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Tales from the Front

Tales from the Front. October 26, 2017. Tales from the Front. Lynn M. Pezzullo, RPh , CPEHR Senior Director, Quality Innovation Pharmacy Quality Alliance Elvia Chavarria, MPH Senior Program Manager PCPI Measure Development Jamie Lehner, MBA, CAPM Program Manager

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Tales from the Front

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  1. Tales from the Front October 26, 2017

  2. Tales from the Front • Lynn M. Pezzullo, RPh, CPEHR Senior Director, Quality Innovation Pharmacy Quality Alliance • Elvia Chavarria, MPH Senior Program Manager PCPI Measure Development • Jamie Lehner, MBA, CAPM Program Manager PCPI Measure Specifications

  3. Tales from the Front Sharing lessons learned • Measure development • Measure implementation • Measure maintenance

  4. When is the right time to update measure language and specifications?

  5. Updating Measure Language or Specifications Update to align with: • Updated guidance • New or revised clinical recommendations • Implementation issues or questions

  6. Updating Measure Language or Specifications During initial measure development • Guideline recommendations change or evidence emerges • Cardiovascular measure • Data elements from the 2012 Appropriate Use Criteria (AUC) for Coronary Revascularization • 2017 AUC released

  7. Updating Measure Language or Specifications During measure maintenance • Heart Failure measure – ACE inhibitor or ARB therapy • Angiotensin Receptor Neprilysin Inhibitor (ARNI) first approved in 2015 for Heart Failure • Combination drug already included in specification as ARB combination

  8. Updating Measure Language or Specifications • PQA’sMeasure Update Panel • Reviews PQA-endorsed measures and consider revisions to ensure: • Alignment with current evidence, guidelines and standards • Accurate medication lists, codes • Clarity and consistency • Additional expert input, as needed

  9. How do I codify the clinical concepts required for my measure?

  10. Coding eCQM data elements eCQMs are constructed with clinical data elements that are required in order to calculate the measure • Examples include: • Diagnosis • Medications or therapies for treatment • Encounters • Patient-reported health assessment

  11. Common Vocabulary Coding Systems • International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) • Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) • RxNORM • Logical Observation Identifiers Names and Codes (LOINC)

  12. Significant Changes to Recommended Terminologies • Assessment • Diagnostic Study • Laboratory Test • Physical Exam

  13. Example: Assessment QDM Category Blueprint v12.0: • Question = LOINC • Answer = SNOMED Blueprint v13.0: • Question = LOINC • Answer = SNOMED or LOINC Answer

  14. Example: Assessment QDM Category LOINC 44250-9: Little interest or pleasure in doing things 444841000124107 – Never (qualifier value) 444521000124103 – Several days (qualifier value) 445231000124102 – Four or more times a week (qualifier value) 444951000124100 – Nearly every day (qualifier value)

  15. Example: Using a Code to Define a Data Element • NIH stroke scale • LOINC code - 70182-1 • What if an assessment instrument (or other required data element) does not have an assigned code?

  16. Requesting New Coding Content • Points to consider: • Code system publication dates • Terminology-specific processes • Submission templates • Proprietary classification systems or tools • Stakeholders involved in submission request

  17. How do you ensure your measures are implemented, as intended, in your registry?

  18. Evaluate Measure Implementation in Your Registry • Involvement in discussions and forums related to electronic measurement • Expertise in code system terminologies • Accuracy of measure calculations • What tool does your vendor use? • Are standards fully supported and built into tools? • Has the tool been validated?

  19. What were some of the successes and challenges PQA faced in the development of physician-level performance measures?

  20. PQA’s Multiple Sclerosis eCQM Development Background • Measure gap • Meaningful measures needed for neurologist reporting • PQA focus: medication-related measures • Multiple sclerosis: Treatment & Monitoring

  21. Four Draft eCQMs • Use of Disease Modifying Therapy (DMT) in Persons with Relapsing Forms of Multiple Sclerosis (MS) • Magnetic Resonance Imaging: • Prior to Initiating or Switching DMT in Patients with Relapsing Forms of MS • To Establish a New Baseline After Initiating or Switching DMT in Patients with Relapsing Forms of MS • ForFollow-Up in Patients with Relapsing Forms of MS Being Treated with DMT

  22. Multi-stakeholder Task Force

  23. Engaging the Task Force Successes Challenges • In-person kick-off meeting • Alignment of objectives • “Team-building” • Patient representatives • Other measure developers • Collaboration • Subgroup to expedite MRI measure development • Learning curve • Guideline- vs. measure-development • Balancing project timeline with clinician availability

  24. Measure Testing Successes Challenges • Existing relationship with primary contact • Four (4) practices using two (2) EHRs • Draft eCQMs aligned with MS Improvement Collaborative objectives • Timeline delays due to contracting • Practices new to testing • Communications

  25. What issues have you encountered or what advice would you give regarding measure use and implementation?

  26. Implementation questions CMS JIRA • Tool that allows you to submit questions or issues with eCQM implementation and tools • Receive feedback from measure developer • Developers must ensure you establish a process to answer questions and provide feedback • Changes made to measures during annual updates

  27. Submission to JIRA – MUC List Challenges • Perceived vs. actual requirements What we learned • CMS feedback • Provide MAT output for all eCQMs • Submit eCQMs once testing is completed

  28. Implementation Opportunities • Objective: Measures included in Merit-Based Incentive Payment System (MIPS) • Meet with key stakeholders • CMS Spotlight Series • CMMI • Approach • Raise awareness; stimulate interest • Highlight measures and status with CMS • Partner with complementary initiatives

  29. Collaboration to Support Adoption NQF Measure IncubatorTM (PRO Project) MS-Advance Study (Single-Center, Patient-Centered Specialty Practice Pilot) MS CQI Collaborative (Multi-Center Research) PQA Clinical Quality Measure Development (Use of DMT and MRI) Identify and Address Gaps in MS Care

  30. Next Steps *By June 30 deadline

  31. Questions

  32. Thank you

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