The American Academy of Neurology’s (AAN) Axon Registry was recently approved as a 2016 qualified clinical data registry by the Centers for Medicare & Medicaid Services (CMS), which has promising implications for neurologists and their practices. The AAN states that the registry can help users “more efficiently manage patient populations, demonstrate their value to payers, share quality improvement strategies with peers, and benchmark their individual and group performance.”
Neurology Advisor spoke with Registry Committee chair Bruce Sigsbee, MD, FAAN, a neurologist in private practice in Rockport, Maine, and past AAN president, to learn more about the purpose of the registry, how it works, and its potential benefits to neurologists, patients, and payers.
Neurology Advisor (NA): What is the Axon Registry, and what prompted its development?
Bruce Sigsbee, MD, FAAN: The registry is a mechanism for collecting information from the patient medical record relevant to quality measures. The leadership of the AAN elected to move forward with the registry for 3 specific purposes: First, insurance companies, including the CMS, are increasingly requiring actual demonstration of attempts at practice improvement through quality measurements as part of the criteria for full payment. The registry is intended to provide support and capacity with little or no burden to the physician.
Second, there is increasing interest among physicians who actually measure the care that they’re providing with an eye towards improving quality – and the Axon Registry certainly does this. Finally, there is a sense that as physicians we need to demonstrate that the care provided by a neurologist contributes to the value of the patient’s health care. Here, “value” specifically refers to improving outcomes and quality of life and doing that in an efficient, cost-effective manner. The registry will provide information that can address this specific area.
The registry operates by being able to extract information from the electronic health record in the background. This requires little or no change to the physician’s documentation style and recording of the patient information, and yet it is able to collect comprehensive information on the quality of care that is being provided. We developed specific quality measures and then assess the chart to see if the patient qualifies for that measure and if the patient has met the requirements of that measure. Because we have developed the measures ourselves, unlike many of the quality measurements currently in place, we will be using measures relevant to the neurologist practice.
NA: How might the registry benefit individual clinicians and practices, as well as the field as a whole?
Dr Sigsbee: As part of the purposes I have outlined, the registry directly benefits physicians by helping to protect insurance company payment for a specialty that is definitely challenged in terms of revenue needed to support the practice, and it also serves as a fundamental tool for practice improvement. For the neurologic community as a whole, it has great promise in terms of being able to look at the care provided and determine if it is benefiting patients and if it is done in an efficient manner.
There is an additional side to this issue: The data we collect on patients, while de-identified in terms of personal health care identifiers, does provide extensive information about the diagnosis, prognosis, and care of the patient. Other specialties that are somewhat ahead of us have used such information to identify gaps in care – for example, care provided to minorities or women – and have developed mitigation strategies to improve that care. It has also been used to identify previously unrecognized risk factors for disease, identify the prognosis and course of disease, and identify differences in care being provided at tertiary centers vs private practice. The anticipated millions of patients, longitudinal data, and the extent of information available far exceed any currently available aggregated information on neurologic patients and their care. We fully anticipate that the Axon Registry will provide the same insights and information, if not more.
NA: What is the significance of the CMS approval of the registry as a 2016 qualified clinical data registry?
Dr Sigsbee: The qualification by CMS indicates that they will accept the registry as meeting requirements for the physician quality reporting system (PQRS). Additionally, we are able to include measures not specifically vetted by CMS as a component of the required measurements. This substantially reduces the reporting burden on physicians and also assures that we’re using measures relevant and important to the practicing physician.
NA: In a practical sense, what might participation in the program look like for a neurologist or neurology practice?
Dr Sigsbee: After implementation, there is a dashboard that is provided to the physician and practice that details the performance on specific quality measures. This is updated each time new information is provided to our vendor. That dashboard provides extensive information including the current performance, the trend lines, as well as the ability to identify specific patients, permitting review of the chart, and also the criteria that we use for assessing compliance and potentially amending the entries. Again, one of the major goals is that this is done with no additional burden, and if possible, a reduced burden to the physician.
NA: What do neurologists need to do if they are interested in participating in the registry?
Dr Sigsbee: If neurologists are interested in participating, they can contact the staff at the AAN. There is extensive information, including an interest form, on the AAN website as well as answers to most of the basic questions.