NCDR's Role in a Quality-Focused Health Care Landscape

Frederick A.Masoudi, MD, MSPH, FACC, chief science officer and chair of the NCDR Management Board, talked with NCDR.18 Update about the role of NCDR in a shifting health care landscape and how NCDR programs have helped advance cardiovascular care and outcomes in the past two decades.

What is the role of NCDR in the changing health care landscape?

NCDR is increasingly important. Our payment system is evolving to one where reimbursement is based on the quality rather than the quantity of care. In a fee-for-service environment, you only need to think about how many procedures you do or the number of patients you see. But in a quality-based system, you need to think about delivering the right care for the right patient at the right time. In order to do that, we need to be able to measure the quality of care we deliver. The best way to do that for patients with cardiovascular disease is to participate in a national registry program like NCDR. Our registries use standardized clinical data to characterize quality and outcomes against national benchmarks, which provides targets for improvement activities for our participants.

How is NCDR advancing health care innovation?

We’ve been developing robust risk-assessment tools that allow practitioners to provide personalized care that is tailored to the patient with respect to the benefits and risks related to particular therapies. We also continue to conduct cutting-edge research on health services that will help inform the national quality landscape and guide policymakers to do things that are in the best interest of patients. Finally, we are exploring partnerships to enhance our capacity to guide institutions to implement best practices.

NCDR celebrated its 20th anniversary in 2017. What are some of its major accomplishments?

NCDR has expanded substantially in terms of the number of programs and the number of physicians, care team members and health systems that participate. We now have 10 registries that span the cardiovascular space, including the outpatient area with the PINNACLE Registry – which is celebrating its 10th anniversary this year – and the Diabetes Collaborative Registry. The CathPCI Registry, our first registry, is woven into the fabric of care for cath labs across the country and is used in nearly all U.S. hospitals that perform PCI.

Our registries have supported post-market surveillance studies and satisfied coverage determinations issued by the Centers for Medicare and Medicaid Services. NCDR data has touched the lives of more than 80 million patients, and we’ve published nearly 400 peer-review papers that have helped advance knowledge of cardiovascular disease. We have been able to generate knowledge about cardiovascular care and outcomes on a national scale that would not be possible without NCDR and its committee registry participants.

In addition, NCDR has supported national quality initiatives like ACC’s Door to Balloon (D2B) initiative, which was associated with a marked, sustained improvement in delivering timely PCI to STEMI patients. Before the D2B project, about 70 percent of patients had timely PCI, despite the existence of guidelines and a focus on getting patients primary PCI within 90 minutes. At my hospital and many others, failing to get patients to PCI within 90 minutes almost never happens now. More recently, we're leveraging the ACTION Registry as part of ACC’s Patient Navigator Program: Focus MI, which aims to reduce MI readmissions and improve patient outcomes.

What will NCDR be working on in the coming years?

One of our big concerns is minimizing the burden of data collection. We’re going to further integrate our data collection, recognizing that a key factor that distinguishes NCDR is the availability of very detailed clinical data. There is clearly a need for standardized clinical data, but we want to do everything possible to ensure that we limit the burden. We are exploring mechanisms to engage patients directly and collect data on patient-reported outcomes like health status. One of the issues we’ve struggled with more recently is federal reimbursement policies. There is still a lot of uncertainty about what a value-based payment approach will look like. With a moving environment in terms of what constitutes qualification for federal plans, the lack of certainty creates important challenges. Rather than reacting to specific policies, we aim to provide value to our participants as they make the transition to payment for quality.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: National Cardiovascular Data Registries, ACC18, ACC Annual Scientific Session, Benchmarking, Registries, Risk Assessment, Peer Review, Percutaneous Coronary Intervention

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