As President of ASE, I have been asked many questions about the operations of the Society in the last year. Recently, I was asked a tough one: How many clinicians report ejection fraction by biplane 2D, global longitudinal strain, diastolic function, or use of contrast in their echo labs? I deliberated but did not have a great answer; however, I did say that ASE is working hard to address this type of question and is “taking care of business” in this era of health care reform. As part of our strategic plan (Goal 3), ASE has been actively working to create an echo-specific qualified clinical data registry (QCDR), which will be part of the ImageGuide Registry platform. In November 2016, at our strategic planning meeting in North Carolina, the ASE Board unanimously approved the creation of a new echo registry. I consider this to be “Next Big Thing for Echo!” This president’s page will outline what you need to know about this registry and how it will impact you and your clinical practice.
What is the background for the creation of an imaging registry? The ACC, in collaboration with imaging subspecialties, has published two white papers about improving quality in the imaging field. One of the action items was the need to create registries amongst the imaging subspecialties including echo, nuclear, CT, CMR, and cardiac catheterization. The important essentials of an ideal imaging registry should include the following: indications for the study, demographic and clinical information, the imaging acquisition settings, key study results, and the ability to link the data to other databases and relate to outcomes. Eventually, this information from the registry should give feedback to the clinician in terms of how they are doing compared to national benchmarks and incentivize quality improvement. ASE took on this project after discussion with ACC leadership and other cardiac subspecialties, which indicated that this type of specialty-specific registry was not planned to be undertaken by the ACC’s National Cardiovascular Data Registry (NCDR).
Why is this important for ASE and other stakeholders? Currently ASE does not have a QCDR that can report quality metrics to CMS. ASE has traditionally relied on surveys from its members (2016 Benchmarking Survey in conjunction with MedAxiom) and administrative or industry databases in order to answer important questions about the national use of different echo techniques such as the use of 3D, strain, or contrast. There are many advantages to developing a QCDR. Chief among them is the goal to improve quality and provide value to all the stakeholders, including the clinician, echo lab, hospital, health enterprise, payors, and, of course, the patient who prioritizes great value with the best outcome. Finally, the registry could provide new, cutting edge research involving comparative effectiveness of echo relating to outcomes. This new QCDR is crucial in the era of health care reform as clinicians and hospitals are facing challenges in satisfying their quality metric requirements in the new value-based health care model (MACRA). If these quality requirements are not met, this could lead to negative payment adjustments–a significant setback in the current era of decreasing reimbursements to hospitals.
What is the timeline for this registry? Figure 1 shows the timeline of the creation of the ASE ImageGuideEcho Registry. The Workflow and Lab Management Task Force lead by Dr. Sherif Nagueh and Sarah Beth Bdoyan (ASE staff) is working hard to develop the registry. ASE realized early on that it would be too difficult as well as too costly to develop an independent registry. We have thus combined forces with the American Society of Nuclear Cardiology (ASNC) who have already developed an ImageGuide Registry for nuclear studies. The ImageGuide Registry will be part of a broader registry collaboration and will partner with other subspecialties as well. ImageGuideEcho will be developed as a separate echo module as part of the ImageGuide Registry platform. Therefore, ASE will have complete control over its content and operations. Currently, we are finalizing the standardized data elements in the registry and are contracting with FIGmd to create and run the echo module. We hope to begin the pilot phase in summer 2017 with a full launch of the registry soon thereafter to ensure all 2017 participants will fulfill 90 day MIPS reporting requirements to avoid a negative payment adjustment.
