implement the Quality Payment Program (QPP), which establishes a series of pathways (practice improvement among them) to measure physicians’ quality and tie payment to performance. Additionally, CMS is setting targets to increase the number of physicians who are paid through alternative payment models (APMs) vs. traditional fee for service. The CMS Learning Action Network (LAN) set a goal that half of all physicians participating in Medicare will join an APM. Achieving this goal may seem insurmountable, but it is happening. Participation grew from 23 percent in 2015 to 29 percent a year later, according to the LAN. 

Adapting to new demands 

These goals and the trends they are generating create urgency for physicians to be measuring and improving their quality and outcomes. Soon it will not be enough for physicians to take pride in the quality of care they provide to patients; all practices will need a robust and consistent quality improvement (QI) program. The most basic model QI plan is based on the Plan-Do-Study-Act paradigm. Essentially, this model encourages physicians to select an element of their practice that may benefit from improvement, usually one based on the need to improve patient outcomes. 

To develop and implement a QI program, it is important to have tools that support successful implementation. A clinical data registry is among many tools that may be helpful and provide significant benefit to practices. This is because registries can be used to support and enhance professional development through clinical improvement as well as novel data sources for research. 

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Clinical data registries typically are structured to provide participants with benchmarks of overall performance and performance on specific metrics. Data elements are the backbone of any clinical data registry; they help define which data can be submitted to the registry and bring uniformity. From the data elements, performance metrics then can be created. The performance metrics help physicians track their individual performance and/or that of their entire practice. Metrics also can help identify regional and national practice variations. All of this information can be important for improving overall value. 

Over the past several years, a number of medical specialty societies have developed registries to help their members succeed in the changing healthcare environment. Society-developed data elements—and therefore, performance metrics—directly relate to their members’ practices. One example is the Image-Guide Registry, which was developed by the American Society of Nuclear Cardiology (ASNC) in 2015 and, as of last fall, is being expanded through a partnership with the American Society of Echocardiography (ASE). ASNC and ASE intend for the registry to help improve cardiovascular imaging, measure performance, support quality imaging practices and define value. To that end, the ImageGuide Registry is being expanded to feature a new module focused on echocardiography, thus enabling registry participants to collect data and measure performance for most cardiovascular imaging services.

A common misconception is that registry participation is onerous and expensive. The reality is that registry enrollment and participation are not complicated and do not need to be expensive. Many societies, including ASNC, offer participation as a benefit of membership or at low cost. Some registries have developed mechanisms that allow data submission via an online portal equipped with time-saving tools. And trained staff support most registries. In fact, most physicians who join registries find the data submission process can be adapted into their workflow with significant resulting benefits. 

*Kathleen B. Flood is the chief executive officer of ASNC.