Michigan Oncology Quality Consortium Biannual Meeting January 2020 Culture, Faith, & Difficult Conversations: Patient- and Family-Centered Care To all practices: Please contact MOQC for VBR targets as this is proprietary information.
Hospices Sponsor Partners POQC 3
Continuing Medical Education Disclosur sures • Jennifer Griggs, MD, MPH is a consultant for Pacific Business Group on Health (PBGH),* which hold the CMS contract. • Michael Smith, PharmD, BCPS is a consultant for Wolters Kluwer. • No other disclosures *Non-profit entity 4
Continuing Medical Education Learning o objecti tives 1. Analyze experience and improve practice 2. Integrate relevant content to provide cost-effective health care that does not compromise care quality 3. Integrate relevant content to ensure multispecialty/multidisciplinary coordination of care Compete tencies 1. Practice-based learning and improvement 2. Systems-based practice Program has details on number of credit hours. Pharmacy CE approved
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MOQC Performance by Practice
Pain addressed appropriately by 2nd office visit & during most recent visits 25 th Percentile 75 th Percentile Median 100% 100% 100% 100% 100% 99% 98% 98% 98% 98% 99% 98% 97% 97% 96% 96% 96% 96% 95% 95% 93% 100% 91% 90% 90% 88% 88% 86% 85% 86% 84% 83% 82% 82% 82% 82% 77% 77% 77% 76% 80% Proportion 56% 56% 60% 40% 20% 0% QOPI Measure CORE6e - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Signed patient consent for chemotherapy 25 th Percentile 75 th Percentile Median 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 99% 99% 98% 98% 96% 97% 95% 94% 94% 100% 93% 93% 92% 91% 91% 91% 88% 88% 87% 86% 87% 84% 84% 82% 77% 80% 67% Proportion 63% 60% 40% 28% 17% 20% 11% 0% 0% QOPI Measure CORE14 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Tobacco cessation counseling administered or patient referred in past year 25 th Percentile 75 th Percentile Median 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% 100% 93% 93% 89% 89% 88% 88% 87% 86% 80% 78% 77% 76% 75% 74% 80% 73% 71% Proportion 70% 68% 67% 67% 67% 60% 52% 40% 33% 33% 29% 25% 21% 14% 20% 0% QOPI Measure CORE22bb - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
NK1 Receptor Antagonist or Olanzapine administered for low or moderate emetic risk Cycle 1 chemotherapy (Lower Score – Better) 75 th Percentile 25 th Percentile Median 93% 100% 80% 71% Proportion 54% 60% 49% 44% 40% 40% 37% 33% 33% 40% 32% 29% 29% 28% 23% 20% 19% 18% 17% 15% 15% 15% 20% 13% 13% 11% 10% 9% 9% 8% 6% 6% 4% 4% 4% 3% 3% 2% 0% 0% 0% 0% 0% QOPI Measure SMT28a - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Infertility risks discussed prior to chemotherapy with patients of reproductive age 25 th Percentile 75 th Percentile Median 100% 100% 100% 100% 100% 100% 100% 86% 80% 80% 80% 80% Proportion 67% 60% 57% 56% 60% 51% 50% 50% 50% 40% 33% 33% 29% 25% 23% 22% 20% 17% 17% 20% 0% 0% 0% 0% 0% 0% 0% 0% 0% QOPI Measure SMT33 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Complete family history documented for patients with invasive CRC 25 th Percentile 75 th Percentile Median 100% 77% 80% 67% Proportion 63% 60% 55% 60% 50% 49% 48% 44% 44% 40% 39% 38% 40% 33% 26% 25% 25% 21% 20% 19% 17% 17% 17% 15% 20% 13% 13% 13% 13% 12% 10% 9% 6% 4% 0% 0% 0% 0% 0% 0% 0% 0% QOPI Measure CRC63 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy 25 th Percentile 75 th Percentile Median 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 100% 92% 93% 92% 89% 89% 88% 86% 86% 79% 80% Proportion 69% 67% 67% 67% 60% 50% 50% 38% 40% 30% 20% 0% QOPI Measure CRC73 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Pain addressed appropriately at end of life 25 th Percentile Median 75 th Percentile 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 98% 97% 97% 97% 96% 96% 95% 94% 100% 94% 94% 93% 92% 91% 90% 88% 88% 87% 85% 84% 75% 80% 73% 71% Proportion 59% 60% 40% 20% 0% QOPI Measure EOL38 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Hospice enrollment 25 th Percentile 75 th Percentile Median 100 % 94% 100% 88% 75% 80% 72% 71% 69% 68% 67% 67% 67% Proportion 64% 60% 60% 58% 57% 56% 55% 55% 60% 54% 53% 51% 50% 46% 41% 40% 40% 38% 38% 40% 32% 32% 30% 25% 24% 23% 17% 14% 20% 11% 5% 0% 0% 0% QOPI Measure EOL42 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Hospice enrollment within 3 days of death (Lower Score - Better) 75 th Percentile 25 th Percentile Median 100% 80% 67% 62% Proportion 60% 50% 50% 38% 35% 36% 36% 40% 33% 33% 33% 33% 33% 29% 27% 25% 25% 22% 21% 20% 19% 18% 15% 15% 20% 14% 13% 8% 8% 8% 5% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% QOPI Measure EOL44 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Hospice enrollment or documented discussion 25 th Percentile 75 th Percentile Median 100% 94% 100% 89% 88% 83% 81% 80% 79% 79% 77% 75% 74% 80% 71% Proportion 68% 68% 67% 66% 63% 63% 62% 60% 60% 60% 58% 59% 60% 51% 50% 50% 50% 50% 46% 45% 44% 44% 43% 38% 34% 40% 32% 26% 24% 20% 0% 0% QOPI Measure EOL47a - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Chemotherapy administered within last 2 weeks of life (Lower Score - Better) 25 th Percentile 75 th Percentile Median 100% 80% Proportion 60% 40% 29% 25% 21% 20% 20% 20% 19% 19% 18% 17% 16% 14% 14% 20% 14% 13% 13% 13% 13% 13% 13% 12% 12% 11% 10% 10% 10% 10% 9% 9% 9% 8% 8% 6% 5% 5% 0% 0% 0% 0% 0% 0% 0% QOPI Measure EOL48 - Practice and Comparative Groups Round 1 2019 Note: Practices with no eligible cases in the denominator are not shown
Started Round 2 of 2019 Maintaining MOQC Measures • Oral chemo monitored: medication adherence assessed • Tobacco cessation counselling administered or patient referred • NK1 RA or olanzapine administered with Cycle 1 low or mod emetic risk chemotherapy (lower is better) • Pain addressed appropriately (EOL) • Hospice enrollment or documented discussion (EOL) (revised) • Chemotherapy in last 2 weeks of life (EOL) (lower is better) • Serum tumor marker surveillance (30-365 days p dx) in early stage breast cancer (lower is better) 20
Started Round 2 2019 Changes to MOQC Measures Added or or Creat ated • Oral chemotherapy monitored on visit/contact following start of therapy • NK1 RA and olanzapine prescribed or administered with high emetic risk chemotherapy • Hospice enrollment • Hospice enrollment within 7 days of death (lower is better) • Patients with prostate ca receiving ADT who received bone density testing within 1 year of initiating ADT • Bone modifying agents administered for breast ca bone mets or multiple myeloma • Complete family history for patients with invasive cancer • GCSF administered to patients who received chemo for non-curative intent (lower is better) 21
Started Round 2 of 2019 Changes to MOQC Measures Re Remove ved • Pain managed appropriately (initial therapy) • Signed patient consent for chemotherapy • Infertility risks discussed • Dyspnea addressed (EOL) • Hospice enrollment within 3 days (EOL) (lower is better) • Complete family history for patients with invasive colorectal cancer • Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy 22
Changes in VBR Measures
Criteria for Selection of VBR Measures • Meaningful measures at patient- & population-level • Clinicians have interest in practice improvement • Addresses the value equation • Current performance not too high • Current performance not too low • Variation in practice between practices & regions • Novel & interesting VBR, value-based reimbursement
MOQC VBR ELIGIBILITY PAYMENT Retrospective care Region meets target for 3 of 4 (abstraction) measures + One physician/practice attends one biannual meeting and both regional meetings (12 hours) Prospective payment
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