Anesthesia Management: National Anesthesia Clinical Outcomes Registry (NACOR)

This is a letter I received from the ASA 

Dear Fellow ASA members  

It is with great pride that I announce that the National Anesthesia Clinical Outcomes Registry (NACOR), maintained for our specialty by the Anesthesia Quality Institute (AQI), has been designated by the Centers for Medicare and Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR). A QCDR is a new mechanism to report physician performance.  NACOR was among the first 40 registries to receive the QCDR designation. This designation will have significant implications for our specialty. 

In the next five years, CMS will phase out claims-based reporting in favor of registry-based reporting.  With this change, responsibility for measure development, data collection and reporting will move from CMS to specialty society registries like AQI/NACOR.

The most important aspect of the QCDR designation is that it allows ASA to select and develop its own measures. Previously, physician anesthesiologists were limited to reporting three measures to the Physician Quality Reporting System (PQRS). Now we can use more than a dozen additional anesthesia-related measures through the QCDR option to meet the evolving federal requirements. Further, we will have the ability to add additional measures in coming years, to cover subspecialty areas and related disciplines such as pain medicine and critical care. The goal is to enable every physician anesthesiologist to readily report on outcomes that matter to them and their patients.  

New QCDR Registry Measures include:

•Post-anesthestic transfer of care: Use of checklist or protocol for direct transfer of care from procedure room to Intensive Care Unit (ICU)

•Post-anesthestic transfer of care measure – procedure room to post-anesthesia care unit

•Prevention of post-operative nausea and vomiting – combination therapy (adults)

•Prevention  of post-operative vomiting – combination therapy (pediatrics)

•Composite anesthesia safety

•Immediate perioperative cardiac arrest rate

•Immediate perioperative mortality rate

•PACU reintubation rate 

•Short-term pain management

•Composite procedural safety for central line placement

•Composite patient experience measure

The QCDR option has far-reaching implications regarding how physician anesthesiologists receive the 2014 payment bonus or incentive of 0.5 percent. It will also impact physician anesthesiologists who fail to successfully report after 2015 with payment penalties starting at 1.5 percent and increasing steadily afterwards.

This new reporting vehicle will transform how physician anesthesiologists participate in PQRS. It will also significantly change how measures impacting patients, physician anesthesiologists and other providers are developed, tested and ultimately used to improve patient care and safety. 

More information about performance reporting and the QCDR mechanism is available atwww.aqihq.org/PQRSReporting.aspx. 

Practices wishing to use NACOR and the QCDR mechanism to report performance in 2014 should notify Lance Mueller, director of the Anesthesia Quality Institute (AQI), atl.mueller@asahq.org or call (847) 825-5586, ext. 190.

Jane C. K. Fitch, M.D.

2014 President

American Society of Anesthesiologists