Gynecology-Oncology Initiative Inaugural M Meeting October 14, - - PowerPoint PPT Presentation

Gynecology-Oncology Initiative

Inaugural M Meeting

October 14, 14, 2017 2017

Inn at St. John’s, Pl Plymouth M MI

Thank you

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Welcome

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Jennifer J. Griggs

Program Director

Louise Bedard

Program Manager

Emily Mackler

Clinical Pharmacist

Arthi Ramakrishnan

Project Manager

Sam Beusterien

Project Manager

Jennifer Yanchula

Outreach Manager

Shitanshu Uppal

Program Co-Director

A Few Details

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• Documents at Seat
• Group Photo at Break
• Q & A Opportunities
• Six Question Evaluation
• Confidentiality Agreement
• Food and Beverage
• Cell Phones

Resources

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• MOQC Pathway Measures
• MOQC-BCBSM VBR FAQs
• ASCO-QOPI material
• BCBSM Value Partnerships/CQI
• Business cards

For Your Use

On MOQC.org/ Today’s Slides: Monday October 16th Today’s Videos: November 1st @MOQCTeam or #moqc Password: None Point your browser to “Inn at St. John’s”

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Dedicated to all the women and their families who have suffered with cancer

Acronyms

MOQC – Michigan Oncology Quality Consortium MSQC – Michigan Surgical Quality Collaborative QOPI – Quality Oncology Practice Initiative APM – Alternative Payment Models MACRA - The Medicare Access and CHIP Reauthorization Act of 2015 MIPS – Merit based Incentive Payment System POQC – Patient and Caregiver Oncology Quality Council EOL – End of life SSI – Surgical Site Infections

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QOPI Data & MOQC

• MOQC has a standing agreement to receive data twice-

yearly from QOPI

• All participating MOQC sites’ practice-level data
• Regional, MOQC (state) and national aggregate
• MOQC provides practices with comparative reports &

statistical analyses

• Data are used to identify areas for improvement & to

monitor outcomes

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Michigan Oncology Quality Consortium

Colors denotes MOQC’s five regions

MOQC Practices

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Type pe o

• f Practice

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3 18 26 Academic Private Practice System or Hospital Owned Group

Source: MOQC Landscape Survey, 2017 N=47 practices

Practice Size

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7 13 16 6 5

2 4 6 8 10 12 14 16 18 20

1 2 3-5 6-10 >10

Number of Medical Oncologist FTEs

Source: MOQC Landscape Survey, 2017 N=47 practices

Number of Practices

Coordinating Center/Team

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Steering Committee

Patient & Caregiver Oncology Quality Council (POQC)

BCBSM/CQI Value Partnerships Quality Projects

• Chemotherapy consent

(2017)

• Advance care planning

(2016)

• Data abstraction (2016)
• Oral oncolytic (2015)
• Tobacco cessation (2014)

Practices

• Participate in QI projects
• Align with CMS & MOC
• Regional structure for

data sharing and collaboration

Measures Group

MOQC Leadership

Role of Coordinating Center

1. Quality/performance improvement support

• Training
• Advisory role
• Resources

2. Data abstraction 3. Data reporting with statistical analyses 4. Support opportunities for state-wide improvement

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Four priorities

Role of the Steering Committee

1. Support MOQC leadership in decision-making 2. Set priorities of the Collaborative 3. Ensure broad multidisciplinary representation 4. Select speakers & help set agendas 5. Attend Biannual Meetings 6. Participate in teleconference meetings

• 30 – 60 minutes
• 3-4 times a year

7. Review agenda, documents and feedback via email 8. Enhance practice engagement as needed

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Patient & Caregiver Oncology Quality Council

Name Residence

Diane Drago Ann Arbor Mary Duncan Ionia Marilyn Gilin Waterford Mike Harrison Allen Park Cynthia Koch Ann Arbor Erika Jane Lojko

• St. Clair Shores

Johanna Mabry Ann Arbor William Polkinghorne Houghton Barbara Rau Lake Isabella Samantha Schadel Sterling Heights Shanna Simpson-Simpson Taylor Derek Singleton Taylor Deborah Stocking Morrice Peggy Taylor-Albaugh Britton

POQC Priorities

• 1. Improve access to resources for all cancer

patients across the State of Michigan – 100 100%

• 2. Improve patient-provider communication – 72%

72%

• 3. Present the patient- and/or patient-caregiver

story to MOQC practices – 36% 36%

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2018 priorities will be established by December 2017 Regional meetings are identifying opportunities

POQC

Members participate in these ways

Offer patient/patient-caregiver input at meetings - 82% Improve patient outcomes by contributing to a quality initiative - 82% Review patient materials 72% Tell my story at meetings 55%

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Why Participate?

• 1. Receive rewards
• 2. Receive practice performance data with benchmarks

against other statewide & national data

• 3. Share & acquire best practices
• 4. Access clinical & performance improvement resources
• 5. Receive profession and payer quality “points”
• 6. Collaborate & influence priorities of the consortium

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Why Participate?

Rewards

• One ASCO Membership
• Annual Reimbursement
• Value of $600 + $35 initiation fee (as of 1/2017)
• Costs of abstraction are reimbursed
• Value-Based Reimbursement (VBR) from BCBSM and CMS
• Reimbursement is submitted to Provider Organization

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Expectations

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Data Collection

Physician Participation Practice Participates in Quality Improvement

QOPI Data & MOQC

• MOQC has a standing agreement to receive data twice-

yearly from QOPI

• All participating MOQC sites’ practice-level data
• Regional, MOQC (state) and national aggregate
• MOQC provides practices with comparative reports &

statistical analyses

• Data are used to identify areas for improvement & to

monitor outcomes

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Measures

QOP OPI M Measures es

• Nearly 200 measures

MOQC QC P Pat athway

• 17 selected measures

MOQC Pathway

Domain QOPI Measures CORE

• Pain management
• Tobacco cessation counseling/referral
• Signed consent for chemotherapy
• Inappropriate chemotherapy in

patients with advanced disease & poor performance status

• Assessment of adherence to oral

chemotherapy END OF LIFE

• Pain management
• Dyspnea management
• Death on hospice
• Palliative care/hospice services or

documented discussion

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MOQC Pathway

Domain QOPI Measures SYMPTOM & TOXICITY MANAGEMENT

• Counseling regarding infertility

risks for patients of reproductive age

• Inappropriate use of

aprepitant/fosaprepitant or netupitant administered for low

• r moderate emetic risk

chemotherapy (cycle 1)

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Vision and Direction

Gynecology Oncology Initiative

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Opportunities

Ovarian Cancer:

• Registry to monitor short-

term and long-term

• utcomes
• Underlying layer for

homegrown region multi- centric clinical trials

• Funding opportunities

(⬆ sample size)

• Studies with patient

reported outcomes Endometrial Cancer:

• Sentinel Lymph nodes (SLN)
• Dr. Rabbi Hanna (HFH)
• Registry SLN outcomes
• Outcomes of type II cancers

Cervical Cancer:

• Access to care
• Adherence to guideline based care
• Access to fertility sparing options

Gynecology Oncology Initiative

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Opportunities

Ovarian Cancer

• BRCA testing of all OVCA patients
• Population based reduction in breast

and ovarian cancer as a result of increased BRCA testing in OVCA patients Endometrial Cancer

• Cost-effective ways of lynch syndrome

testing in Endometrial cancer

Goals for First Year

• Application to BCBS to include gynecologic cancers
• Start with one cancer site  Ovarian cancer
• Participation of Gynecology Oncology practices in

MOQC

• Steering committee meeting  June 13th, 2017
• Select measures for the first year
• Pending
• Practice agreements
• Start data abstraction for the first year
• Priorities for year 2

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What is Reasonable to Achieve Year One?

Ovarian Cancer Quality Matrix

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Surgical Chemotherapy Surveillance/ Genetics End-of-life Access to surgical care

• Proportion of

patients undergoing debulking surgery

Guideline based chemotherapy Imaging utilization (CT/PET-CT/MRI) in surveillance Aggressive end-of-life care Quality of surgery

• Rate of optimal

debulking

• Documentation of

residual disease

Time from diagnosis/surgery to initiation of therapy Proportion of patients referred to genetic counselling Hospice utilization 30-day measure

• SSI
• Readmissions
• 30 & 90 day

mortality

Symptom management

• Nausea/Vomiting
• Pain control

Proportion of patients with documented genetic testing Advance care directives

Steering Committee

• Bonnie Dockham, MSW
• Robert Morris, MD
• Beegal Ganti, PharmD, BCOP
• Adnan Munkarah, MD
• Charles Harrison, MD
• Rebecca Liu, MD
• Soumit Pendharkar, MHA, FACHE
• Roxanna Miller, RN
• Renae Vaughn, MSN, ANP-C, AOCNP
• Shitanshu Uppal, MBBS
• Jennifer Griggs, MD MPH

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Team

Measures

Measures for Gynecology Oncology

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Gynecology Oncology Measures

• An evidence link to provision of care within the

time period

• Assurance of a high degree of precision in

measurement

• Accurate risk adjustment
• Avoidance of unintended consequences

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Criteria for choosing the measures

Gynecology Oncology Measures

• An evidence link to provision of care within the

time period

• Assurance of a high degree of precision in

measurement

• Accurate risk adjustment
• Avoidance of unintended consequences
• Feasibility

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Criteria for choosing the measures

160 QOPI measures

Steering Committee 11 measures

Gynecology oncology specific measures

Gynecology Oncology Measures

Gynecology Oncology Measures

• Cor

Core m measures

• CORE

RE6e 6e1 - Pain addressed appropriately by second

• ffice visit and during most recent office visits
• CORE

RE13a 13a1 - Chemotherapy administered to patients with performance status 3, 4 or undocumented (Lower er s score b e bet etter er)

• CORE

RE14 14 - Signed patient consent for chemotherapy

• Core 22b

22bb1 - Tobacco cessation counseling administered or patient referred in past year

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Measures selected for the first year

Gynecology Oncology Measures

• Symp

mptom m m manage geme ment

• SMT

MT33 - Infertility risk discussed prior to anti- neoplastic treatment with patients of reproductive age

• SMT28a

28a - Aprepitant/Fosaprepitant or Netupitant prescribed with Cycle 1 of low or moderate emetic risk chemotherapy (Lower er s score b e bet etter er)

• Carboplatin @ AUC ≥4  Emend is recommended by

latest ASCO guidelines

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Measures selected for the first year (Contd.)

Gynecology Oncology Measures

• En

End-of

• f-life

fe

• EOL3

OL38* - Pain addressed appropriately

• EOL4

OL41 - Dyspnea addressed appropriately

• EOL4

OL44 - Hospice enrollment within 3 days of death (Lower er score b e bet etter er)

• EOL4

OL47* - Hospice enrollment, palliative care referral/services, or documented discussion (combined measure EOL43 or EOL46)

• EO

EOL43 - Hospice enrollment or palliative care referral/services

• EO

EOL46 - For patients not referred, hospice or palliative care discussed within the last two months of life​

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Measures selected for the first year (Contd.)

Gynecology Oncology Measures

• Surg

rgical

• GY

GYNONC90 - Operative report with documentation of residual disease (Optimal/Suboptimal)

• Chem

emother erap apy

• GY

GYNONC94 - Platinum and taxane administered within 28 days following cytoreduction (or staging surgery) to women with invasive stage I (grade 3), IC- IV ovarian, fallopian tube, or primary peritoneal cancer

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Measures selected for the first year (Contd.)

Future Areas of Focus

• Standardization of Operative Notes
• Dr. Barry Rosen (Beaumont)
• Standardization of other documents
• Clinic visits
• Chemotherapy encounters
• Documentation of end-of-life discussions
• Ovarian Cancer Longitudinal Registry

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Ovarian Cancer Longitudinal Registry

Future Areas of Focus

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Group Photograph

2018 Set-up

Sign Participation Agreements

• Contract between a CQI (MOQC) and an entity
• Three parts:
• Eligibility and Requirements
• HIPAA
• Data Use Agreement
• Several practices are covered by current contracts
• Both electronic and paper copies are available
• Next steps:
• What is your employment agreement?
• Who has signature authority?
• Need signature contact information before you l

lea eave t e today

• Provide “heads up”

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Minimum Requirements

• 1. Meet eligibility requirements
• 2. Agree to:
• Abstract data
• Share & use data for performance
• Collaborate with other practices
• Attend MOQC meetings
• Biannual meetings (January and June)
• 3. Participate in a quality project & committee
• 4. Communicate with Coordinating Center

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What Do You Have to Do?

Minimum Requirements

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What Do You Have to Do?

Quality Group Communicate with Coordinat

• Agree to abstract data from medical records
• Submit to ASCO-QOPI platform
• Register your practice with ASCO-QOPI
• Appoint a QOPI lead to oversee abstraction

Next steps:

• Submit person’s name to MOQC
• Access one ASCO membership number
• Register your practice with QOPI (MOQC will assist)
• Prepare for Spring 2018 round registration

Set-Up QOPI Account

ASCO and QOPI

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The Moon Door

Log On

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New Account

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Registration

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Practice & Round

XXXXX XXXXX XXXXX

Patient Selection

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Patient Selection

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Enter a Chart

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Enter Round

Summary of Progress

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Add Chart

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Patient Characteristics

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ICD-10 Code and Number Assignment

Diagnosis

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Chart Assigned to Measures

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Sample Data Entry Screen

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MRN to QOPI Assigned Number

Fall 2017 Abstraction Round Practice Name: ________________________________________________ Completed by: ________________________________________________ Date Completed: ______________________________________________ Note: All practices should complete and retain for their files for each abstraction round

Count of Unique Charts MRN Number QOPI Number Last Name First Name DOB

1 2 3 4 5 6 7 8 9 10

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Fall 2017 Abstraction Round Practice Name: ________________________________________________ Completed by: ________________________________________________ Date Completed: ______________________________________________ Note: All practices should complete and retain for their files for each abstraction round Count of Unique Charts MRN Number QOPI Number Last Name First Name DOB 1 2 3 4 5 6 7 8 9 10

What Do You Get?

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Me Measure reID MO MOQC Me Measure re D Description Spring 17 Proportion b by D De-Iden entified ed P Pract ctice N ce Number er MOQC C - S14 14-S17 17 (ag aggregated dat ata o

• f 6

rounds) MOQC S C S17 QOPI S S17 (all o ll oncolo logy pract ctices ces a across country w who submitted d data) 53 53 106 106 45 45 50 50 Denom

• m

Propor

• rtion
• n

Denom

• m

Propor

• rtion
• n

Propor

• rtion
• n

CORE6e Pain addressed appropriately by second office visit and during most recent office visits (defect-free measure, CORE6 and CORE6d) 98% 96% 73% 88% 12381 77% 1799 82% 76% EOL38 Pain addressed appropriately (defect-free measure, EOL35, EOL36a, and EOL37)* 97% 86% 88% 98% 6083 79% 1172 84% 81% CORE13a1 Chemotherapy administered to patients with metastatic solid tumor with performance status of 3, 4, or undocumented. (Lower Score - Better) (Top 5 Measure) (Defect-free measure CORE13a1a, and CORE13a1b) 0% 18% 20% 6% 1166 19% 362 16% 15% CORE13oral6a Oral chemotherapy monitored on visit/contact following start of therapy: medication adherence assessed (Test Measure) . . . . 479 73% 36 94% 65% CORE14 Signed patient consent for chemotherapy 100% 88% 93% 74% 9457 76% 1343 77% 76% CORE22bb Tobacco cessation counseling administered or patient referred in past year 100% 56% 23% 17% 2195 45% 323 54% 41%

Practice MOQC QOPI

Graphic Presentation

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Choose Abstraction Model

• Abstract data in one of two ways
• Own abstractors & submit time to MOQC
• Contract with MOQC to abstract data
• Selection drives who is reimbursed for work effort

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Sign Participation Agreements

• Contract between a CQI (MOQC) and a practice
• Covers:
• Eligibility and Requirements
• HIPAA
• Data Use Agreement
• Several practices are covered by current contracts
• Both electronic and paper copies are available
• Next steps (at lunch):
• What is your employment agreement?
• Who has signature authority?
• Need signature contact information before you l

lea eave t e today

• Provide “heads up” communication (email to be sent to

you for modification/use)

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Minimum Requirements

• 1. Meet eligibility requirements (surgeon, PGIP, age of

patient)

• 2. Agree to:
• Abstract data
• Share & use data for performance
• Collaborate with other practices – continuous learning
• Attend MOQC meetings
• 1 of 2 Biannual meetings (January or June)
• What of regional meeting?
• Develop data abstractor capabilities (not this = hiring)
• 3. Participate in a quality project and a quality committee
• 4. Communicate with Coordinating Center

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What Do You Have to Do?

Next Steps

Save the Dates

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A physician and practice manager/administrator

MOQC BIANNUAL MEETINGS 2018 Friday January 19 Inn at St. John’s Plymouth Friday June 22 Location TBD Grand Rapids

• 1. Practice Participation Agreements & QOPI Registration
• Not
• tif

ify c con

• ntact
• As

Assist, i if requi uired

• 2. Steering Committee Member
• 3. POQC Representatives from Practice
• 4. Practice Contact Information

Reminders . . .

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Closing Comments

• Email us: first initial, last name@mocq.org
• Telephone us: (734) 232-0043
• Visit www.moqc.org for updates
• Pick up a charger & fidget spinner on way out
• Complete your Evaluation and deliver at door
• Travel safely & thank you for coming

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