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An Overview of theVascular Quality Initiative

Presented by M2S

Value of Participation Recent Accomplishments Current Landscape Costs Questions

Agenda

3

The Era of Pay For PerformanceCOST

VALUE

In the era of Pay for Performance, providers must deliver high quality patient care at a low cost.

Optimize Clinical Quality

Reduce cost of care

4

Optimize Clinical QualityCapture real-time

granular procedure data.

Identify variation within and across your hospital, regionally and nationally.

Implement best practices

Evidence-based practice to improve and optimize patient care

5

Proven Quality Process

M2S PATHWAYS

Platform for QI

Create VQI Registry

data

Collect VQI procedure

data

Benchmark with the SVS

PSO

Conduct market

surveillance

Identify/ explain

variation

Drive shift in outcomes

National Quality Initiatives: Center Opportunity Profile for Improvement (COPI) Reports:

1-In Hospital Surgical Site Infection Rate after Infra- Inguinal Bypass.

2-Length of stay (LOS) after elective endovascular aneurysm repair (EVAR).

3-Length of stay (LOS) after Carotid Endarterectomy (CEA).

VALUE OF PARTICIPATION

** ** **0%

4%

8%

12%

16%

20%

24%

28%

32%

36%

Surgical Site Infection Rate after Infra-Inguinal Bypass Procedure Observed and Expected by Centers

4,081 patient procedures, January 2010 December 2012

Observed Expected

Overall rate SSIVQI = 3.6%AUC = 0.65

VQI Centers

adjusted for: skin preperation, ankle/brachial systolic pressure index, transfusion, length of procedure

Significantly higher than expected:* p<0.05**p<0.01

VALUE OF PARTICIPATION

VALUE OF PARTICIPATION

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VQI sites changing to chlorhexidine skin prep saw a decrease of up to 50% in Surgical Site Infection rate

• Benchmarked outcomes locally, regionally and nationally for Lower Extremity Bypass procedures

• Identified factors related to surgical site infection rate

• Demonstrated the value of chlorhexidine skin prep in reducing SSI

• Recommended process change across sites

Chlorhexidine Usage, All VQI Centers January 2012 – December 2013

Centers with Most Improvement in Chlorhexidine Use

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2011 20130

1

2

3

4

5

6Infection Rate

Percentage

Percentage

2011 20130

10

20

30

40

50

60

70

80

90

100Chlorhexidine Use

** * ** ** ** ** ** * ** ** ** * ** ** **0%

10%20%30%40%50%60%70%80%90%

100%

8,000 Procedures, 2011 to 2012(Excludes inhospital deaths, previous ipsilateral CEA, concombinant CABG)

Observed Expected

Adjusted for: age, gender, race, hypertension, diabetes, pre-op beta blocker, CAD, CHF, COPD, stress test, discharge ASA, discharge statin, prior radiation therapy, pre-op MRA

Observed significantly different than ex-

pected:* p<0.05**p<0.01

Center Process Variation

% Patients with Length of Stay > 1 Day after Elective Carotid Endarterectomy

VQI Centers

Factors Associated with LOS> 1 Day after CEA

Patient Factors18% Process Factors

7%

Low Surgeon Volume 10%

IV Meds Required for Hyper- or Hypotension

31%

Major Adverse Events

23%

Unexplained11%

• Patient Characteristics• Not modifiable, but could be used

to focus discharge planning prior to procedure

• Procedure Details• Could be modified or investigated

to improve current practice

• Post-op Complications• Key opportunities to investigate

and improve to reduce LOS

• Surgeon Volume• Opportunity to change practice of

low volume surgeons

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Carotid Endarterectomy Length of Stay COPI Report

• 50,000 Patients in VQI who underwent– Leg bypass, intervention, oAAA/EVAR, CEA/CAS

• Evaluated pre-operative and discharge medications:– Antiplatelet agent (ASA, PY212 inhibitors)– Statins (HMG-CoA reductase inhibitors)

• Outcomes analyzed:– Effect on patient survival– Variation across centers– Impact of participation in VQI

Optimal Medical Management Peri-operatively

-De Martino et al, SVS VAM, June, 2014

81% Both75% AP 68% Statin 55% None

P<0.001 SE < 0.1

Years

26% Absolute improvement in 5-year survival when patients are discharged on AP & Statin

Effect of Discharge Medications on Survival

Variation in Optimal Medical Management Across VQI Centers by Procedure

Both Anti-platelet and Statin

Perc

enta

ge o

n Bo

th M

edic

ation

s

20%

60%

80%

100%

40%

Patients on Antiplatelet and Statin Pre-op and Discharge Based on Center Years Participation in VQI

Number of Years Participating in VQI

1 2 3 4 5 6 70%

10%

20%

30%

40%

50%

60%

70%

80%

58% 56% 58%61%

65%69%

71%

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• Accelerate the development of best practices through regional and national benchmarking with the SVS PSO– Reduce overall and post procedure length of stay.– Reduce procedure complications.– Reduce avoidable readmissions.

• Reduce CMS penalties for pay-for-performance initiatives such as Physician Quality Reporting Initiatives (PQRS) with M2S support

• Participate in the VQI Industry/FDA Device Surveillance Programs to access the latest medical devices while funding data collection for quality initiatives.

Reducing the Cost of CareUsing the VQI Registries, your hospital can gain visibility and insights into key metrics to manage your healthcare costs.

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Registry ROI for your Hospital

Cost of Participation

Value of Participation

Reduce CMS $$$ thru PQRS

$$$ to hosp. from Industry

Reduced LOS

Benchmarking

Hospital data entry

Registry FeesCOST

OF

CARE

QU

ALIT

Y O

F CA

RE

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• Leverage relationships with medical societies, hospitals, physicians, device companies, regulators and insurers to create better understanding

• Establish effective collaboration among stakeholders

• Benefit from return on investment based on savings, cost reduction and improvements

The result is better patient outcomes.

The M2S PATHWAYS platform enables providers to gain insights which drive quality improvement. Working with us, your organization can:

• Carotid Artery Stent• Carotid Endarterectomy• Endovascular AAA Repair• Hemodialysis Access• Inferior Vena Cava Filter• Infra-Inguinal Bypass• Lower Extremity

Amputation

• Open AAA Repair• Peripheral Vascular

Intervention• Supra-Inguinal Bypass• Thoracic and Complex EVAR• Varicose Vein

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Available VQI Registries

326 Centers, 45 States + Ontario

0153045607590

105120135150165180195210225240255270285300315330345

Growth of Participating Centers

18 Regional Quality Groups

AL

HI

Total Procedures Captured (as of 3/1/2015)

203,850

Carotid Endarterectomy 48,882

Carotid Artery Stent 7,462

Endovascular AAA Repair 19,276

Open AAA Repair 6,618

Peripheral Vascular Intervention 64,739

Infra-Inguinal Bypass 23,277

Supra-Inguinal Bypass 7,648

Thoracic and Complex EVAR 3,883

Hemodialysis Access 17,401

Lower Extremity Amputations 2,569

IVC Filter 2,469

Varicose Vein 156

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13Jan

-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14Jul-1

4

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14Jan

-150

25000

50000

75000

100000

125000

150000

175000

200000

225000

250000

275000

300000

VQI Total Procedure Volume

Academic Med-ical Center

38%

Community Hospital

35%

Teaching Affilate27%

CURRENT LANDSCAPE

VQI Hospitals: Distribution

• M2S Fees per Registry: $1,595• SVS PSO Fees per Registry: $ 638

$2,233 TOTAL• Plus one time set up fee

Fees include training, PATHWAYS technical support, real time reporting and analytics, on-going product development, Regional Quality Group support and SVS PSO benchmarking

VQI Pricing

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Contact us today to arrange:

• Discussion of benefits of VQI participation for your organization

• Interactive demo for your organization

www.svsvqi.org29