Using Confidential Clinical Data Registries for Public Reporting and Pay for Performance
The American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) is an example of a confidential clinical data registry, and is utilized in more than 600 hospitals across the United States. ACS NSQIP uses trained and data coordinators to collect more than 200 high-quality clinical variables per case, based on rigorous specifications, maintaining superior validity in capturing outcomes when compared with administrative databases.2 Data are fed back to each individual hospital through risk-adjusted and non-risk-adjusted reports on 14 universal outcomes (ie, 30-day mortality, surgical site infection), and many other operation-specific outcomes, allowing for internal, and also multi-institutional benchmarking. Hospitals enrolled in ACS NSQIP have demonstrated improvement in clinical outcomes over time, potentially increasing in magnitude with length of time in the program.3 There are many other validated clinical registries within the surgical realm that contribute significantly to QI, one of them being The Society of Thoracic Surgeons National Database. This confidential clinical registry provides validated, robust, risk-adjusted data that are used to advance patient outcomes in adult cardiac, congenital cardiac, and general thoracic surgery through clinical research and National Quality Forum (NQF)-endorsed quality measures.4
Health plans, including those of the government, currently use administrative claims data to monitor provider performance and to benchmark providers against competitors. Recently, payers have begun to create incentives for, or to mandate altogether, hospitals to submit performance results from confidential clinical data registries such as the ACS NSQIP. Payers are using, or are anticipated to eventually use, these results to implement their own pay for performance (P4P) protocols.
Public reporting of patient outcomes data has become more common, with the laudable goals of increasing transparency and improving patient awareness. Driven in part by federal mandates from the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) have made patient outcomes data available for public consumption from over 4000 Medicare-certified hospitals through hospital ranking efforts such as Hospital Compare.