Hypoglycemia and Quality Measurement Sam Stolpe PQA Senior Director - - PDF document

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Hypoglycemia and Quality Measurement

Sam Stolpe PQA Senior Director

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The Triple Aim

Better Care Better Care Affordable Care Affordable Care

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Healthy People/ Communities Healthy People/ Communities

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PQA 2 Comprehensive Overview of CMS Quality Programs

Hospital Quality Physician Quality PAC Quality Payment Models Population Health

• Meaningful use

EHR incentive

• Inpatient quality
• Meaningful use

EHR incentive

• Physician Quality
• Inpatient

rehabilitation facility

• Medicare Shared

Savings Program (ACOs)

• Medicare Part C
• Medicare Part D

M di id Ad lt p q y reporting

• Outpatient

quality reporting

• Ambulatory

surgical centers

• Readmission

reduction program HAC t y y Reporting System (PQRS)

• Value-based

Payment Modifier (VM)

• Maintenance of

certification

• Nursing Home

Compare measures

• LTCH quality

reporting

• Hospice quality

reporting

• Home health

quality reporting

• Hospital value-

based purchasing

• Physician

Feedback

• ESRD QIP
• Innovations

Pilots

• Medicaid Adult

Core Measures

• Medicaid Child

Core Measures

• Health Insurance

Exchange Quality Reporting System (QRS)

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• HAC payment

reduction program

• PPS-exempt

cancer hospitals

• Inpatient

psychiatric facilities qua y epo g

Hypoglycemia Contribution to Health Burden

• Ambulatory Patients

Insulin 1st most common drug implicated in ED visits for

• Insulin 1st most common drug implicated in ED visits for

ADEs overall (~8%)1

• Insulin and oral diabetes drug implicated in ~25% of

emergent hospitalizations for ADEs in older adults2

• Hospitalized Patients

Hypoglycemia was 3rd most common ADE3

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• Hypoglycemia was 3rd most common ADE3
• Skilled Nursing Facility Patients
• Hypoglycemia was 1st most common ADE4
• 1. JAMA. 2006;296:1858-1866 2. N Engl J Med. 2011;365:2002-2012
• 3. Adverse Events in Hospitals, 2010, OEI-06-09-00090
• 4. Adverse Events in Skilled Nursing Facilities, 2014, OEI-06-11-00370

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PQA 3 National Adverse Drug Event Action Plan

Three key focus areas

• Hypoglycemia-inducing medications
• Anticoagulation medications
• Opioids

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National Adverse Drug Event Action Plan

Four key strategies

• Surveillance
• Evidence-based prevention tools
• Incentives and Oversight

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• Research

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PQA 4 National Adverse Drug Event Action Plan

Four key strategies

• Surveillance
• Evidence-based prevention tools
• Incentives and Oversight

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• Research

National Focus on Hypoglycemia Measures

• Update measures
• Individualize hypoglycemic risk targets, comorbidities

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• Coordinated models of care (esp. inpatient)
• Most recent science
• ER/Hospitalizations from ambulatory care, community
• Address payment barriers to uptake of evidence-based, high-quality

ADE prevention strategies

• E.g., use of patient engagement and health literacy principles.

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• Improve EHR standards to identify high risk patients
• Transitions of Care/Coordinated Care
• 2/3 of post-discharge complications are from ADEs1
• 1. Forster AJ et al. Ann Intern Med 2003;138:161–7.

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PQA 5 Current Measure Examples

• Community setting
• PQA Diabetes Dosing Measure

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• The percentage of patients who were dispensed a dose higher than the daily

recommended dose for the following therapeutic categories of oral hypoglycemics: biguanides, sulfonlyureas, thiazolidinediones and DPP-IV inhibitors.

• Currently included inside CMS Part C & D Display Measures
• Inpatient setting
• NQF 2363: Glycemic Control – Severe Hypoglycemia
• Patients administered short acting insulin within 12 hours or other DM agent within 24

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Patients administered short acting insulin within 12 hours or other DM agent within 24 hours

• Suitable for inclusion inside of the Hospital Inpatient Quality Reporting System

DDM 5-Year Plan Average Performance

1.71% 1 80%

PDP & MA-PD Measure Performance

1.71% 1.33% 1.13% 0.89% 0.74% 0.60% 0.80% 1.00% 1.20% 1.40% 1.60% 1.80% PQA PQA 0.00% 0.20% 0.40% 2011 2012 2013 2014 2015

Source: CMS Part C & D Display Measure Data

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PQA 6 New PQA Measure Concept

• Serious Hypoglycemic Events Requiring Hospital Admission or ED

Visit Associated with Anti-Diabetic Medications

• The rate of events among individuals receiving anti-diabetes medications that
• have evidence of a hospitalization or emergency department visit related to a

hypoglycemic event

• expressed as number of events per member-months.
• This measure is used among plans with both prescription and medical

claims/services, and a lower value is indicative of higher quality

• Currently undergoing measure testing

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Contact info: Questions?

Sam Stolpe SStolpe@PQAalliance.org 703-470-4741

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