Vera H. Rigolin, MD, FASE

All of us who use echocardiography intuitively know that it is an invaluable technique that makes a huge impact on patient care. In this day of scrutiny of every healthcare dollar that we spend, however, intuition is not enough. Rather, solid proof is needed. During the past several years, healthcare payment models have been shifting toward quality-based measures. How can we measure quality in echo and show its benefit to patient care? Introducing…ImageGuideEcho!

In 2009, the American College of Cardiology held the second Quality in Cardiovascular Imaging Think Tank. A summary of this forum, published in JACC Imaging, identified the creation of imaging registries as one of the ways to address quality issues. Congress also identified registries as a means to track disease patterns and patient outcomes. As a result, Congress created the Qualified Clinical Data Registries Program (QCDR) and encouraged the medical field to create registries.

Another important event occurred in 2016 when the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repealed the flawed Sustainable Growth Rate (SGR) reimbursement formula and replaced it with a value-based reimbursement system called the Quality Payment Program (QPP). This program begins the shift away from a fee-for-service payment model and towards one that is quality-based. Under the QPP, providers will participate in either the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (Advanced APMs). It is anticipated that 90% of providers will participate in MIPS rather than APMs in 2018. MIPS defines four categories of eligible clinician physician performance that include quality, advanced care information, clinical practice improvement activities, and cost. Quality carries a 50% weight in the final MIPS score for 2018. Through participation in a QCDR, providers may earn points toward both their Clinical Practice Improvement Activities (CPIA) and quality components of MIPS. By participating in a registry, there is the possibility to achieve 10 points.

In 2015, the American Society of Nuclear Cardiology (ASNC), created the first national registry, called the ImageGuideRegistry, for noninvasive cardiovascular imaging. This was (and still is) a physician-run data endeavor that provided free or low-cost access to benchmarked data in an effort to improve quality in nuclear imaging. Once the structure of the registry was created, ASNC successfully applied for and received the designation as a QCDR by CMS. For several years, ASE leadership has also been discussing the development of an echo registry to assess specific quality metrics and patient outcomes in order to help members improve the performance in their laboratories and eventually link to patient outcomes. In 2017, ASE finalized an agreement with ASNC to create an echo module within the ImageGuideRegistry. Thus, ImageGuideEcho was created. ASE is excited to offer participation in ImageGuideEcho as a complimentary member benefit for U.S.-based echo labs in 2018.

The ImageGuideRegistry allows the opportunity for laboratories to participate in the nuclear module, the echo module, or both. Participation in the registry will allow physicians and their labs to track their location-specific data and then benchmark their performance compared to national aggregates. The registry allows for performance analysis of the imaging lab as a whole as well as each individual participating member of the lab. Feedback is then provided that helps labs improve their quality metrics.

Both the nuclear and echo modules of the ImageGuideRegistry are approved QCDRs by CMS. The QCDR designation allows the registry to submit quality data reports directly to CMS on behalf of its participants. In turn, this can help labs and physicians avoid negative payment adjustments under the new MIPS regulation. There are echo-specific data elements and performance measures within the echo module. Fulfilling MIPS reporting requirements through ImageGuideEcho requires a smaller patient pool than a non-cardiology specific registry, which decreases the amount of effort for physicians and their labs. Echo labs will also receive feedback on their quality metrics that can be used for internal quality assurance programs.

Under the guidance of Dr. Sherif Nagueh from Methodist Hospital in Houston, a phased data implementation model of the registry was created. Launched in 2017, the first phase of the registry data elements includes the institutional site profile, patient demographics, and transthoracic echo data. Phase 2 will include stress echo, and phase 3 will include transesophageal echo and an initial link to patient outcomes. Future phases will include pediatrics, vascular, and other new technologies. The speed of the phases is dependent on funding levels.

Once enrolled, labs and individuals have three options for reporting their data: electronic health record (EHR) extraction, imaging software vendor extraction (highly recommended), and web-based data collection. ASE is currently working with several imaging software vendors to allow for direct data extraction so that there is no change in work flow for participating sites. If your lab is interested in a PACS-based system report extraction, ASE recommends that you please contact the PACS software vendor working with your institution to let them know that you desire this capability, and also reach out to ASE registry staff ( info@imageguideecho.org ) to coordinate efforts. ASE can then directly communicate with your institution and the PACS software vendor to provide the specifications needed to allow for this feature.

Enrollment in ImageGuideEcho opens in Winter 2018. Visit the ImageGuideRegistry website ( ImageGuideEcho.org ) for enrollment information, the ability to sign up for updates and alerts as well as access articles and FAQs. An informative webinar has also been created ( aseuniversity.org/ase/sessions/11435/view ). Those who enroll after January 1, 2018 will have the capability to backfill their 2018 data to best comply with MIPS standards. Questions can also be answered by email ( info@imageguideecho.org ).

ASE is excited to partner with ASNC in the ImageGuideRegistry and to offer participation to its members. This registry has the potential to help not only individual physicians and noninvasive imaging labs, but also to demonstrate the value of echo and nuclear imaging technologies in the care of our patients.

Vera H. Rigolin, MD, FASE, is a cardiologist at Northwestern Memorial Hospital, Professor of Medicine at Northwestern University’s Feinberg School of Medicine, and is the current president of ASE. She specializes in echocardiography, valvular heart disease, and women’s heart health. She speaks fluent Portuguese, and has collaborated in the translation of four of ASE’s guideline webinars into Portuguese.