Rami Doukky, MD, MSc, FACC, FASNC Professor of Medicine, Preventive Medicine & Radiology

Chief, Division of Cardiology John Stroger, Jr. Hospital of Cook County

Director, Stress Testing Laboratory Rush University Medical Center

Astellas Pharma - Research Grants

- Advisory Board

ASNC - Board of Directors

- ImageGuideTM Registry Oversight Committee

Disclosures

Slides Curtesy of Peter Tilkemeier and ASNC

Evidence Application Outcome

Registry

Concept

Outcomes

Clinical

Evidence

Guidelines

Decision Support

+ QI Initiatives

Measurement + Feedback

Clinical Registries

Adapted from Califf RM, Peterson ED

et al. JACC 2002;40:1895-901

What is ImageGuideTM?

The ImageGuide Registry is the first cardiovascular registry of its kind, focusing on SPECT and PET imaging

studies.

The primary purpose of the registry is quality improvement, and it provides a fully integrated platform to seamlessly collect data in nuclear imaging labs to measure

quality, safety, and efficiency.

What is ImageGuide?

To support nuclear cardiology specialists and laboratories in their efforts to enhance the quality,

safety, and value of nuclear cardiology in clinical care locally, nationally, and across the globe.

ImageGuide Mission

1. To provide timely data feedback and tools for nuclear cardiology practices

2. To facilitate fulfillment of regulatory and other reporting requirements

3. To inform health policy and reimbursement advocacy

4. To demonstrate the value of nuclear cardiology

5. To serve as a platform for research and education

ImageGuide Goals

ImageGuide provides the operational framework to support a community of practices committed to

patient centered imaging, practice

transformation, and innovation through

ongoing data collection and quality

improvement.

Data Collection

Practice

Payment

Quality

Research

Background

Accreditation

ImageGuide Purpose

ImageGuide enables

providers to track data for

each study

Captures standardized data across all practices

Providers can benchmark

performance on location,

practice, and national

levels

Quality is ever-evolving

Improves Value of Nuclear

Cardiology

Data Structure

Permissible Values

Structured and standardized sources

• DICOM (Digital Imaging and Communications in Medicine)

- Distribution and viewing of medical images

• SNOMED-CT (Systematized Nomenclature of Medicine - Clinical Terms )

- Reference set of terminology

• HL-7 communications standard

Use of Structured Data

1. Complies with guidelines for interpretation & reporting

2. Insures utilization of a single “language”

3. Allows comparison of data from multiple sites

4. Facilitates data flow

Data Submission Methods

Web-based Data Collection Tool Web-based data collection tool to manually enter imaging study data directly into the registry.

ASNC Certified Reporting Vendor ASNC has partnered with reporting vendors to collect and submit all required data elements to the registry.

EHR/EMR/Imaging System It may be possible to automatically extract and submit data from EHR/EMR/Imaging System.

Future integration in major structured reporting software is key

Automated Data Entry

- Studies will automatically be added to the registry file when the physician signed the report.

- Prevents “cherry-picking”

- There is work involved at the onset of the project, once it is in place there will be little maintenance.

- This pathway provides “real-time” feedback to physicians, allowing for meaningful, targeted, QI programs and ultimately improve the quality of care for patients.

• Study referral information

• Patient demographics

• Clinical information

• Stress testing data

• Resting ECG data

• Imaging parameters

• Radiation dosing

• LV perfusion

• LV perfusion quantification

• Stress LV function parameters

• Resting LV function parameters

• Study quality

• RV parameters

• Signature date/time

Data Element Categories

Hundreds of data elements

Nuclear Cardiology Study Workflow in the Future

Patient Assessment

Stress Imaging Study

Interpretation

Signed Report

Extract Data to ImageGuide

What is for me in it?

Why Participate in a Registry?

• Advance clinical practice

• Enhance patient care

• Justify services to payers and policymakers

In the current evolving healthcare

environment, in which reimbursement is

increasingly tied to performance, it is

essential that medical professionals take part in quality improvement

initiatives to:

Physicians are required to participate in mandatory quality tiering under the Value-Based Modifier Program (VM)

Upward and downward payment adjustments based on participation Physician Quality Reporting System (PQRS)

2016 Value-based Payment Modifier Program

PQRS, Physician Quality Reporting System

ImageGuide is a CMS-designated Qualified Clinical Data Registry (QCDR), through which one can receive credit under Physician Quality Reporting System (PQRS).

Regulatory Update

What is a Qualified Clinical Data Registry

(QCDR)?

• QCDRs are a CMS reporting mechanism that allow registries to

develop their own performance measures

Providers who report via QCDR can receive credit under

Physician Quality Reporting System (PQRS)

• Providers must satisfactorily report on 9 measures in 2016 or

receive penalties

QCDR, Qualified Clinical Data Registry PQRS, Physician Quality Reporting System

ImageGuide & MIPS

The traditional PQRS & VM programs will sunset on December 31st, 2018 and will be replaced by

the Merit Based Incentive Payment System (MIPS)

Providers who do not successfully report on

quality measures will be subject to higher negative payment adjustments in

subsequent reporting years:

Participation in a QCDR can aid in achieving

successful and meaningful quality reporting

2019

-4%

2020

-5%

2021

-7%

2022

-9%

MIPS, Merit Based Incentive Payment System

Sample Penalties Under PQRS/VM & MIPS

$-

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

Annual Per-Physician Penalties Based on $500,000 in CMS Receivables

Penalty (USD)

-2% (PQRS) + -4%* (VM)

-4% (MIPS) -5% (MIPS) -7% (MIPS) -9% (MIPS)

*Physicians in groups of 1-9 will receive a -2% penalty for

unsatisfactory PQRS participation under the VM

ImageGuide vs. Other CV Registries

• In office practice, ImageGuide requires entry only nuclear imaging tests rather than every patient encounter

• Hospital-based registries (NCDR) may not apply to physicians not performing invasive procedures

• NCDR is labor intensive vs ImageGuide which can be automated

• Good choice for imaging physicians

Performance Measures

ASNC 1 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Preoperative

Evaluation in Low-Risk Surgery Patients

ASNC 2 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Routine Testing

After Percutaneous Coronary Intervention (PCI)

ASNC 3 Cardiac Stress Nuclear Imaging Not Meeting Appropriate Use Criteria: Testing in

Asymptomatic, Low-Risk Patients

ASNC 4 Utilization of Standardized Nomenclature and Reporting for Nuclear Cardiology Imaging

Studies

ASNC 5 Single-Photon Emission Computed Tomography (SPECT) Myocardial Perfusion

Imaging (MPI) study report turnaround time 24 hours

ASNC 6 Positron Emission Tomography (PET) Imaging Study Report Turnaround time < 24 h

ASNC 7 Nuclear Cardiac Stress Imaging Not Meeting Appropriate Use Criteria

ASNC 8 Laboratory Accreditation for Nuclear Cardiology Imaging Studies

ASNC 9 Physician Reader is CBNC or Nuclear Medicine Certified

ASNC 10 Nuclear cardiology Imaging Studies Terminated Due to Technical Problems

ASNC 11 Overall Study Quality

2015 QCDR CMS Approved Quality Measures

First Year as a QCDR

• As a QCDR, ImageGuide submits data to CMS on 11 measures.

• This information is not publicly reported in the first year.

• As measures evolve and mature they will be publicly reported.

• 2016 measures were just completed and submitted to CMS for approval

- Radiation exposure

- Use of stress only protocol

ImageGuide Benefits

Fulfil Reporting Requirements

Avoid negative payment adjustments on all services

billed under Medicare Part B by successfully participating

in PQRS via QCDR

Report on performance measures developed by and

for nuclear cardiologists

Demonstrate Value

Gain access to standardized data to present to all payers

that demonstrates appropriate use of nuclear imaging tests in a practice

setting

Participate in a community of providers dedicated to

improving patient care and demonstrating the value of

the profession

Proactively Contribute to Shaping

Healthcare Reform

Contribute to a system that gives Nuclear Cardiologists a

voice in how they are measured

Succeed in a market of quality-based reimbursement

Short Falls

No outcome data

ImageGuide is a diagnostic procedure registry

• The relationship between the test and the outcome is indirect, dependent upon changes in management by the overseeing physician

Limited ability to integrate ImageGuide with older reporting and imaging systems in current use

• Will improve going forward

Data represents only performance of voluntarily participating sites

• Quality practices, Preaching to the quire?

Physicians

Industry

Payers

Federal

CMS Value-based purchasing

FDA post market surveillance, NIH/AHRQ research

State

State-level reporting and mandates

Government

Cardiovascular Imagers Leading Publications: JNC, JACC, JACC Imaging Payment Dominant membership position Negotiations Clinical Team Technologists Primary Care Improved referrals Informed clinical decision-making

Innovation and Growth

Clinical Credibility

Data Queries

Informed Payer Coverage

Inform Payers and CMS

Drive Core Measurement of the Field

Defined Value of Technology

Nuclear Lab Report Card

Incentivizing high quality CV care

Centers of Excellence

Promoting Appropriate Use Criteria

Links with ACO, PCMH, ICNAL, CBNC, ABIM

VALUE

Summary

• ImageGuide is a CMS designated QCDR helps in fulfilling regulatory requirement

•Provide feedback and facilitates quality improvement and better patient care

•Support practices in providing high value, safe practice

• Inform health policy and payment strategies

• Inform research and education efforts

•A resource for laboratory accreditation

Thank You!

Additional Information

email imageguide@asnc.org with any questions.

Visit http://www.asnc.org/imageguide Web portal demonstration Complete data element list Sign-up portal access & requirements FAQs

Imaging Registry: Laboratory driven

ASNC ImageGuideTM

CMS Qualified Clinical Data Registry Reporting (QCDR)

Objectives:

• Improve overall lab performance and patient safety

• Increase value

•Create a community

•Provide tools and resources

•Provide feedback / benchmarks

ImageGuide 2016 QCDR Status

ImageGuide was recognized as a QCDR in 2015

Self-nomination applications must be submitted annually

ASNC submitted Self-Nomination & Data Validation Plan on January 31, 2015

Approval of 20 proposed performance measures anticipated in March

How Does ImageGuide Differ From Other Registries?

Representation of Nuclear Cardiology

Other hospital-based registries may not apply to physicians not performing invasive procedures

ImageGuide captures a greater level of granularity on nuclear imaging studies

Efficient Quality Improvement

Other office based registries require data submission for every patient encounter

ImageGuide requires data collection only on nuclear imaging tests

ImageGuide is an effective solution for imaging physicians

ImageGuide does not duplicate any existing system Data collection is focused on SPECT and PET studies

Sample Penalty Illustrated

Medicare 2% Penalty

Penalty applies to TOTAL Medicare receivables NOT only nuclear cardiology related CPT codes

• 2018 Total receivables for one physician

- $500,000

• In 2018 Medicare will apply 2% penalty if not in compliance with Merit-based Incentive Program (MIPS)

- $10,000

Medicare 9% Penalty

Penalty applies to TOTAL Medicare receivables NOT only nuclear cardiology related CPT codes

• 2022 Total receivables for one physician

- $500,000

• In 2022 Medicare will apply 9% penalty if not in compliance with Merit-based Incentive Program (MIPS)

- $45,000

Enrollment

Practice administrators can enroll via ImageGuide’s online Sign up portal

• Information is collected on the site and participating providers

• Participation agreements with sites must be executed to complete enrollment

The first 100 members to enroll before May 1st will participate in ImageGuide for free in 2016

• Annual per-provider participation fees for 2016 are $500/ASNC member and $750/nonmember

What does it offer the providers

• Real-time feedback reporting - Allows practices to monitor and improve nuclear imaging

- Quality Improvement & Radiation Safety

• Meet regulatory challenges - Eases accreditation

- Platform for Physician Quality Reporting System (PQRS)

• Provides report card and testament for quality, “Bragging rights”

QCDRs & 2016 PQRS Reporting

• QCDRs are a CMS reporting mechanism that allow registries

to develop their own performance measures that satisfy PQRS requirements

What is a Qualified

Clinical Data Registry?

• Providers must satisfactorily report on 9 quality measures for 50% of patients

• Providers who fail to meet reporting requirements in 2016 will receive a 2%

penalty on all CMS Part B receivables in 2018

Providers who report via QCDR can receive

credit under PQRS

Physicians are required to participate in mandatory quality tiering under the Value-Based Modifier Program (VM) program

Upward and downward payment adjustments based on participation Physician Quality Reporting System (PQRS)

The maximum downward adjustment is up to -4%* in addition to the 2% PQRS penalty

2016 Value-based Payment Modifier Program

2016 Penalties for Unsatisfactory PQRS Participation

PQRS VM Total

1-9 Providers

-2% -2% -4% (in 2018)

10+ Providers

-2% -4% -6% (in 2018)

*In 2016, providers will receive upward, neutral, or downward payment adjustments based on quality

tiering results

PQRS, Physician Quality Reporting System