CMS has certified FORCE-TJR, the national registry for total hip and knee joint replacement patients and their surgical outcomes, as a Qualified Clinical Data Registry (QCDR). This allows members to use their data for submission to the Physician Quality Reporting System (PQRS), avoiding a 2% payment adjustment for failing to do so. The Medical Group Management Association (MGMA) has estimated that up to 40% of providers with Medicare patients will be docked pay for not submitting this data.
Along with the financial benefits, FORCE-TJR leadership believes that by being able to use data collected once multiple times, they will be able to cut the time spent on data collection and submission, instead devoting that to activities related to patient care — something that the MGMA says 83% of its members report is an issue.
The opportunity to go for certification first came about last year, says Patricia Franklin, MD, the registry director. But the registry, which had 150 hospital and practice members stemming from its initial $12 million grant from the Agency for Healthcare Research and Quality (AHRQ), held off. Instead, they planned for application this year. “The advantages are that it allows us to be able to make decisions on the most effective measures for our members and then submit them to PQRS,” she says. “Members aren’t just validating quality data and sending it in. But they are using data that we have processed and benchmarked and given back to them for use, and allowing them to use it for another purpose as well.” After a year of submitting data for them without certification, they applied, and were granted the QCDR status.
Doing so required showing CMS how the data were used, displayed, and returned. “We had to show we were more than an intermediary,” Franklin explained. “In PQRS, you take some measures they approve as the quality endpoint, and help them collect and submit them. In this case, we get to choose the measures which are most relevant to our members. If you are a FORCE-TJR member, you will still get your risk-adjusted function and pain data, and all the other data you used to. Only now, it counts, too, as your PQRS submissions.”
You aren’t just validating quality data, but using and processing and providing it for benchmarking that can helping them. We had a year submitting data for them, and then figured we could apply.
FORCE-TJR had a grid of proposed measures they gave to CMS on application, along with a description of why each was important to include. Any new measures they want to include will have to go through the same review during the annual re-certification process, says Franklin.
There are 16 measures. (For more information, see page 93.) It is possible that at some point, some will be retired, too, just as new ones may be added. The measures they chose were all items in which members had expressed interest, for which there were national benchmarks available, and which quality literature indicated were important to measure. “We need to include things which we can compare amongst members, which are of interest to stakeholders, and also which newcomers can find important,” she says.
Many of them are patient-reported outcomes, which could be a shift for new members, she says. However, Franklin calls orthopedics a leader in the arena, and notes that FORCE-TJR leadership has been called upon by the Institute for Healthcare Improvement to give webinars on the topic. Expect to see more such measures in the future. “This is becoming the norm.”
Currently, rather than specific measures, FORCE-TJR is focusing energy on looking at alternative survey methods for members, and ways to get patients to respond in higher numbers.
Shorter surveys, or surveys that change according to the answers given are high on the priority list, she says. For example, if a patient answers a question about mobility with the option of “no pain,” then there is no sense in asking a question about being seated with pain. A patient who can walk without pain is unlikely to have pain when still, she explains. Looking for alternative survey methods like these could be a way of getting more and better data from patients. This is especially important given the increasing emphasis on patient-reported outcomes.
They are also looking for ways to put surveys onto apps for mobile devices, Franklin adds.
Members who use the PQRS reporting feature pay a one-time additional fee of a couple hundred dollars — Franklin wasn’t sure of the exact cost, but says it was in the $200-300 range — to cover the initial costs of setting up PQRS reporting functions. They can choose which of the 16 measures they want to report as part of the PQRS requirement. Some, particularly those that are part of hospitals or multispecialty clinics, may opt to use just one or two, given that other measures related to other specialties or functions (like pediatric asthma, or cardiac care, for example) may also be of import for those organizations, Franklin notes.
When FORCE-TJR was under its grant, it was limited to just 150 organizations. However, since the grant period ended last year, it has opened up its membership, and Franklin says the registry has admitted another 75 institutions. It is scalable, she says, and can take as many comers as are interested. The 30,000-plus patients they have followed thus far can grow with the registry, and they welcome that growth. “The training of new sites is staggered, because that is the hardest thing to do.”
More information on FORCE-TJR and membership is available at http://www.force-tjr.org.
For more information on this topic, contact Patricia Franklin, MD, MPH, MBA, Registrar, FORCE-TJR, Worcester, MA. Email: [email protected].
