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Updating Clinical Measures: Best Practices and Challenges

Learn when to update measure language and specifications, how to codify clinical concepts, and ensure successful measure implementation. Discover the process, terminologies, and challenges faced in developing physician-level performance measures.

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Updating Clinical Measures: Best Practices and Challenges

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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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