Prevention and Wellness: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians

Transcription

1 Performance Measurement Prevention and Wellness: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem, MD, Eileen D. Barrett, MD, J. Thomas Cross, MD, Andrew Dunn, MD, Nick Fitterman, MD, Robert A. Gluckman, MD, Susan Thompson Hingle, MD, Kesavan Kutty, MD, Eve A. Kerr, MD, Ana Maria López, MD, Catherine MacLean, MD, Stephen D. Persell, MD, and Terrence Shaneyfelt, MD, and Sarah West, RN ACP Performance Measurement Committee Members* Eve A. Kerr, MD, MPH (Chair); Catherine MacLean, MD, PhD (Vice Chair); Eileen D. Barrett, MD, MPH; J. Thomas Cross, MD, MPH; Andrew Dunn, MD; Nick Fitterman, MD; Robert A. Gluckman, MD; Susan Thompson Hingle, MD; Kesavan Kutty, MD; Ana Maria López, MD, MPH; Stephen D. Persell, MD, MPH; and Terrence Shaneyfelt, MD, MPH Corresponding author: A. Qaseem 190 N. Independence Mall West Philadelphia, PA * Individuals who served on the Performance Measurement Committee from initiation of the project until its approval

2 ACP supports NQF 0028: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention. ACP supports this measure. Reduction of tobacco is a key element in the management of pulmonary disease. The United States Preventive Services Task Force recommends that clinicians ask all their adult patients about tobacco use and offer cessation interventions. Tobacco use is a modifiable risk factor and clinical evidence suggests that patient counseling and re-counseling by physicians increase attempts to quit. NQF 0028: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention Status: NQF Endorsed, Last Updated Jul 01, 2014 (MU2 EHR Incentive Program, MSSP) Measure AMA-Convened Physician Consortium for Performance Improvement Description: Percentage of patients aged 18 years and older who were screened for tobacco use at least once during the two-year measurement period AND who received cessation counseling intervention if identified as a tobacco user Numerator Patients who were screened for tobacco use* at least once during the two-year measurement period AND who received tobacco cessation counseling intervention** if identified as a tobacco user *Includes use of any type of tobacco ** Cessation counseling intervention includes brief counseling (3 minutes or less), and/or pharmacotherapy All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy) Clinician: Group/Practice, Clinician: Individual, Clinician: Team Ambulatory Care: Clinician Office/Clinic, Behavioral Health/Psychiatric: Outpatient, Other Administrative claims, Electronic Clinical Data, Electronic Clinical Data: Electronic Health Record, Electronic Clinical Data: Registry, Paper Medical Records

3 ACP supports NQF 0032: Cervical Cancer Screening. ACP supports this measure. The current evidence supports screening in women years of age. This measure is based on the most recent recommendations of various organizations. NQF 0032: Cervical Cancer Screening Status: NQF Endorsed, Last Updated Dec 23, 2014 (MU2, EHR Incentive Program ) Description: Numerator Percentage of women years of age who were screened for cervical cancer using either of the following criteria: - Women age who had cervical cytology performed every 3 years. - Women age who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years. The number of women who were screened for cervical cancer. Women years of age as of the end of the measurement year. Exclude: Women who had a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix any time during their medical history through the end of the measurement year. Health Plan, Integrated Delivery System Ambulatory Care: Clinician Office/Clinic Administrative claims, Electronic Clinical Data, Paper Medical Records

4 ACP supports NQF 0033: Chlamydia Screening in Women. ACP supports this measure because it aligns with recommendations from the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC) and evidence supports screening in primary care as feasible and effective. NQF 0033: Chlamydia Screening in Women Status: NQF Endorsed, Last Updated Dec 23, 2014 (MU2, EHR Incentive Program) Description: The percentage of women years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. Numerator At least one chlamydia test during the measurement year. This claims-based measure can be used in either of two patient cohorts: (1) patients aged 65 years or older or (2) patients aged 18 years or older. The cohort includes admissions for patients discharged from the hospital with a principal discharge diagnosis of AMI and with a complete claims history for the 12 months prior to admission. Exclude patients who qualified for the denominator based on a pregnancy test (Pregnancy Tests Value Set) alone and who meet either of the following: - A pregnancy test (Pregnancy Test Exclusions Value Set) during the measurement year followed within seven days (inclusive) by a prescription for isotretinoin (Table CHL-E). - A pregnancy test (Pregnancy Test Exclusions Value Set) during the measurement year followed within seven days (inclusive) by an x-ray (Diagnostic Radiology Value Set). Outcome Facility Ambulatory Care: Clinician Office/Clinic Administrative claims, Electronic Clinical Data, Electronic Clinical Data: Pharmacy

5 ACP supports NQF 0034: Colorectal Cancer Screening. ACP supports this measure. While screening is extremely effective in detecting colorectal cancer, it remains an underutilized clinical tool. Only about half of people age 50 and older, for whom screening is recommended, have been screened. The ACP supports this measure because the current evidence demonstrates the benefit of screening in early detection and prevention of disease progression. Additionally, the measure reflects the importance of shared decision making when selecting a screening test. Although we support this measure, the ACP recommends the specifications include Fecal Immunochemical Test (FIT) as a screening strategy. NQF 0034: Colorectal Cancer Screening Status: NQF Endorsed, Last Updated Dec 23, 2014 (2015 PQRS Measure #113) Description: The percentage of patients years of age who had appropriate Numerator screening for colorectal cancer. One or more screenings for colorectal cancer. Any of the following meet criteria: - Fecal occult blood test during the measurement year. For administrative data, assume the required number of samples were returned regardless of FOBT type. - Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year. - Colonoscopy during the measurement year or the nine years prior to the measurement year. Patients years of age as of the end of the measurement year. Exclude patients with a diagnosis of colorectal cancer or total colectomy Health Plan, Integrated Delivery System Ambulatory Care: Clinician Office/Clinic Administrative claims, Electronic Clinical Data: Imaging/Diagnostic Study, Electronic Clinical Data: Laboratory, Paper Medical Records

6 ACP supports NQF 0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up. ACP supports this measure, however; the United States Preventive Services Task Force (USPSTF) recommends offering behavioral interventions for patients labeled as obese (BMI of 30 kg/m²), not overweight individuals (BMI of kg/m²). Additionally, there is no evidence about appropriate intervals for screening. As written, the measure would pressure physicians to spend a disproportionate amount of time on a patient s weight, when other conditions should take precedence. Therefore, we advocate for annual versus biennial screening. NQF 0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Status: NQF Endorsed, Last Updated Mar 12, 2014 (2015 PQRS Measure #128) Measure Centers for Medicare and Medicaid Services Description: Numerator Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal Parameters: Age 65 years and older BMI > or = 23 and < 30 Age years BMI > or = 18.5 and < 25 Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, follow-up is documented during the encounter or during the previous six months of the encounter with the BMI outside of normal parameters All patients aged 18 years and older A patient is identified as a Exclusions (B) and excluded from the Total Population (TDP) in the Performance (PD) calculation if one or more of the following reason (s) exist: Patient is receiving palliative care Patient is pregnant Patient refuses BMI measurement (refuses height and/or weight) Any other reason documented in the medical record by the provider why BMI calculation or follow-up plan was not appropriate Patient is in an urgent or emergent medical situation where time is of the essence, and to delay treatment would jeopardize the patient s health status

7 Clinician: Group/Practice, Clinician: Individual, Population: County or City, Population: National, Population: Regional, Population: State Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Outpatient Rehabilitation, Behavioral Health/Psychiatric: Outpatient, Home Health, Other Administrative claims, Electronic Clinical Data: Electronic Health Record, Electronic Clinical Data: Registry, Paper Medical Records ACP does not support NQF 1395: Chlamydia Screening and Follow-Up. ACP does not support this measure because its specification that the screening is based on the patient turning 18 years old during the measurement year is arbitrary and needs to be aligned with Healthcare Effectiveness Data and Information Set (HEDIS) measures. NQF 1395: Chlamydia Screening and Follow-Up Status: NQF Endorsed, Last Updated Apr 01, 2014 Description: The percentage of female adolescents 18 years of age who had a chlamydia screening test with proper follow-up. Numerator Adolescents who had documentation of a chlamydia screening test with proper follow-up by the time they turn 18 years of age. Sexually active female adolescents with a visit who turned 18 years of age during the measurement year. None Clinician: Group/Practice, Clinician: Individual Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Urgent Care Electronic Clinical Data, Electronic Clinical Data: Laboratory, Electronic Clinical Data: Pharmacy, Paper Medical Records

8 ACP supports NQF 2372: Breast Cancer Screening. ACP supports this measure because the current evidence supports the benefit of biennial screening mammography for women ages 50 to 74 years. NQF 2372: Breast Cancer Screening Status: NQF Endorsed, Last Updated Sep 18, 2014 (2015 PQRS Measure #112) Description: The percentage of women years of age who had a mammogram to screen for breast cancer. Numerator Women who received a mammogram to screen for breast cancer. Women years as of December 31 of the measurement year Note: this denominator statement captures women age years; it is structured to account for the look-back period for mammograms. Bilateral mastectomy any time during the member s history through December 31 of the measurement year. Any of the following meet criteria for bilateral mastectomy: 1) Bilateral mastectomy 2) Unilateral mastectomy with a bilateral modifier 3) Two unilateral mastectomies on different dates of service and 4) Both of the following (on the same date of service): Unilateral mastectomy with a right-side modifier and unilateral mastectomy with a left-side modifier. Health Plan, Integrated Delivery System Ambulatory Care: Clinician Office/Clinic Administrative Claims, Electronic Clinical Data

9 Financial Financial support for the Performance Measurement Committee comes exclusively from the ACP operating budget. Conflicts of Interest: Any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved. A record of conflicts of interest is kept for each PMC meeting and conference call and can be viewed at: tm APPROVED BY THE ACP BOARD OF REGENTS ON: November 7, 2015 Members of the PMC: Individuals who served on the Performance Measurement Committee from initiation of the project until its approval: Eileen D. Barrett, MD, MPH J. Thomas Cross, Jr., MD, MPH Andrew Dunn, MD Nick Fitterman, MD Robert A. Gluckman, MD Susan Thompson Hingle, MD Kesavan Kutty, MD Eve Askanas Kerr, MD, MPH Ana María López, MD, MPH Catherine MacLean, MD, PhD Stephen D. Persell, MD, MPH Terrence Shaneyfelt, MD, MPH Requests and inquiries: Amir Qaseem, MD, PhD, MHA, FACP, American College of Physicians, 190. N Independence Mall West, Philadelphia, PA 19106: , aqaseem@acponline.org