Registry Can Help APA Demonstrate Value of Psychiatric Treatment

Health care patient registries—systems of data collection for tracking and evaluating outcomes among populations of patients—are increasingly viewed as vital to the goals of the so-called “triple aim”: improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.

They are being developed by integrated and collaborative care networks to help them improve outcomes for the populations they treat. Today some medical specialty groups are developing registries around the populations with the disorders treated by the specialty.

In a presentation at the July meeting of the APA Board of Trustees, Gregory Dalack, M.D., chair of the APA Registry Work Group, recommended that APA begin development of its own psychiatric registry. Such a registry, he said, could help improve health outcomes for patients served by APA members, identify effective patterns of care and best practices on a national basis, and track the unique risks, complications, and benefits associated with psychiatric care at a point in time and longitudinally.

Development of a registry will also help the profession meet the growing demand for quality measurement and can assist members with meeting quality-reporting requirements for Medicare and Maintenance of Certification (MOC) requirements, he said.

After the presentation, the Board voted to request that the APA administration prepare a detailed business plan for development of a medical registry.

At the meeting Dalack said registries are an important approach for providers and health systems to monitor and assess value. “It’s a major interest of the federal government, and other medical specialty organizations view registries as a way of capturing the value of what they do,” he said. “It is part of the movement from fee for service to value-based care. Registries are an alternative to data warehouses and can allow medical specialties to own and maintain large amounts of saleable data, while keeping their membership’s interests in mind—especially the ethical use of these data.”

Ultimately, he said, data on the value of care offered by psychiatrists will be collected by some entity. “If we don’t do it, someone else will,” he said.

Dalack presented seven recommendations developed by the 11-member work group. APA should take the following actions:

• Focus on collecting circumscribed, validated patient self-assessment data with patient self-entry into a HIPAA-compliant, web-based platform.

• Engage with third-party payers in planning discussions to be proactive in identifying how registry activities would align with quality initiatives and reimbursement.

• Implement its own registry while simultaneously engaging other disciplines around current and future complementary and collaborative efforts.

• Involve patients and families through advocacy groups (such as the National Alliance on Mental Illness) in the registry-development process to ensure a patient-centered focus.

• Work with an established registry vendor rather than develop the electronic infrastructure in-house.

• Work initially to engage a subset of members in a wide variety of routine practice settings to pilot enrollment and participation in a registry and determine how to scale up, both in terms of instruments/data included in a registry and number of enrollees.

• Create the position of patient registry specialist at APA. A standing committee should be established, formally reporting to the Council on Quality Care, and with member representatives from the Council on Research, the Council on Healthcare Systems and Financing, and the Committee on Health Information Technology.

At the meeting, Terrence Cascino, M.D., president of the American Academy of Neurology (AAN), and Bruce Sigsbee, M.D., chair of AAN’s Registry Committee, spoke about the group’s experience in developing a registry. “We think the registry helps to demonstrate the value of neurology to stakeholders who need better data on the outcome of our patients,” Cascino said. “And for our members, participation in the registry gives them credit for Part 4 of MOC.”

Part 4 of the MOC requirements, or Performance in Practice (also known as Improvement in Medical Practice), requires physicians to build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines. ■