Accountable Care Clinical Quality Measures Subgroup

Accountable Care Clinical Quality Measures Subgroup

August 20, 2013

Subgroup Members

• Co-chairs:– Terry Cullen, Veteran’s Administration– Joe Kimura, Atrius Health

• Members:– Helen Burstin, National Quality Forum– David Kendrick, Greater Tulsa Health Access Network– Ted von Glahn, Pacific Business Group on Health– Marc Overhage, Siemens Healthcare– Eva Powell, Evolent Health– Paul Tang, Palo Alto Medical Foundation– Sam VanNorman, Park Nicollet Health Services

04/22/2023 Office of the National Coordinator for Health Information Technology 2

04/22/2023 Office of the National Coordinator for Health Information Technology

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Agenda

9:00 AMIntroductions and overview of subgroup charge

9:10 AMPresentation of Potential Framework Janet Corrigan

9:25 AMDiscussion by subgroup

10:00 AMPresentation on CMS Medicare Shared Savings ProgramJohn Pilotte

10:15 AMSubgroup member experiences

10:30 AM Discussion by subgroup

10:55 AM Public Comment

11:00 AM Adjourn


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Charge

• Within the next three to four months for the October/November HIT Policy Committee, develop recommendations for the next generation of e-measure constructs that are patient-centered, longitudinal, cross settings of care where appropriate and address efficiency of care delivery.

• These measures should be feasible to develop and implement in the next 2-3 years. In order to represent the various models by which patients currently receive care, a use case of Accountable Care Organizations (ACOs) will be developed showing how the recommendations on the domains, concepts, and infrastructure can be applied.


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Charge cont.

• Within the next 3-4 months, develop recommendations for how electronic clinical quality measure concepts and specific measures could be used in place of MU objective measures. The goal is to “deem” eligible providers (EPs) and eligible hospitals (EHs) as meaningful users through their ability to perform on quality outcomes. The HITPC would like this work group to give recommendations on specific quality measures that will demonstrate meaningful use of HIT.


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Goals for this Call

• Overview of potential frameworks and previous experiences with ACOs and Medicare Shared Savings Program

• Develop preliminary framework for “high stakes” e-quality measurement for ACOs

• Begin to identify known gaps in measurement for accountable care

• Begin discussion on identifying measures for “deeming” (described in next slide)


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Questions Specific to Deeming Charge

• HIT-sensitive measures are ideal for deeming.– Which measures that currently exist in CMS programs are appropriate to use

for deeming? (charge to QMWG)– Which measures in the pipeline for MU3 time frame are appropriate to use

for deeming? (charge to ACO CQM WG)– What measure gaps exist, that could be filled in time for MU3, that are

exemplars of HIT sensitive measures for deeming? (charge to ACO CQM WG)• Eligible professionals and group reporting (charge to ACO CQM WG)

– What parameters should be used for a group reporting option for MU overall (including deeming).

– If there is a group reporting option, how do you attribute a provider's membership in a group and his/her ability to receive incentives (or avoid penalties)?


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JANET CORRIGAN

Presentation of Potential Framework

* Table 1 from A Framework For Accountable Care Measures. Posted in Health Affairs blog by Richard Bankowitz, Christine Bechtel, Janet Corrigan, Susan D. DeVore, Elliott Fisher, and Gene Nelson on May 9, 2013.


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Overview of Two Frameworks


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Questions for Discussion

• Accountable Care Framework– Are all the domains and subdomains of

interest identified and appropriately named?

–Would this framework be appropriate for a variety of population and value-based payment arrangements?

– Does it get at longitudinal measures across settings and time?


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JOHN PILOTTE

Presentation on CMS Medicare Shared Savings Program (MSSP)

JOE KIMURA

Pioneer ACO ExperiencePerformance Measurement


Overview

• Review of Pioneer Metrics– Patient Experience Metrics– Quality Metrics– Financial & Utilization Metrics

• Summary of Metric Feedback• Operational Challenges of e-Metrics


Patient Experience

ACO Measure # Measure Description

ACO 1 (NQF #0005): Getting Timely Care, Appointments, and Information

ACO 2 (NQF #0005): How Well Your Providers Communicate

ACO 3 (NQF #0005): Patient Rating of Provider

ACO 4 (NQF #0005): Access to Specialist

ACO 5 (NQF #0005): Health Promotion and Education

ACO 6 (NQF #0005): Shared Decision Making

ACO 7 (NQF #0006): Health Status/Functional Status


Quality Metrics


ACO 8 (CMS; adapted NQF #1789): Risk Standardized All Condition Readmission

ACO 9 (NQF #0275; AHRQ PQI #05): (ACO version 1.0) Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults

ACO 10 (NQF #0277; AHRQ PQI #08): (ACO version 1.0) Ambulatory Sensitive Conditions Admissions: Heart Failure (HF)

ACO 11 (CMS): Percent of Primary Care Physicians who Successfully Qualify for an EHR Program Incentive Payment

ACO 12 (GPRO CARE-1) (NQF 0097): Medication Reconciliation

ACO 13 (GPRO CARE-2) (NQF #0101): Falls: Screening for Future Fall Risk

ACO 14 (GPRO PREV-7) (NQF #0041): Preventive Care and Screening: Influenza Immunization

ACO 15 (GPRO PREV-8) (NQF #0043): Preventive Care and Screening: Pneumococcal Vaccination for Patients 65 Years and Older

ACO 16 (GPRO PREV-9) (NQF #0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

ACO 17 (GPRO PREV-10) (NQF #0028): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

ACO 18 (GPRO PREV-12) (NQF #0418): Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

ACO 19 (GPRO PREV-6) (NQF #0034): Preventive Care and Screening: Colorectal Cancer Screening

ACO 20 (GPRO PREV-5) (NQF #0031): Preventive Care and Screening: Breast Cancer Screening

ACO 21 (GPRO PREV-11) (CMS): Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented


Quality Metrics


ACO 22 (GPRO DM-15) (NQF #0729): Composite (All or Nothing Scoring): Diabetes Mellitus: Hemoglobin A1c Control (< 8%)

ACO 23 (GPRO DM-14) (NQF #0729): Composite (All or Nothing Scoring): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control

ACO 24 (GPRO DM-13) (NQF #0729): Composite (All or Nothing Scoring): Diabetes Mellitus: High Blood Pressure Control

ACO 25 (GPRO DM-17) (NQF #0729): Composite (All or Nothing Scoring): Diabetes Mellitus: Tobacco Non-Use

ACO 26 (GPRO DM-16) (NQF #0729): Composite (All or Nothing Scoring): Diabetes Mellitus: Daily Aspirin or Antiplatelet Medication Use for Patients with Diabetes and Ischemic Vascular Disease

ACO 27 (GPRO DM-2) (NQF #0059): Diabetes Mellitus: Hemoglobin A1c Poor Control

ACO 28 (GPRO HTN-2) (NQF #0018): Hypertension (HTN): Controlling High Blood Pressure

ACO 29 (GPRO IVD-1) (NQF #0075): Ischemic Vascular Disease (IVD): Complete Lipid Profile and Low Density Lipoprotein (LDL-C) Control

ACO 30 (GPRO IVD-2) (NQF #0068): Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

ACO 31 (GPRO HF-6) (NQF #0083): Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

ACO 32 (GPRO CAD-2) (NQF #0074): Composite (All or Nothing Scoring): Coronary Artery Disease (CAD): Lipid Control

ACO 33 (GPRO CAD-7) (NQF #0066): Composite (All or Nothing Scoring): Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)


Financial & UtilizationACO Measure # Measure Description

Indicator [1] 30-Day All-Cause Readmissions Per 1,000 Discharges

Indicator [2] Ambulatory Care Sensitive Condition Discharge Rate: Diabetes, Short-Term Complications

Indicator [3] Ambulatory Care Sensitive Condition Discharge Rate: Uncontrolled Diabetes

Indicator [4] Ambulatory Care Sensitive Condition Discharge Rate: Chronic Obstructive Pulmonary Disease or Asthma

Indicator [5] Ambulatory Care Sensitive Condition Discharge Rate: Congestive Heart Failure

Indicator [6] Ambulatory Care Sensitive Condition Discharge Rate: Bacterial Pneumonia

Indicator [7] Hospitalizations per 1,000 Person-Years

Indicator [8] Hospitalizations at Short-Term Acute-Care Hospitals per 1,000 Person-Years

Indicator [9] Hospitalizations at Critical Access Hospitals per 1,000 Person-Years

Indicator [10] Emergency Department Visits per 1,000 Person-Years

Indicator [11] Emergency Department Visits Resulting in Hospitalization per 1,000 Person-Years

Indicator [12] Computed Tomography Events per 1,000 Person-Years

Indicator [13] Magnetic Resonance Imaging Events per 1,000 Person-Years

Indicator [14] Ambulance Events per 1,000 Person-Years

Indicator [15] Total Medicare Expenditures PBPM, Uncapped

Indicator [16] Total Medicare Expenditures PBPM, Capped

Indicator [17] Decedent Spending in Last 6 Months of Life

Indicator [18] Mean Percent of Office Visits with Primary Care Providers

Indicator [19] Median Percent of Office Visits with Primary Care Providers

Indicator [20] Percent of Beneficiary Expenditures Received Outside the ACO’s Professional Providers

Indicator [21] Percent of Beneficiary Expenditures Received Outside the ACO’s Participating Institutional Providers

Indicator [22] Percent of Aligned Population that is Dual Eligible

Summary of Measure Feedback

• General Issues Identified in High Stakes Measurement:– How metrics applied to assess improvement

• Relative change to various benchmark and reference groups• Adjustment of PMPM & Utilization by Clinical Risk

– Role of Fixed Cohort Measurement over Time

• Operational Issues:– Measurement Specification Feedback– Variation in e-Metric from EMR implementation variation


E-Metric Specifications

• eMetrics require detailed specifications– Encounter Type (Face to Face, Telephone, Email)– Provider Type (Billing Providers vs Team Members) – Problem Lists (Active vs Inactive)– Medication Lists (Historical vs Active)– Results (Patient vs Clinician vs Automated Results)

• Differences in operational implementation leads to substantial variation in metric results – threat to the fairness of the metric in high stakes use.


E-Metrics example: Falls Assessment


Integration of Claims + EMR Data for Measurement (Diagnoses & Medications)


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Questions for Discussion

• For ACOs:– How can the experiences with MSSP and

Pioneer ACOs inform a potential framework?

– How can the framework be refined or interpreted to facilitate identification of e-measure concepts that matter and drive improvements in quality and efficiency?


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Next Call

• Finalize potential framework for ACOs• Presentation from CMS on current

and future measure development work

• Begin discussion on measure concepts needed to move forward– For ACOs– For “deeming” of eligible hospitals and

providers

Accountable Care Clinical Quality Measures Subgroup

Documents

Transcript of Accountable Care Clinical Quality Measures Subgroup