2023-03-15 Quality Measures Full Member Meeting

Date: March 15th, 2023

Time: 3:30pm ET

Attendees (13)

Action items

• Anthony → send new (1) CodeX Quality Measures – Terminology Meeting and (2) CodeX Quality Measures - Full Member Meeting (done)
  • Zoom link + passcode are now included in each invite
• Becky M → send new NCQA contact list to Anthony to include in the CodeX QM Outreach spreadsheet
• Anthony → formalize Use Case Development Guidelines and share document with CodeX QM Full Member team for one complete pass-through (before a formal submission to CodeX OC and SC members)
• Sharon S and Randi → consider submitting a new JIRA ticket to mCODE IG stating that there is strong support and interest in modeling systemic therapy in mCODE
  • Then the mCODE TRG team would review the JIRA ticket and discuss whether it should be modeled in future work

Decision Points

(1) Quality Measure Modeling Approach:

Near-term:

1. ASTRO measure: Oncology: Treatment Summary Communication - Radiation Oncology
   1. This is the ASTRO eCQM treatment summary measure – linked here
2. Performance Status
   1. This is one of the VA measures - linked here

Longer-term:

1. 28 Days from Diagnosis to Any Treatment (#All-B-1) ASPIRATIONAL
   1. This will require modeling “systemic therapy” as a FHIR concept
2. 14 Days from Simulation to First Radiation Treatment
   1. This will require modeling of “simulation” as a FHIR concept (RT-specific)

(2) Decided not to use CPT codes to define Simulation

1. CodeX RTTD team is modeling the Simulation concept

(3) A JIRA ticket r/t constraining the value set associated with .medication[x] to only systemic therapies. It will be considered during ballot reconciliation for mCODE STU3.

• https://jira.hl7.org/browse/FHIR-40655

Planned Agenda Topics

1. Update meeting invite to our HL7 CodeX QM account
2. Interest to present at upcoming CodeX CoP? QM use case updates, movement in federal quality measure models (EOM, etc.), cross-over between QM and other use case work, etc. 
3. Review the updated Use Case Guidelines criteria: Quality Measures - Use Case Development Guidelines Checklist
4. Continue VA radiation therapy measures discussions:
   1. Confirm with the team to move forward with modeling the "28 days to therapy" VA measure (RT focus, not systemic)
   2. Discuss additional 1-2 of the VA measures (filtering on “medium” priority measures that won't require mCODE modeling)
      1. this will require discussion during 3/15 call to decide on another VA measure(s) (in addition to 28 days)
   3. ASTRO to bring existing, radiation-specific eCQM(s) to the 3/15 meeting for review
5. Review updated Outreach Spreadsheet (attached)

Time-permitting:

1. New CMS proposed rule: CMS’ Proposed Universal Foundation Latest Health Equity Lever | InsideHealthPolicy.com
   • In particular, the article mentions: “The universal foundation would function as something of a “building-block approach” applied to as many CMS quality-rating and value-based care programs as possible. That, in turn, would help align the multitudinous quality measures at play across various programs and in use by insurers…”
   • Have folks heard of this CMS proposal to develop a universal foundation of core quality measures? And if so, are there additional resources we could review to identify which “core quality measures” CMS is proposing to include?
2. Upcoming Conferences

   1. ViVE Conference (focused on digital health solutions): If any members are planning to attend and interested in presenting on CodeX-related initiatives at ViVE, let me know. CodeX has a kiosk.

      • POCP folks on the CodeX team may be at ViVE (Kim Boyd)
      • Also, if there are specific content/messaging that should be present at ViVE, I can connect us with CodeX PM team about incorporating
   2. NCQA Health Innovation Summit – October 23-25th in Orland, FL
      • Abstracts due March 31st
3. Updates to the September 2023 Connectathon – pending follow-up from CQI WG
   • Gail/Anthony checking with Bryn Rhodes about FHIR informed authoring work - TBD

Additionally during our 3/15 Full Member Meeting:

• Confirm with the team that we will include “28 Days from Diagnosis to Any Treatment (#All-B-1) ASPIRATIONAL” as (1) of our measures in Phase 1
• Continue reviewing the prioritized VA quality measures spreadsheet (attached – “Prioritized eCQM List_ASTRO_ASCO_MITRE_Telligen_v6”)
• Determine 1-2 additional VA measures to include in Phase 1
• Review column A of the spreadsheet. Specifically, this is where the team stands which each measure, based on our recent discussions
• Review the existing radiation-specific eCQMs that Randi will share with the team
• Determine ~1 measure(s) to include in Phase 1

Discussion Notes

(1) Zoom link

• Anthony → send out new Zoom link details and create a new meeting invite to replace the Teams invites

(2) CoP

• Gail and Anthony will blend demonstration options into a dual CoP / Public Call
• Gail is working on reporting of the UI – so its more user friendly to naïve viewers
• Anthony → connect with Gail for use case demo at CoP

(3) NCQA

• CQI Co-chair has good relationship with the NCQA contacts that are being sent from Telligen. CQI co-chair at Telligen also knows Ben Hamlin (?) confirm with Becky
• Becky → send NCQA contact list to Anthony

(4) Use Case Guideline

• Anthony to formalize UC Guidelines and share document with team for one full pass-through before a formal submission to CodeX PM and OC members

(5) VA measures

For 28 days measure

• If you’ve been diagnosed, you may not have had the radiation. Depending on diagnosis there is a whole algorithm of potential options. You can’t have 28 Day Measures with just radiation therapy because many patients would fall out of it.
• mCODE only looks at if medications are related to a diagnosis – so it wouldn’t include other types of systemic therapies outside of chemo (immunotherapy, etc. would not be included).

• this is not a viable option to only use RT specific concepts

For 21 days measures

For people who start RT (only), were there 21 days or less from consult to any treatment.

Systemic therapy will be a concept that will need to be tackled – it’s a major gap because tons of modeling needs to be done.

Decision: To get attention of mCODE TRG team and show that there is strong support and interest in modeling systemic therapy in mCODE we will need to submit a new JIRA ticket for mCODE. Then the mCODE TRG team would review the JIRA ticket and discuss whether it should be modeled.

• 21 Days measure is not a viable option to only use RT specific

14 Days from Simulation

It is not a direction that CQI is trying to go into using CPT codes as a stepping stone for codes to represent simulation. We need to take the complete approach of modeling simulation in FHIR – not rely CPT codes as placeholders.

Next steps

• if we need an RO eCQM as a follow-up to the pain measure proof of concept – then there is one ready to go for us to begin modeling/testing. Randi to share with the group.
  • ASTRO treatment summary measure – created many moons ago and CMS picked it up for RO Model. ASTRO took it to PCPI for approval. RO Model does have this and aligns nicely with the RTTD use case so far.
  • The next measure we could consider is a “low” prioritized VA measure that doesn’t require additional modeling work. this can be the Performance Status VA measure or the Prior Radiation Documentation VA measure. There would not be data currently available in vendors systems to collect to support the Prior Radiation Documentation measure, so let’s start with the Performance Status measure.
• Then, we look at the specification → let’s wait for simulation to be specified in RTTD group. Once specified we can look at 14 Days from Simulation to First Radiation Treatment or the 28 Days from Diagnosis to Any Treatment (once systemic therapy is measured for 28 Days – this will take much longer).

Approach (confirmed by the QM team during 3/15 Full Member call):

Near-term:

1. ASTRO eCQM treatment summary measure – Randi shared this document
2. “Low” priority / no modeling VA measure – Performance Status (based on feasibility of what’s in mCODE / most practical approach)

Longer-term:

1. 28 Days from Diagnosis to Any Treatment (#All-B-1) ASPIRATIONAL
1. This will require modeling “systemic therapy” as a FHIR concept
2. 14 Days from Simulation to First Radiation Treatment
1. This will require modeling of “simulation” as a FHIR concept (RT-specific)

(6) Upcoming Conferences

• Telligen is attending HIMSS, September HL7 Connectathon and ASCO Symposium
• No orgs on the call were interested in the NCQA conference in October 2023
• No orgs are attending ViVE Conference in Nashville

Decisions

1. Not using CPT codes to define simulation – CodeX RTTD team is modeling simulation
2. We decided on our near-term and longer-term quality measure approach