6/12/2020 TE TECUP UPP P Vi Virtual ual Meeting eeting Lordn via Adobe Stock 1 Agenda 9:00am PT/12:00pm ET Welcome & Introductions 9:15am PT/12:15pm ET Project Re-orientation 9:30am PT/12:30pm ET Beta Test Preliminary Findings / Q & A 10:00am PT/1:00pm ET Discussion: • COVID impact on practices • Stakeholder support • Measure performance and quality improvement 10:50am PT/ 1:50pm ET Next Steps & Closing Comments 11:00am PT/ 2:00pm ET Close 2 2 1
6/12/2020 Welcome (from the project team)! Katherine Ast, MSW, LCSW AAHPM Project Director Kelly McKenna, MA AAHPM Project Manager Joe Rotella, MD, MBA, FAAHPM (CMO) AAHPM Team Leadership Wendy-Jo Toyama, MBA CAE (CEO) Rodney Tucker, MD MMM (President) Sangeeta Ahluwalia, PhD RAND Project Directors Carrie Farmer, PhD Jessica Phillips, MS RAND Project Manager Amy Melnick, MPA Coalition Project Director Gwynn Sullivan, MSN Coalition Project Manager Cozzie King Coalition Manager Sydney Dy, MD, MS, FAAHPM TECUPP Co-Chairs Mary Ersek, PhD, RN, FPCN 3 3 Potential Conflicts of Interest Disclosed • Name, me, Creden edential tials – List conflict(s) noted here . 4 2
6/12/2020 Does anyone have any new conflicts nflicts of interest rest to report? 5 5 PROJECT RE-ORIENTATION 6 6 3
6/12/2020 TECUPP roles and responsibilities • Provide input on key decisions • Engage in group discussions • Share informed opinions freely • Remember the importance of a “by us, for us” process 7 7 Project goal: Develop two wo patien ient-rep eported ed qu quali ality ty measu sures es of outpatien atient t palliati iative e car are e exper erience ience for CMS’s Merit -Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) created by MACRA 8 8 4
6/12/2020 Measures under development Measure Name Measure Name Measure Name Measure Name Palliative care outpatients’ experience Palliative care outpatients’ experience of feeling heard and understood of receiving desired help for pain Measure Description Measure Description Measure Description Measure Description Percentage of patients aged 18 years and Percentage of patients aged 18 years and older per year who are fielded a patient older per year who are fielded a patient experience survey within 3 months of an experience survey within 3 months of an outpatient palliative care visit, who report outpatient palliative care visit, who report feeling heard and understood by their having pain and wanting help for their pain, palliative care provider and team over the and who report getting the help they last six months wanted for their pain by their palliative care provider and team over the last six months 9 9 Project timeline PREPARATION TESTING FINALIZATION/ENDORSEMENT Information Gathering Alpha Field Test TECUPP Meeting Final Business Final Measure Specifications Jun 2020 Case Oct 2020 Sept 2018 – Jun 2019 Aug – Oct 2019 Jan – Jun 2021 Beta Field Test Submit Measures to MUC List Jun 2021 Nov 2019 – Nov 2020 Cognitive Testing Public Comment NQF Intent to Submit Mar 2019 – Feb 2020 Dec 2020 – Feb 2021 Aug 2021 (Fall 2021 review c ycle) NQF Submission Nov 2021 [AAHPM] 2019 2020 2021 2022 10 10 5
6/12/2020 TESTING 11 Alpha field test Goal: l: Establish data collection procedures and prepare for national field test (beta) • What response rates could we expect? • Would eligibility criteria yield an adequate sample? • Could a web-based survey be feasible for beta? • What could preliminary data tell us about the items and measures? Parti ticip ipants ants: : 300 patients across 5 outpatient palliative care programs Methods hods: : Mixed mode survey administration 12 12 6
6/12/2020 Alpha field test: key findings Respons nse rates were e as antic icipat ated ed • 40% (120 completed surveys, out of 300 fielded), with a range of 26% to 53% across 5 programs Eligib igibilit ility criteria eria (1 outpati atien ent t visit it in 3 months hs) are feasib ible le and optim imal al • Of 996 patients with 1 visit in 6 months, 662 (66%) had the eligible visit in 3 months • Of 662 patients (48%), 318 had only one visit in 3 months Web-base ased d survey is feasib ible le to test t in beta ta Potential for topping out with “heard and understood” (H/U) data elements • Revised response option from “very true” to “completely true” The convenien nience e sample le limit ited ed program gram and patient ient repres esen entat tation ion • Beta testing will use a nationally representative sample of programs, distributed by geographic region and program type 13 13 Beta field test Goal: l: Examine reliability and validity of proposed quality measures and explore measure implementation for the QPP Schedule edule: : November 2019 to November 2020, but currently paused due to COVID-19; last round of fielding was 3/30/20 to 5/25/20 Sample le size e goal: : 6,000-7,500 sampled patients for 2,400-3,000 completed surveys (assuming 40% response rate) Methods hods: : “Enhanced” mixed mode administration (web to mail to phone) in both English and Spanish (planned, pending completed translation) 14 14 7
6/12/2020 Beta program recruitment Midwes est Northea heast st South West st TOTAL AL Targeted Number of Programs 2 1 3 1 7 Hospi spice Programs Recruited (with executed 2 2 5 1 10 10 DUAs) Percent of Target 100% 200% 167% 100% 143% Midwes est Northea heast st South West st TOTAL AL Targeted Number of Programs 5 9 7 7 28 28 Hospi spital Programs Recruited (with executed 5 6 7 7 25 25 DUAs) Percent of Target 100% 67% 100% 100% 89% 89% Midwes est Northea heast st South West st TOTAL AL Targeted Number of Programs 3 2 5 5 15 15 Other her Programs Recruited (with executed 2 3 2 1 8 DUAs) Percent of Target 67% 150% 40% 20% 53% 53% TOTAL AL PRO ROGRAMS AMS 9 11 11 14 14 9 43 43 15 15 As of April 2020, we have received 914 completed beta test surveys Survey ey adminis inistrat ation ion Number er Patients removed from Number of surveys fielded 2030 219 denominator Number of patients eligible for inclusion 1811 Deceased 165 Number of completed surveys 914 Other 54 Mail surveys 424 (46%) Phone surveys 384 (42%) Web surveys 106 (12%) Response rate (914/1811) 51% 16 16 8
6/12/2020 Patient/respondent characteristics Chara racter cterist stics cs (n=914) 4) % (n) or M (SD) 64.2 Age (sd = 13.8, N = 913) 44.6% Male (n = 407, N = 913) 20.5% Proxy Assistance (n = 187, N = 914) Reason for proxy assistance… Phone Mail Web Count of Proxy Response by Mode 72 102 13 8.3% Patient Helped Answer Some Questions -- -- (n = 6) 48% 53.8% Read the questions to me -- (n = 49) (n = 7) 47.1% 7.7% Wrote down the answers I gave -- (n = 48) (n = 1) 38.2% 46.2% Answered for me -- (n = 39) (n = 6) 2.9% 0% Translated into my language -- (n = 3) (n = 0) 5.9% 0% Helped in some other way -- (n = 6) (n = 0) 17 17 Patient/respondent characteristics ( n =914) 18 18 9
6/12/2020 Most patients reported feeling heard and understood by their outpatient palliative care provider and team Completely y Very Somewhat t A Little Not at All DE# Questi tion on N True True True Bit True True Q12 I felt heard and understood by this provider and team. 71.3% 21.3% 4.2% 2.1% 1.2% 908 Q13 I trusted this provider and team. 75.5% 18.4% 3.9% 1.7% 0.7% 909 Q14 I felt comfortable asking this provider and team questions. 79.4% 15.1% 3.3% 1.3% 0.9% 908 I could tell this provider and team anything, even things I might not tell Q15 anyone else. 60.5% 23.5% 10.8% 2.6% 2.7% 899 I felt this provider and team … Q16 Put my best interests first when making recommendations about my care. 73.6% 18.8% 4.7% 1.8% 1.1% 909 Q17 Always told me the truth about my health, even if there was bad news. 76.9% 17.0% 4.2% 1.2% 0.7% 904 Q18 Saw me as a person, not just someone with a medical problem. 78.4% 15.3% 4.0% 1.4% 0.9% 908 Q19 Knew what worried me most about my health. 64.0% 24.5% 8.9% 0.9% 1.8% 903 Q20 Understood what is important to me in my life. 64.7% 22.4% 9.9% 1.3% 1.8% 903 Q21 Would know what I would want done if I was unconscious or in a coma. 55.7% 22.3% 14.1% 2.6% 5.4% 875 19 19 Most patients who wanted help for their pain received the help they wanted 20 20 10
6/12/2020 Similarly, most who wanted emotional support from their provider and team reported receiving it 21 21 We evaluated the heard and understood (H/U) multi-item scale • Inter-item correlations • Item-total correlations • Reliability • Factor analysis 22 22 11
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