Summary of the Kalamazoo Forum

KVCC Arcadia Campus, Anna Whitten Hall

5:30 to 7:30 pm, March 20, 2014

Overview:

The Kalamazoo forum had 13 individuals preregistered, of whom, 10 attended with another 5 attending without preregistration for a total of 15 attendees. This number reflects 1 from BCBSM, 2 from the Coordinating Center and 12 external participants representing:

Borgess Medical Center (4), Bronson Methodist Hospital (1), West Michigan Cancer Center (6), University of Illinois Cancer Center (1) . These individuals were from pathology, oncology, hematology/oncology, breast surgery, cancer genetics, pulmonary and sleep medicine, laboratory directors, CEO, and contract and systems analysis. The attendees were mostly unfamiliar with PGIP and CQI’s, so Marc’s introduction was new to them. Marc did a good job of explaining the information clearly and simply. The participants appeared to be well engaged throughout the evening and there was an extensive discussion following the presentation.

Discussion Summary

  1. How do you envision an advisory board working?
  2. One participant indicated a recent ARUP study found that 28% of molecular diagnostic testing ordered weremisorders (the wrong tests were ordered by the physicians). An Advisory board can help reduce the number of misorders.
  3. A question was raised as to whether or not BCBSM would pay for the tests if the advisory board recommended they do so. This will be determined by BCBSM and is outside of our scope of authority.
  4. How will we deal with somatic mutations vs mutations that drive therapies?
  5. The approach we take will vary depending upon the tests under consideration. They won’t all be addressed in the same manner as each has its own implications for the patient. The consortium will carefully select the tests that we will target – just a couple initially, to ensure we have the proper infrastructure in place and are able to develop appropriate processes.
  6. A concern was raised that if we concentrate on one area, we will end up missing other things. This may be true. However, it is not feasible for us to focus on everything – the field is just too broad. We will of necessity have to target specific tests and take them in a well-considered order for greatest impact on patient care. If we try to tackle too many tests at one time, we will not be successful.
  7. What are your thoughts regarding the employment of data abstractors?
  8. The attendees believed it would not be an issue for non-employees to gain access to the EMRs as long as the proper agreements were in place.
  9. They recommended that these abstractors be assigned to a specific area – for example, Kalamazoo abstractors could work with Borgess and Bronson facilities and drift between them.
  10. It was suggested that we may want to make use of the HIE’s for data collection. This is a good idea, however, at this point, the amount of data available through HIE’s is insufficient for our needs. This will likely be a source of information in future years, but it is not yet sufficiently developed to be useful.
  11. Not all of the data we need will always be in the EMR. Sometimes there are lags in getting the data input into the EMR. How are you going to audit this?
  12. One of the roles at the Coordinating Center is that of Data Auditor. This individual will go out and visit the sites and do a manual audit of the patient information that is collected by the abstractors to be sure all relevant data has been included. The data auditor may not look at every patient record, but just a sample of them. If issues are found, a more indepth audit will be undertaken to ensure all of the appropriate information is included and any necessary training will be done.
  13. Patients often see providers in multiple systems and their patient identification may vary between providers (i.e. M. Smith vs Mary Smith vs. Mary M. Smith, etc.) and databases will not recognize these as the same patient. How do we plan to reconcile these differences?
  14. Part of the Coordinating Center staff’s responsibility will be to review the patient identifiers and attempt to manually reconcile patient records using other patient identifiers such as date of birth and address. Once we identify that Mary Smith is the same as Mary M. Smith, we will be able to link those records that come into the database. This is not a perfect process, but we should be able to link the majority of the patient records in this way.
  15. What are your greatest needs that the GTRQC may be able to help with?
  16. Reimbursements. A frequent issue is that doctors do not call for pre-authorization for the test. The test cannot be done in the local lab and needs to be sent out to a reference laboratory. The hospital has to pay the reference lab for conducting the test, but then the reimbursement is denied because no preauthorization was done. The patient is often unaware that the doctor even ordered the test and so cannot be held liable for payment of the bill. This causes a serious financial issue for our hospital labs.
  17. A participant suggested that we may want to establish a reimbursement committee to help resolve reimbursement issues.
  18. Part of the GTRQC’s goal will be to help educate the physicians on how to properly order these tests to alleviate some of these issues. A thought that we have is that in our Genetic Testing Resource, tests could be color coded such as the test name in green = no preauthorization is needed, blue=preauthorization is required and red=this test is not reimbursable at this time.
  19. Adherence to national guidelines. Guidelines are in place, but are not being followed. This is one of the goals of the GTRQC. We will be tracking and measuring adherence to these guidelines. Any type of incentive will depend on adherence to guidelines, such as 80% adherence gets a full incentive, with lower adherence receiving a lower incentive.

Interest Surveys

Six Interest surveys were turned in from West Michigan Cancer Center and Borgess Medical Center.

Phone: 734-763-2616 ● ● ● Fax: 734-936-2629