MEASURING

QUALITY OF
UROLOGY CARE
USING A
QUALIFIED
CLINICAL DATA
REGISTRY
 INTRODUCTION

THE QUALIFIED CLINICAL DATA

REGISTRY[QCDR] merges 2 Concepts

Collection of large Reimbursement

volumes of data to adjustments based on
research and improve the quality of care
existing quality of care provided
HISTORY OF QUALITY MEASURES AND REIMBURSEMENT ADJUSTMENTS
Began in USA [Tax Relief and Health Care ACT of 2006]

Prompting health care centres to create the Physician Quality Reporting Initiative [PQRI]

First report measured for a potential increase of 1.5% in medicare reimbursements.

Initial data were based on 74 measures.

6 of these measures pertained to perioperative care [focusing mainly on antibiotic prophylaxis and DVT prophylaxis]

Only 3 measures were specific to Urological conditions [Female incontinence]

In 2008, 32 registries to collect and submit datas to Medicare System were made and collectively known as ‘Qualified Registries’

Patient Protection and Affordable Care Act passed in 2010

PQRS programmes got established

Total number of measures increased to 200

Urological measures increased to six.

Original 3 for Female Incontinence, 2 measures for Prostate Cancer Clinical Care, and 1 measure for Prostate cancer pathology reports
Without defining a clear measure, did not attract many
physicians to report

American Taxpayer Relief Act passed in 2012.

Specialty specific metrics developed.

Incorporating existing data registries with new measures

tailored to specialty focus, known as ‘QCDR’ [qualified
clinical data registry]
QCDRs provide a framework
for quality improvement,
clinical research and QCDRs allow urologists to
reimbursement adjustment drive efforts in defining and
under the merit based improving the quality of
incentive payment system. urological care.

Most quality measures

developed by the Urology
QCDRs are derived from
existing clinical guidelines.
 Medicare Accessibility and Children’s Helath Insurance Programme reauthorization Act[MACRA] passed in 2015.

PQRS was incorporated into the quality arm of the merit-based incentive payment system {MIPS}

Under this, physicians can participate in Quality Payment Programme [QPP] to receive reimbursements of upto 4% in 2019
and upto 9% by 2022.

Physicians who decline participation [failure to report/track] will receive a penalty of 4% Medicare payment in 2019, and
upto 9% in 2022.

Thus measures in QCDR became profound and extensive now known as ‘MIPS quality Measures’

2018, 10 of these measures pertain to UROLOGY. 2 for Female incontinence, 3 for Prostate Cancer, 5 for POPS.

18 more measures are under development but none pertain to Urology

So need for more urology specific measures is significant to monitor and to improve the quality of urological care as well
as to appropriately reflect the efforts of urologists who provide high qualified healthcare for urological conditions.
QCDR Certification and Measures
• Self-nominate to Medicare System every year
• Collection of Clinical data
• Follow up of all cases regardless of insurance status
• Audit of these datas and certifying it.
• Complete Audit updated electronically to Medicare System.
• Proposal of a Measure should be well established in literature and clinical practice
guidelines.
• Proposal should not be based on emerging or controversial studies, rare diseases,
high performance rates, simply documentation based measures or abstract ideas.
• Application of proposal should be submitted to Medicare Sytem electronically for
approval.
Approval mandates atleast one of the six national quality strategies

physician centered
Communication and Efficiency and cost
experience and
care co-ordination reduction
outcomes

Community/population
Patient safety measure Effective clinical care
health
 Process Outcome
measures measures
Activities that
increase the
probability of Results of clinical care
achieving a desired
outcome

Eg: prophylactic
Eg: Percentage of
antibiotics before trus
admissions for sepsis
biopsy to avoid postbx
post bx
admission for sepsis
 Outcome measures

Intermediate outcomes not perceived by patients

(Eg: BP control in Chronic renal disease

Patient reported outcomes

Eg: Urine control after RP based on patient survey

Other measures
• Guidelines to limit side effects
• Cost/Resource effectiveness [limiting USG in boys with uncomplicated
unilateral cryptorchidism]
• Structural measures [maintaining radiation dose registry after CT]
• Patient engagement/experience measures – Satisfaction survey