No, those are two separate measures. So one measure is, did you offer pesteries? Because obviously, we want to see people offering the intervention. But then the second measure is, are people actually truly offering them and giving them to patients? Or are people simply paying lip service to it, while saying something like, well, you can try a pestery, but it doesn't really work? So the idea is just to look and see on both measures, what are we seeing? I would say yes, right? It's very clear that the patient attempted a pestery. The key is the diagnosis and the reason for the procedure. So if you were, for instance, all of us will be in the hospital, and we're going to be in the hospital, and we're For instance, all of us will periodically go to the OR with the oncologist, who will have somebody with an endometrial cancer and need a prolapse repair. Well, it's kind of silly to be offering a pestery to that patient. They're going to the OR anyway. So I think that's the vision. If you go to the OR for a legitimate reason, and while you're there, you're fixing prolapse, or you're addressing incontinence, et cetera, well, that becomes an exclusion for some of these non-surgical measures. Because it would not be appropriate to penalize somebody for not offering a non-surgical measure when you're going to the OR anyway. I don't think anybody would fault you for doing that. That would be a potential solution. I think longer term, we'll want to come up with ways that you can revise or edit an incorrect entry. I think anybody who deals with registries understands that every now and then, somebody's going to make a mistake and hit the wrong button. So we have to have a way to correct that. And so, as we all know, clearly this registry is going to undergo some change and reiteration and expansion as we develop it further. And that'll be one of the things we'll want to address. So, Brian, I think all the things you're suggesting are very good ideas. And I completely agree that as we revise this and we really look and see what works well to try to find more efficient ways to enter the data. One of the things that we'll want to do, and I know there's a lot of discussion at different levels of AUGS, is to try to get some of the post-operative outcomes, particularly for slings and things like that, try to make this a larger database that can really give us a lot more information about what's happening with outcomes. But that then involves a secondary data entry. That involves a whole other layer that's going to have to be developed. But the suggestions you have, I think, are very good. And as we revise this over the next year, those are things we'll want to consider. Right, that's right. When you are a qualified clinical data registry, which is what AUGS is working toward right now, right now we're a qualified registry and we got that letter back. And so if you want to just use this as a qualified registry, then it's the nine MIPS measures that we put in, six of the nine. But we're waiting to get our letter to be a qualified clinical data registry. That registry is going to have nine plus 11 measures that are not MIPS measures. But one of the beauties of the qualified clinical data registry program is that medical societies can put measures in their registries that have not gone through the CMS process and individuals can report on those measures. So it gives us more flexibility in regards to the measures that people can choose out of the six. We have a couple questions from our virtual audience. So the one question is, so is the registry right now just for surgical patients? And then I would also say, what's the plan for the future? Right now it is for surgical patients and you can see that the data does require entry. Trying to do non-surgical patients, the logistics for data entry can be pretty daunting. There's not yet an automated way that we can get some of the non-surgical data in there. It's something that we would love to see, but we have to figure out what is a simple user-friendly way to do it. For instance, there's one of the quality measures that have been developed is looking at assessing urinary incontinence in women over 65. You know, every odds memo should be able to blow that out of the park, but the reality is, how do you get that data entry? I can tell you at the end of the day, when I'm doing all my billing and all my documentation, the last thing I wanna do is for 15 patients, now go in and manually enter data into the database. So until we have a good way to automate the non-surgical, we focused on the surgical because for each of these patients, you can do it probably in about a minute. Once you're logged in, the data entry is very quick. So another question we have is, when you're working with a qualified clinical data registry or qualified registry, do you only enter surgery patients that have Medicare? The answer is no. You actually enter all your patients when you're choosing this route. It does mean that CMS gets your non-Medicare data as well, but then it also, you don't have to think about what patient to put in, you just put in all patients, right? And that'll give us and you benchmarking data that you may choose to use with your non-Medicare payers to go talk to them about paying you more for quality because you'll have this benchmarking data from your OGS acquire participation that is your data and you will be able to personally use that data to work with other payers because you will have to put in all your patients. Yes, it was optional, but people can put in the payer in the very first block of demographic information. Do we have to get a bit, oh, this is good, Mike. This is, Tricia and Mike, this is your question. Do we have to get a business associate agreement with OGS to meet HIPAA requirements for entering PHI? Yeah. This is how you set it up. Tricia, tell us how to get into their OGS registry. What do we do? The acquire registry will fully launch to membership at the end of the year. Membership at the end of April. Right now we are in a pilot phase with about 13 sites entering data currently. And once you do agree to participate, yes, you will have to sign a business associate agreement and a data warehouse agreement. And is that hard? That is not hard to do, but you will need to go through the proper channels in your institution. If you are not a private practitioner in a solo practice. So just keep in mind, this does disenfranchise those of us in large academic institutions. Full disclosure, I'm at Emory Healthcare, huge, and they do not like this stuff. They don't. And I can do it as part of a research because I do do the OGS PFD registry as part of clinical trial work, but that's all under consent and the patients know it. They know they're going into a registry. This thing will never fly. And my experience with academic institutions coming from the College of Surgeons, the NSWIP program would be that, yes, that is true, but however, you will need to show most likely some ROI. In this case, it would be benchmarking for some of the larger academic institutions and still reporting, utilizing it as a reporting mechanism. However, you may need to, depending on your institution, present this more as a research tool, okay? Yeah, Trish is exactly right. When NSWIP was first founded, right, and I know the Vascular Quality Initiative that vascular surgery has, they originally founded it as a research program, not a quality reporting program, and actually signed up mostly academic centers under that rubric to do quality research, quality benchmarking, quality projects, et cetera. And I would say that that, not speaking for the board, but I would still speak for the board and say that is one of the hopes for ACQUIRE is that it will get to a robustness that the academic community will come to it as a research tool to really look at quality research in the true sense of the word. And we're trying to work through how to put that ROI together. Trish has got some great ideas from her previous journeys that we think are gonna help us because we realize that for our private practice people, it is easier to get signed up, but for our academic people, it may be that they are more interested in it from a quality improvement research activity than for payment reporting. So it's a little bit of a catch-22 because the minute you say research, you have to consent everybody, right? And so you have to be careful when you're doing that. I think it is really difficult for everybody at this point, whether you're in private practice. I mean, unless you're in your own solo practice, there are always people that you have to kind of float this by. And so right now it is really difficult. I think over time, it's gonna become a lot more accepted. But right now, I think every single person who is entering data in ACQUIRE has had many meetings, personal discussions. I had to talk to our CEO and our IT person at length about whether we had to consent people, right? An hour-long conversation going around and around in circles until everybody felt comfortable that this was okay to put patients' data into this registry because it is for quality and the government is requiring it. But it's also new that nobody's comfortable with it yet, right, even if it passes all the rules. In our community, it's very new. Yeah, very new. Ours is probably the farthest along of anyone in the OBGYN family of specialties and subspecialties. So for our community, it's extremely new because we have some who have participated in NISQIP possibly if they're in surgery department or have some relationship with the surgery department. But it's not like the OBGYN departments have had big registry programs. We just haven't. So it's gonna take some time, but we wanna get there, I think. Does the data from ACQUIRE get reported to CMS identifiably? So do patients- No, right? It goes in de-identified. But we do have a good question on that, Blair. That's a good point. Will the public be able to see individual provider results on ACQUIRE? Have any of you ever checked your scores on Physician Compare? Okay, that's a note to self. Monday, you will all go and check your Physician Compare because you're on it. You know, Ryan was saying that patients can start to find information about you. Well, Physician Compare is one of those places, right? And one of the things you'll be surprised at is your addresses probably aren't even correct on Physician Compare. So you want to check that. And that's where, over time, measures will be reported on physicians. It'll be your total measure score, but CMS's goal is to add all of the measures on physicians onto Physician Compare. There's also a hospital compare, by the way. If you'd like to look at how your hospitals are doing on their measures where you practice, go take a look at them. Their measures are much more robust because they all report the same things. But you'll find out how many have high catheter rate infections, how many have high hysterectomy, surgical site infection, hydrogenic pneumothorax, class B. It's all there, man. You can see it. And some of them are not as good as you thought they were. Let me just say that. So you want to check that out. So FIG-MD has a data validation tool within it that what they do is they do an auditing mechanism where they will audit 10 patient charts randomly. And that's how they do a data validation, to make sure that there is no cherry picking of cases. Same thing with NISQIP and some of the other registries as well. So people could do bad stuff, right? We can't stop people from lying. You can't police everybody. But we would hope that people would not change their data. Now, could CMS at some point come in and say, we want you to pull records? I mean, all registries, if you certify your registry, are now required to hold all data for seven years. And CMS can come back and look at that data any time within seven years. And we're now required to have ability to find every physician for seven years who put data in. So it's not an auditable data. Now, would Medicare go to the distance of going back to your practice and pulling charts to compare? I don't know. We're not far enough along to think that CMS is going to try that stuff. But don't count the government out, right? So let's just be good stewards and do it. So here's another good question. If we have selected other quality measures, can we submit through Acquire and another QCDR? Well, that is a good question. So if you've, you know, right, Bob was talking about, know your benchmarks, know your data, then go back and pick your measures. So what if you're doing well on measures that we don't have in Acquire, right? But you're in another QCDR that has some of the measures. You're in Acquire that has some of the measures. Um, that is a really good question. We may have to find the answer to that. Trisha, do you know the answer? Yes, you can report to more than one QCDR. Initially, when MACRA, the rule came out, the proposed rule, you could not. They were saying you can only report to one, but that's changed since then.

ACQUIRE

quality reporting

benchmarking

Obstetrics and Gynecology

registry