At the 2017 annual meeting of the American Society of Clinical Oncology, the use of patient reported outcomes took center stage with the release of a landmark randomized clinical trial comparing web-based patient-reported outcomes for symptom (pain, nausea, fatigue) monitoring versus usual care for 766 patients receiving chemotherapy. Use of the tool was associated with a significantly better medial overall survival of 31.2 months compared with 26.0 months in the usual care. Congratulations to principal investigator and MNCM measure development workgroup member, Ethan Basch MD. Read the article here.
MNCM is currently conducting pilot testing of its newly developed measures for Symptom Control During Chemotherapy (SCDC). Submission of data from volunteer test sites from MN Oncology and the University of Minnesota Physicians will occur during July-August and the measure development workgroup will convene later this fall to review results and make recommendations for use.
On June 22, The Minnesota Department of Health (MDH), MN Community Measurement and Stratis Health will hold a public forum to present quality measure recommendations and other related information in connection with the annual update of the Quality Reporting System for the 2018 reporting year. The public forum provides an opportunity for interested stakeholders to comment on the recommendations and to ask questions.
Public forum details: June 22, 2017, 9:00 am – 10:30 am, online registration [Web conference registration link] Call-in number: 1-888-742-5095, conference code: 933 209 2697.
Visit the MDH website for rulemaking milestones, timeline more information at http://www.health.state.mn.us/healthreform/measurement/ruleupdate.html
MNCM Optimal Diabetes Care specification
MNCM Optimal Vascular Care specification
MNCM Optimal Asthma Control specification
MNCM Diabetes Poor Control specification
MNCM IVD Aspirin Antiplatelet specification
In the 2018 report year, MNCM will modify the Index and Assessment Periods for the Depression Care Measures Suite. These date modifications are being done to ensure that all follow-up contacts for patients in the denominator population meet CMS’s Merit-Based Incentive Payment System (MIPS) requirements. CMS requires that all data related to a measure must be captured by December 31. These changes allow for completion of the assessment period by December 31. This will necessitate changes to the dates of service submitted annually.
We also want to alert medical groups about the need to implement the PHQ-9 or PHQ-9M assessment tool for all patients ages 12 and older by November 1, 2017. This date marks the start of the index period that identifies the denominator from which depression rates will be calculated for both adolescent and adult patients in the 2020 report year. Of course, groups can begin tool implementation sooner, but tool administration to adolescents should begin no later than this date to ensure accurate rate calculation in 2020.
Diagrams, tables and measure specifications demonstrating all changes – including future expansion of the depression six and 12-month follow-up windows to +/- 60 days for result calculation starting in the 2020 report year – can be found here.
For more information, contact firstname.lastname@example.org
In April 2017, MNCM’s Measurement and Reporting Committee (MARC) approved recommendations that further align the Colorectal Cancer Screening measure with CMS’s Merit-Based Incentive Payment System (MIPS) requirements. MARC approved two modifications to the Colorectal Cancer Screening measure that are set to begin in the 2018 report year:
A) Remove death as an allowable exclusion; and
B) Expand encounter type criteria to include both new and established patient office visits and home visits.
In 2009, the National Committee for Quality Assurance’s (NCQA) measure for colorectal cancer screening was adapted for direct data submission accommodating for some philosophical differences regarding acceptable screening modalities. With recent changes in recommendations by the US Preventive Services Task Forces (USPSTF) that include CT Colonography and FIT-DNA testing, and NCQA’s recent update of the measure, these measures are now completely aligned.
While we understand the frustration with implementing additional modifications to the Colorectal Cancer Screening measure, keeping our measures aligned with federal programs is essential for all of us.
In addition, both the Colorectal Cancer Screening and Optimal Asthma Control measures were included on the list of finalized quality measures available for MIPS reporting in 2018 (2017 dates of service). To better align our data for these measures with MIPS requirements, it will be necessary to change the dates of service to a calendar year (January-December). Currently, these measures use mid-year to mid-year dates of service. This change will not only support medical groups in meeting federal MIPS reporting requirements, but will also support health plans in meeting state and national reporting requirements.
All of the changes mentioned above will apply to the 2018 report year (2017 dates of service). Because MIPS reporting requires data submission by March 31 each year, MNCM will move the data submission for Colorectal Cancer Screening and Optimal Asthma Control measures to Cycle A in the 2018 report year (e.g., with data submission occurring in January/February 2018).
Please note that the Maternity Care: C-Section Rate measure is not moving to Cycle A data submission because it was not on the final list of MIPS measures.
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Learn about the components to the CASE approach to HPV vaccine hesitancy at this one hour webinar on Thursday, April 13, 2017. Presented by Robert M. Jacobson, MD, with Mayo Clinic and sponsored by the American Cancer Society and Wisconsin Area Health Education Centers Scenic Rivers AHEC. View the event flyer here and to register click here.
The 2017 Health Information Technology (HIT) Ambulatory web survey opens February 15, 2017. This survey is an annual reporting requirement established in the Minnesota Statewide Quality Reporting and Measurement System (SQRMS) by the Minnesota Department of Health (MDH) through Minnesota Rules, Chapter 4654. All Minnesota physician clinics must complete the 2017 HIT Ambulatory Clinic Survey between February 15, 2017 and March 16, 2017.
MNCM will post a PDF version of the survey in two locations: under the “Resources” tab in the Data Portal and on the MNCM website at http://mncm.org/submitting-data/provider-tools/#online-resources (Submitting Data, Provider Tools, then Online Resources). To reduce data entry time, MNCM highly recommends that respondents gather all responses on a paper copy prior to web entry. Please note that due to required survey settings, respondents cannot start a web survey entry and then “resume” at a later date. The survey must be completed in one sitting.
Results from the survey are used by MDH, MN e-Health Initiative, MNCM and others to report the status and use of electronic health records, health information exchange, and other health information technology across Minnesota.
Physician clinics will receive an email communication from MNCM with a link to the web version survey in mid-February. Those with questions can contact Dina Wellbrock of MNCM at mailto:firstname.lastname@example.org (612) 454-4829.
The National Quality Forum (NQF) has endorsed four measures related to cardiovascular conditions. Six measures were evaluated against NQF’s endorsement criteria. Among the four measures that received endorsement was the Optimal Vascular Care (OVC) composite measure from MN Community Measurement. Of the endorsed measures, one was a new measure and MNCM’s OVC measure was among three that were re-endorsed. A complete list of NQF cardiovascular measures can be viewed on the project page.
A first-ever comparison of what commercial insurers are paying for healthcare in different regions shows wide variation in spending. This report is valuable as a first attempt to compare costs across regions.
The report from the Network for Regional Healthcare Improvement (NRHI), a national organization of local groups working to improve healthcare, analyzed spending by commercial health insurance plans in five different regions nationwide (Utah, Maryland, St. Louis, Minnesota and Oregon). Analysts found a $1,080 yearly difference in the amount plans spend, on average, per enrollee, with a high of $369 per-enrollee-per-month in Minnesota and a low of $279 in Maryland.
“Identifying regional differences in healthcare costs is important because high costs are depleting family budgets. Entire communities pay the price as money that could go to schools, housing and other needs are instead eaten up by healthcare costs. This information will enable physicians to identify cost drivers, address them, and get better outcomes. This enables a transformation in healthcare delivery, enabling better care decisions while potentially saving individuals, employers and other private payers hundreds of millions of dollars.” Elizabeth Mitchell, president and CEO of NRHI
Regional variation on medical spending has long been shown to exist in the Medicare market, but differences in the amount commercial insurers pay for care has been difficult to decipher, because multiple insurance plans participate in a single market. This project was important as a technical learning opportunity about how to standardize reporting across regions.
The data within the report are detailed in From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data, which was developed with support from the Robert Wood Johnson Foundation.
MNCM has made progress in preparing for providing significant value to the community under MACRA. For years, MNCM’s role has been as the central point for quality measurement and data collection and reporting from clinicians to the State and Health Plans for various programs and reporting requirements. Work is now underway to include reporting to CMS for MIPS.
CMS Registry Application
MNCM submitted an application to become a Qualified Clinical Data Registry (QCDR). Currently and in the past, submitting to MNCM has allowed clinicians to attest they are meeting some of their CMS meaningful use requirements. With some modifications to our system, making this transition as a MIPS registry is feasible and a natural next step.
Several MNCM developed measures have a CMS QPP (Quality Payment Program) number and can be used locally and nation-wide. Additionally, data elements from the Diabetes (A1C) and Vascular (Ischemic IVD) measures also have a QPP number. Specifically:
- Q113 Colorectal Cancer Screening
- Q370 Depression Remission at 12 Months*
- Q371 Depression Utilization of the PHQ-9Tool
- Q411 Depression Remission at 6 Months*
- Q398 Optimal Asthma Control*
- Q001 Diabetes: Hemoglobin A1C* (from ODC measure)
- Q204 Ischemic IVD (from OVC measure)
*Denotes CMS priority classification “Outcome/High Priority”
Additional QCDR Measures
QCDR’s also have the ability to add additional community measures that may not yet have a QPP number but may also be considered as CMS “credit”. MNCM has asked that the MNCM NQF endorsed measures be included. These are:
- NQF0729 Optimal Diabetes Care
- NQF0076 Optimal Vascular Care
- NQF2643 Lumbar Spine Fusion-Avg. Change in Functional Status Following Procedure
- NQF2653 Total Knee Replacement-Avg. Change in Functional Status Following Procedure
- NQF 1885 Depression Response at 12 Months
- NQF 1884 Depression Response at 6 Months
MNCM is pleased with the progress made so far, and will be providing further detail regarding the registry process and programmatic details. Stay tuned!
MN Community Measurement (MNCM) recently published new results for two hospital-based health care quality measures and a refresh of five existing readmission measures. This information can be used to compare hospitals within Minnesota with state and national averages.
The results are available at MNCM’s public reporting website MNHealthScores.org.
The two quality measures are relatively new composites that are required by Centers for Medicaid and Medicare Services (CMS).
Value Based Purchasing Composite
The Hospital Value-Based Purchasing (VBP) composite measures the performance of acute-care hospitals on the quality of care they provide to Medicare beneficiaries, how closely best clinical practices are followed and how well hospitals enhance patients’ experiences of care during hospital stays.
The VBP measure combines results from different measure components into a single score for a hospital. A hospital score can range between 0 and 100. The statewide score is 46.0. A hospital’s performance rating is a comparison to the statewide score and is noted as “above average” (better), “below average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.
Hospital Acquired Conditions Composite
One way to measure hospital quality is to see how many patients developed infections or other specific health issues as a result of their hospital stay, such as bloodstream infections, pressure ulcers, surgical complications, kidney damage, blood clots and other serious conditions.
The Hospital Acquired Conditions Composite measure combines results from different measure components into a single rating for the hospital. A hospital score can range between 1 and 10. The statewide score is 4.94. A hospital’s performance rating is a comparison to the statewide score and is noted as “lower than average” (better), “higher than average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.
Additionally, MNCM refreshed data for five readmission measures for the period of July 1, 2012-June 30, 2015. Measures with refreshed data include Chronic Obstructive Pulmonary Disease (COPD), Heart Failure, Acute Myocardial Infarction (AMI), Pneumonia and Knee or Hip Surgery.
Results for these and other health care quality measures are available at MNCM’s public reporting website MNHealthScores.org.
For many Minnesotans, good health can be elusive, especially for people of color and new immigrants. Health care outcomes vary widely based on where a person lives, their race, preferred language or country of origin, according to a new report from MN Community Measurement (MNCM).
The 2016 Health Equity of Care Report pinpoints distinct differences in health care between numerous patient populations and geographic regions across Minnesota. Results in the 2016 Health Equity of Care Report clearly show that some racial, ethnic, language and country of origin groups have consistently poorer health care outcomes than other groups. The report also shows how those rates vary by medical group across the state and gives examples of what groups are doing to improve outcomes for their patients.
“Minnesota is one of the healthiest states in the nation, at the same time we have some clear and persistent inequities in health status,” said Jim Chase, MNCM President. “Patients from specific geographic regions and populations, including those in Greater Minnesota, people of color, people who identify as Hispanic, immigrants and people who do not speak proficient English are less likely to receive preventive screenings and more likely to suffer from negative health outcomes.”
The third annual Health Equity of Care Report released by MNCM provides a new benchmark in understanding health inequity in Minnesota. The report is at http://mncm.org/health-equity-of-care-report/
The report’s major findings include:
- White patients generally had better health care outcomes across most measures and most geographic areas.
- Patients in Greater Minnesota overall had poorer health outcomes than patients in the 13-county Metro area.
- Patients born in Asian countries tend to have better outcomes across multiple quality measures and geographic regions than patients in other country of origin groups.
- Generally, patients from large medical groups in the Metro area had higher rates of optimal care.
- Across measures and geographic areas, American Indian or Alaska Native and Black or African American patients generally had the lowest health outcomes both statewide and regionally.
- Hispanic patients generally had poorer health care outcomes than non-Hispanic patients across all quality measures and most geographic regions.
- Patients born in Laos, Somalia and Mexico generally had poorer outcomes than other groups.
- Patients who preferred speaking Hmong, Somali and Spanish generally had lower screening and care rates compared to other preferred language groups.
Despite the somewhat stark results, examples of success exist and several such examples are featured in the 2016 Health Equity of Care Report. South Lake Pediatrics is highlighted in the report as one such example for their positive results for numerous populations for the Optimal Asthma Control for Children measure.
“We are very proud of our asthma work,” said Laura Saliterman MD, with South Lake Pediatrics. “A great deal of effort has gone into our asthma program and it has produced great results for our patients.”
The 2016 Health Equity of Care Report contains information collected from patients seen for appointments at medical groups throughout Minnesota, and evaluates health care quality in seven areas. Results for the seven health care quality measures were segmented by race, Hispanic ethnicity, preferred language and country of origin. These measures are further reported at statewide, regional and medical group levels. The seven measures are: Adolescent Mental Health and/or Depression Screening, Adolescent Overweight Counseling, Colorectal Cancer Screening, Optimal Asthma Control for Adults, Optimal Asthma Control for Children, Optimal Diabetes Care and Optimal Vascular Care. The Adolescent Mental Health and/or Depression Screening and Adolescent Overweight Counseling measures are new in the 2016 Health Equity of Care Report.
“To reduce and eliminate the barriers to health equity, we must understand where they exist and their scope,” said Chase.
This report is unique because medical groups across the state report the data in a standardized format, which allows MNCM to compare results across medical groups and regions.
MNCM released The Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups in 2008. This handbook defined and standardized the information that is to be collected from patients by clinics and medical groups, as well as set best practices for collection and reporting. Since then, Minnesota providers have steadily improved their collection and reporting of race, ethnicity, language and country of origin (REL) data. In 2016, nearly all Minnesota providers submitted REL data to MNCM and most did so using best practices. Only data from medical groups who have successfully demonstrated to MNCM that they follow these best practices is included in the Health Equity of Care Report.
Understanding why the gaps exist from one group to another and what can be done to reduce the barriers to optimal health are the reasons behind the MNCM effort to collect and report this information. Specific questions of why, and what is being done, according to Chase, are questions best answered by the state’s medical groups and others health equity advocates.
“We share this report with the community so that advocates, policymakers, public health professionals, communities of color and medical groups can take the necessary steps toward addressing the unique health concerns of their patients, stakeholders and constituents,” said Chase.
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care data and public reporting on quality, cost and patient experience since 2003, MNCM works with medical groups, health plans, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value. Learn more at MNCM.org.