ACR to Unveil Six Landmark Data Registries
The American College of Radiology (ACR) is on the eve of launching the first of six voluntary data registries whose evidence-based benchmarks will aid quality improvement in imaging facilities nationwide, have the potential to increase CMS compensation to individual practitioners, and guide future research. Noting that the National Radiology Data Registry (NRDR) will provide the first national snapshot of radiology on a host of key fronts, ACR Executive Director Harvey L. Neiman, M.D., FACR, calls them “an important strategic initiative for all of radiology.” He describes these registries as “radiologic-centric,” meaning they are designed by radiologists for radiologists.
Neiman says the six-part NRDR will provide a much-needed evidentiary foundation for radiology. “Prior to this,” he says, “there’s been limited evidence-based medicine within radiology. The College’s data registries will enable us to document the value of particular procedures and allow individual radiologists to benchmark their cumulative results with similar practices across the country.” By documenting competencies, radiologists will be able to conclusively demonstrate they are the quality practitioners of medical imaging.
This documentation is expected to yield clear financial benefits to practitioners. “If you do not have evidence that a procedure is effective, then CMS is not going to reimburse it,” Neiman says. He notes that in November 2005, the National Oncologic PET Registry — managed by ACR and ACRIN — began accepting facility registrations in response to a CMS proposal to expanded PET coverage. Facilities today can obtain once-denied Medicare reimbursement by participating in this registry.
ACR Director of Data Registries Laura Coombs, Ph.D., notes that the data collected will help on multiple fronts, from quality improvement to CMS reimbursement to CMS facility certification. While three of the six registries are related to specific procedures (carotid artery stent, CT colonography, and CT angiography), all will foster a two-way exchange of information that will advance individual practices and the discipline of radiology alike. “Once a facility sees where its performance benchmarks stand in relation to others,” Coombs says, “the staff will be able to identify their strengths and weaknesses and make needed adjustments.”
ACR-NCR. Starting this month, the College will launch National Carotid Artery Stent Registry (ACR-NCR), and will add a first-ever intracranial piece shortly thereafter. The College will reach out to facilities that specialize in carotid artery stent procedures by way of e-mails, brochures and Web site notices. Joining the registry is entirely voluntary, Coombs says, but facilities “are required to submit certain data elements to CMS to maintain facility certification.” Going through the registry is one possible way of doing that. Participating practitioners stand to gain, she says, by getting “quality feedback reports that help them improve their practice.”
Coombs says facilities will be required to fill out six forms, from start to finish. The first cases are expected to take about 30 minutes to complete, but as staff become familiar with the forms, this should go faster. She says the ACR is committed to streamlining the process and notes that very few facilities “are doing large numbers of these procedures.” This registry is being done in association with the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and American Society of Interventional and Therapeutic Neuroradiology (ASTIN.)
CTC Registry. In the last quarter of 2007, the ACR expects to unveil its registry on CT colonography, after beta-testing is completed this summer. This key registry may help resolve the complex issue of virtual colonography as an alternative to colonoscopy.
Other Registries. Early 2008 should bring the roll-out of the Coronary CT Angiography (CCTA) registry. In mid-2008, ACR will launch the General Radiology Improvement Database (GRID). Data elements for GRID will be developed by late fall 2007.
This voluntary registry will collect key quality indicators about the nation’s imaging facilities, which will then be used to establish benchmarks for quality improvement. According to Coombs, GRID will collect “a variety of information” about the facility. “We want to extract as much information as we can from electronic sources to avoid facilities having too much data to enter manually,” she says. The individual institution’s data is available only for that facility’s use and is protected by the Virginia peer review laws.
Also, in 2008, the ACR expects to launch an updated version of the National Mammography Database (NMD), based on BIRADS®. After a fall 2007 pilot program involving seven facilities, the Dose Index Registry (DIR) will launch nationwide in 2008. This registry will initially collect dose estimates from CR and DR.
For all six registries, facilities will get an initial feedback report that assesses how well their data meets the national, regional, and state benchmarks. “Once sufficient data has been collected, you will be able to … get real-time reports on the data that you entered about your own facility,” Coombs says. “You will also receive periodic benchmark reports that compare your results to the national, regional, and state averages.” These reports will allow participants to identify strengths, weaknesses and inefficiencies. In addition to identifying possible areas in which a physician might need to improve; they could also verify just how strong he or she is in other areas.
Privacy. Coombs says data collected from the registries “are purely for the facility to see how they are doing.” She adds, “I don't see any disclosure issues. Each facility will sign a contract establishing that [a facility’s] patient-level data belongs to them. The only data we will report will be at the aggregate level.” She also notes that the ACR is headquartered in Virginia, and by Virginia law, NRDR reports are considered “peer review and privileged and not discoverable.”
Neiman says that the ACR will ensure fair comparisons. If comparisons are made, he says, “they will be made between like practitioners.” He continues, “If you are in a rural practice doing general radiology, your benchmarks are similar practices and not to an individual practicing in a large, tertiary-care teaching hospital doing only one particular procedure. We will be benchmarking with appropriate profiles.” Cumulative data may be disseminated, he says, but individual, identifiable data will not be.