Webinar #7 Measure Development Education & Outreach for

Webinar #7 Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups AUA Measure Development: PSA Screening Shared Decision Making Measures Presenter: Suzanne Pope, MBA American Urological Association Director of Quality February 7, 2018 2:00-3:00 EST

Vision and Goals: Webinar Series Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups An ongoing process to engage clinical specialty societies and patient advocacy groups in quality measure development. Elicit feedback that will help CMS design toolkits and enduring materials designed specifically for specialty societies and patient advocacy groups interested in measure development. Education Outreach Frequent Communication Enduring Materials Dedicated Websites Measure Development Roadmaps Targeted Newsletters and Communication Spotlight Opportunities 2

Measure Conceptualization Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups Agenda Webinar # 7: 1. American Urological Association (AUA) history with measure development 2. Determining measure topics 3. Helpful steps in completing the conceptualization process 4. Walk through recent example of measure conceptualization process for shared decision making measure 3

Measure Conceptualization Webinar #7 AUA Measure Development History 2008: AUA began measure development through PCPI – Prostate cancer measures – Collaborated with ASTRO – Submitted to PQRS – Obtained NQF endorsement – Currently maintaining 2 measures 4

Measure Conceptualization Webinar #7 AUA Measure Development History 2012: Developed stress urinary incontinence measures – Funded by AUA – Convened multi-stakeholder panel – Obtained NQF endorsement for one measure 5

Measure Conceptualization Webinar #7 AUA Measure Development Urology-Specific Measures: – AQUA Registry (QCDR) developed in 2013; launched in 2016 – CMS Quality Payment Program 6

Measure Conceptualization Webinar #7 AUA Measure Development Measure Topics: Prostate Cancer Bladder Cancer Castration Resistant Prostate Cancer Male Sexual Health (infertility, vasectomy) Female Urology (urinary incontinence, overactive bladder) 7

Measure Conceptualization Webinar #7 AUA Measure Development Measure Topics: Ureteral Stones Pediatric Urology Benign Prostatic Hyperplasia PSA Screening/SDM (QPP measures) 8

Measure Conceptualization Webinar #7 USPSTF PSA Screening Recommendation The U.S. Preventive Services Task Force (USPSTF) recommends against prostatespecific antigen (PSA)–based screening for prostate cancer 2012 recommendation Grade D (recommendation against) Currently under review; final recommendation expected this year 9

Measure Conceptualization Webinar #7 AUA Early Detection of Prostate Cancer Guidelines (2015) The Panel recommends against PSA screening in men under age 40 years. (Recommendation; Evidence Strength Grade C) The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C) 10

Measure Conceptualization Webinar #7 AUA Early Detection of Prostate Cancer Guidelines For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decisionmaking for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man's values and preferences. (Standard; Evidence Strength Grade B) 11

Measure Conceptualization Webinar #7 AUA Early Detection of Prostate Cancer Guidelines To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C) The Panel does not recommend routine PSA screening in men age 70 years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C) 12

Measure Conceptualization Webinar #7 AUA Initiatives on Shared Decision Making White Paper on Implementation of Shared Decision Making into Urological Practice (2015) QI Summit on Shared Decision Making and Prostate Cancer Screening (2016) 13

Measure Conceptualization Webinar #7 Non-Recommended PSA Measure: CMS Spotlight Series Address measures on non-recommended PSA-based screening Focus on: 1) Modifying the age range 2) Adding a component on shared decision-making Involve multi-stakeholder panel 14

Measure Conceptualization Webinar #7 Key Stakeholders American Urological Association American Academy of Family Physicians American Cancer Society American College of Physicians American Geriatrics Society ASTRO (American Society for Radiation Oncology) American Society of Clinical Oncology Society of Urologic Oncology NCQA Prostate Health Education Network Prostate Cancer Foundation 15

Measure Conceptualization Webinar #7 Measure Criteria Important: Evidence based, can affect quality where there is variation or low performance Feasible: Data are readily collectible for measurement or could be captured without undue burden Usable: Performance results used (or can be used) to infer quality Valid: Underlying data are accurate and scores are accurate indicators of provider quality Reliable: Can distinguish performance among those being measured, results are consistent over time Goal: Measure that matter (important, usable) and can be measured in a meaningful way (feasible, valid, reliable) 16

Measure Conceptualization Webinar #7 Elements of a Measure Numerator – clinical action that meets the conditions of the measure Denominator – patient population eligible for the measure Exceptions/Exclusions – patients removed from the denominator Rationale – description of the need for the measure, focusing on gaps in care, level of available evidence 17

Measure Conceptualization Webinar #7 AUA Measure Development Conceptualization Process Development Process Approval/ Incorporation into AQUA Registry 18

Measure Conceptualization Webinar #7 Measure Development Conceptualizatio n Process Identify urologic condition on which to develop measures Review evidence (AUA and other guidelines) Identify/invite members of the technical expert panel - Clinical and technical experts 19

Measure Conceptualization Webinar #7 Measure Development Conceptualizatio n Process Data Gathering/Environmental Scan Assess gaps in care Review existing measures/consider harmonization Develop search terms for lit search Identify relevant guidelines Gather measure development materials, evidence, and other relevant measure sets for panel review Draft measure concepts Convene initial conference call(s) 20

Measure Conceptualization Webinar #7 Measure Development Developmen t Process Draft preliminary measures Consult with AUA Coding experts Convene additional TEP calls to review/revise draft measures Participate in CMS Spotlight Series 21

Measure Conceptualization Webinar #7 Measure Development Finalize measures for public comment period Developmen Public comment t Process Convene additional calls with the TEP to address feedback received 22

Measure Conceptualization Webinar #7 Promoting Shared Decision Making before PSA Screening for Men Age 55-69 Numerator Statement Patients (or their caregiver, if appropriate) who participated in shared decision making regarding prostate cancer screening options before the prostate specific antigen (PSA) screening was performed. Denominator Statement All men between the ages of 55 to 69 years old who had prostate specific antigen (PSA) screening performed in the measurement period. Denominator Exclusions Men with a past or current diagnosis of prostate cancer. Men with an active diagnosis or history of diagnosis benign prostatic hyperplasia (BPH) or lower urinary tract symptoms. Denominator Exceptions Medical reason for the patient (or their caregiver, if appropriate) not participating in shared decision making regarding prostate cancer screening before the PSA screening (e.g. significantly cognitive impaired and no caregiver available) Patient reason for the patient (or their caregiver, if appropriate) not participating in shared decision making regarding prostate cancer screening before the PSA screening (e.g. patient refuses to participate in shared decision making) 23

Measure Conceptualization Webinar #7 Promoting Shared Decision Making before PSA Testing for High Risk Men Age 40-54 Numerator Statement Patients (or their caregiver, if appropriate) who participated in shared decision making regarding prostate cancer screening before the prostate specific antigen (PSA) screening was performed. Denominator Statement All men at high risk* for prostate cancer between the ages of 40 to 54 years old who had prostate specific antigen (PSA) screening performed in the measurement period. *High Risk: Men who are black or who have a family history of prostate cancer. Denominator Exclusions Men with a past or current diagnosis of prostate cancer. Men with an active diagnosis or history of diagnosis BPH or lower urinary tract symptoms. Denominator Exceptions Medical reason for patient (or their caregiver, if appropriate) not participating in SDM for prostate cancer screening (e.g. patient cognitively impaired) Patient reason for patient (or their caregiver, if appropriate) not participating in SDM for prostate cancer screening (e.g. patient refuses to participate in SDM) 24

Measure Conceptualization Webinar #7 Lessons Learned Collaboration with key stakeholders is critical Take advantage of the CMS Spotlight Series opportunity if available The process is not quick or easy but it’s worth it 25

Measure Conceptualization Webinar #7 Collaborate! 26

Measure Conceptualization Webinar #7 Questions 27

Measure Conceptualization Webinar #7 Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups Planned Upcoming Webinars: 02/28/2018, 1:00-2:00pm EST: A Focus on eCQMs: Value Sets in the Measure Development Process 03/07/2018, 2:00-3:00pm EST: Measure Specification and Testing Suggestions for future topics? Email: [email protected] 28

Measure Conceptualization Webinar #7 Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups MACRA Outreach Newsletter: 29

CMS Spotlight Opportunities Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups Reminder: If you are currently developing quality measures that you would like to present to CMS contact the MMS Support Desk at [email protected] 30

Measure Conceptualization Webinar #7 Contact Information Battelle Measures Management System Contractor: Battelle Contact: [email protected] CMS Golden Davis: [email protected] Kim Rawlings: [email protected] 31