The ongoing transformational shift to value-based payment in healthcare is fueling the rise of clinical data registry participation. The average U.S. healthcare facility participates in five to 10 registries, and the 20 largest registries are expected to increase in participation at an average of 7% each year until 2021.
Because registries are widely recognized for their proficiency in assessing the effectiveness of care, their growth is welcome news, but many hospitals are missing out on their full range of benefits.
As CEO of an organization that works with hospitals to measurably improve quality of care, I have witnessed more times than not that hospital executives are unaware of the number of registries their facilities are involved in.
For some, registry participation is limited to producing evidence to back up marketing claims such as "our team is the best in the Midwest for heart care." Even when clinical department heads overseeing a registry appreciate its full potential, they are often not in a position to manage it with an eye toward improving care quality and value.
Many hospitals today face a perfect storm of operational and financial challenges. Competition from outpatient facilities, increasing care costs and adapting to value-based approaches are among the compounding factors impacting budgets. Thus, getting more than quality improvement out of registry participation should be a goal of every hospital.
At the same time, unlocking the full potential of registries requires a facility, or systemwide, strategy. In other words, a strategic enterprise approach.
A “Side Effect” of Quality
When I mention registry, I am referring to inpatient clinical data registries—sophisticated databases that provide hospitals with the benchmarking information needed to assess and improve the quality of care. Well-established programs like the IMPACT Registry and the American Heart Association's Get With The Guidelines-Stroke program are examples of major clinical data registries.
Cost savings can be a potential benefit of registries that stems directly from improving the quality of care. It is no secret that mistakes and readmissions drastically drive up healthcare expenses. Most sources put the cost of errors between $17 billion and $29 billion annually, while readmissions cases are among the costliest of all—to the tune of more than $50 billion a year.
Fortunately, reducing readmissions is a registry strength. For example, the American Heart Association's Get With The Guidelines-Heart Failure program is associated with significantly improved outcomes, including reductions in 30-day readmissions. When programs like these are implemented with the proper collaboration, feedback, education, process improvement and technology, enhanced adherence to care guidelines has been the result.
When it comes to quality improvement, knowledge is of little value if you don’t put it to work. Because registries record information about procedures and outcomes, they become valuable tools in understanding which treatments, tests, devices and medications will most likely help a patient.
A classic example is whether to do surgery. For instance, the Vascular Quality Initiative Varicose Vein Registry collects data on which surgical and non-surgical venous procedures result in the best outcomes for certain types of patients. When the most promising approaches are apparent, fewer resources—and therefore costs—are needed to deliver the best possible care.
A significant factor driving registry participation is the shift to value-based care (VBC). Hospitals that don’t meet quality targets risk incurring penalties or are denied payment and rewards from payers. Registry participation directly satisfies certain quality reporting requirements (PDF). Less obvious, but just as important, is how registry participation fosters a more VBC-embracive culture through clinician engagement.
When used effectively, registries provide clinicians with the data needed to determine best practices. This empowers them to play a direct role in establishing new standards of care and corresponding goals.
With registry participation, clinicians become champions in adopting value-based approaches that ultimately improve the quality and cost of care.
The Why for Enterprise
Many hospitals and health systems have multiple departments or facilities reporting to one or more quality programs. When there is no enterprise cross-talk or common organizational goals for these programs, it sells them short as instruments of change with respect to performance and cost containment, especially for registries.
This dilemma is not new to healthcare. Health IT experts have pushed for enterprise management of electronic health record systems since before the technology was widely in use. Cloud technologies and cybersecurity efforts have also demanded an assessment of the full enterprise to best serve the organization as a whole.
In fact, more efficient registry data management alone can save costs.
Take this example from our hospital partner population at Q-Centrix. In April 2018, our team received authorization to submit data to the CathPCI Registry on behalf of approximately 150 hospitals. More than 80% of these facilities participate in at least one other cardiovascular care-related registry using one of the company's solutions.
Since these registries have many overlapping measures, a more coordinated approach to participating in them significantly reduces redundancies in data collection and reporting and therefore the cost of doing so for those hospitals.
To unlock registries’ cost-savings potential, hospital executives, medical directors and clinical and quality department heads must challenge each other to view registry participation as a vital enterprise decision.
A first step is understanding the full scope of their facilities’ registry involvement. They will know they are on the right track when they can answer the question: “How many registries does your organization participate in?”
Cost savings is one of several registry participation benefits beyond quality improvement. Stay tuned for future posts focusing on several other benefits.
Milton Silva-Craig is the CEO of Q-Centrix. He has more than 25 years of experience in the healthcare information technology industry and has held executive positions at leading industry companies, including General Electric Medical Systems.