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Healthcare Policy and Quality Measurement

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The HSAG Healthcare Policy and Quality Measurement Division provides clinical and analytical expertise for quality measure development, healthcare policy and evaluation, and medication safety. To support our customers, HSAG's multidisciplinary team draws on extensive experience in healthcare administration and research, clinical quality measure development, clinical care, medication management, electronic health records, data analysis, and project management. HSAG convenes nationally recognized experts across a wide array of clinical specialties, together with patient and caregiver representatives, to guide these efforts to improve health outcomes.

Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality and Efficiency Measures

Project Duration: 2019–2024
Contract With: Centers for Medicare & Medicaid Services (CMS)

Every three years, CMS publishes an assessment of the impact of the use of endorsed measures in its programs, as required by statute. This report comprehensively evaluates the impact of CMS quality measurement and reporting programs and informs policy to promote quality improvement in health care nationwide.

The 2021 report defines impact as progress toward achieving CMS goals and objectives related to national health care priorities, demonstrated by descriptive statistics about the measure portfolio; measure trends, disparities, and gaps; and analyses of the number of patients affected and costs averted. A national survey of home health agencies explored how providers are responding to CMS quality measurement, and qualitative interviews with Medicare beneficiaries and caregivers captured patient perspectives.


CMS Quality Measure Development Plan (MDP)

Project Duration: 2019–2024
Contract With: Centers for Medicare & Medicaid Services (CMS)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), section 102, established new Medicare payment and delivery methods to reward physicians and other eligible clinicians for providing high-quality healthcare. HSAG’s team developed the CMS Quality Measure Development Plan (MDP) as a strategic framework to support the Quality Payment Program established by MACRA, consisting of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). HSAG prepared the draft plan, coordinated a call for public comment, and advised CMS and federal partners on incorporating stakeholder perspectives into the final plan. Through environmental scans to identify measurement gaps and annual progress reports by HSAG, the Measure Development Plan guides the development of quality measures to advance healthcare delivery system reform and achieve higher-quality care without paying more.


CMS Quality Measure Index (QMI)

Project Duration: 2019–2024
Contract With: Centers for Medicare & Medicaid Services (CMS)

CMS uses clinical quality measures in quality improvement and reporting programs to drive improvement in health care and empower patients to make informed decisions. Evaluating the impact and effectiveness of quality measures aids CMS in streamlining the measure portfolio with the goal of reducing reporting burden so that clinicians can focus on providing high-quality care. CMS is contracting with HSAG to develop a tool to support the assessment and selection of quality measures that provide meaningful quality performance information, align with the health care quality priorities of the Meaningful Measures Initiative, and fulfill requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). HSAG is identifying measure scoring approaches in published literature and consulting stakeholders, as well as a technical expert panel, in formulating and testing the index for validity and reliability. The Quality Measure Index (QMI) will facilitate a standardized, repeatable, and transparent process of measure assessment that will be used to augment the current CMS decision-making processes for selecting and implementing measures in quality reporting programs.

CMS Medicare Part D Electronic Prescribing of Controlled Substances (EPCS)

Project Duration: 2021–2023
Contract With: Centers for Medicare & Medicaid Services (CMS)

CMS and other Department of Health and Human Services agencies have many obligations under section 2003 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) of 2018 requiring cross-agency coordination and expertise. Section 2003 of the SUPPORT Act requires Medicare Part D prescriptions for Schedules II–V controlled substances—which include narcotics, depressants, stimulants, and certain steroids—to be transmitted electronically. HSAG will perform an environmental scan and develop a Strategic Plan to support implementation of a new CMS electronic prescribing of controlled substances (EPCS) program. The plan will detail the coordinated activities needed across CMS agencies and contractors to successfully launch the initiative. HSAG will also develop and execute a comprehensive Education and Outreach Plan to increase awareness of the new program rules among prescribers of controlled substances.

HSAG’s quality measure experts support customers in a range of activities that include:

  • Environmental scans and gap analyses
  • Business cases
  • Measure testing plans
  • Technical review of measure specifications and calculation logic
  • eCQM specification
  • Scientific acceptability testing
  • Registry self-nomination
  • Federal rulemaking
  • Public comment
  • Consensus-based entity endorsement

Recent clients include the American Academy of Dermatology, American Academy of Ophthalmology, American Society of Hematology, and the American Medical Association. For more information: Contact Us

Measure & Instrument Development and Support (MIDS) Indefinite Delivery Indefinite Quantity (IDIQ)

Project Duration: 2018–2023
Contract With: Centers for Medicare & Medicaid Services (CMS)

HSAG was awarded an umbrella MIDS IDIQ contract. Under the IDIQ, CMS will issue task orders that are designed to assist CMS with developing and implementing clinical quality measures to assess and manage the quality of healthcare services at national, facility, and community levels.

Implementing Clinical Pretest Probability Tools Into Practice to Improve the Diagnosis of Pulmonary Embolism

Project Duration: 2022–2023
This project is funded by the Gordon and Betty Moore Foundation and the American Society of Hematology.

HSAG is partnering with the American Society of Hematology (ASH) and investigators from Mass General Brigham, Froedtert & Medical College of Wisconsin, and Mayo Clinic to develop electronic clinical quality measures (eCQMs) on the use of clinical pretest prediction tools (CPTPs). This project is part of the Moore Foundation’s Diagnostic Excellence Initiative and aims to improve the diagnosis of pulmonary embolism through increasing use of CPTPs and to safely limit healthcare-associated harm from overimaging. HSAG is providing measure development expertise and assisting ASH and the investigators in the conceptualization, specification, testing, and validation of the eCQMs.

MACRA 102 Cooperative Agreements Technical Assistance (CATA) Task Order

Project Duration: 2019–2021
Contract With: RELI Group, Inc. for Centers for Medicare & Medicaid Services (CMS)

HSAG was awarded a subcontract with the RELI Group to continue supporting CMS grant recipients for measure development projects. The work focused on supporting all phases of development of clinician quality measures suited for the CMS Quality Payment Program. HSAG provided key personnel for this contract, including the Project Director, Education and Outreach Specialist, and Senior Measure Development Specialist. The team supported development of a variety of measures, including patient-reported outcome measures (PRO-PM), patient experience of care, intermediate outcome, and specialty-specific process measures, including electronic clinical quality measures (eCQMs).

Project Duration: 2018–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

HSAG was awarded this one-year contract to provide technical assistance to specialty societies, patient advocacy organizations, providers, and other stakeholders as they developed quality measures for the Quality Payment Program. HSAG staff shared knowledge and experience with grantees receiving funding under section 102 of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA). Technical assistance was offered throughout the development process, from measure conceptualization to implementation, evaluation, and maintenance.

Inpatient Psychiatric Facility (IPF) Outcome and Process Measure
Development Project

Project Duration: 2014–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

Inpatient psychiatric facilities play a critical role in the care of individuals with complex mental illnesses such as depression, schizophrenia, bipolar disorder, and substance use disorder. During the five-year term of this task order, HSAG supported the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program and the overall CMS quality mission by developing, maintaining, and implementing measures for facilities using the IPF Prospective Payment System. Five new quality measures were developed to evaluate the care provided by each IPF during the inpatient stay. Beta testing was completed for a sixth measure, Inpatient Assessment of Depression Symptoms, and CMS is considering future use of a patient-reported outcome measure in IPFs. HSAG engaged with patients, providers, and other key stakeholders during measure conceptualization and development to ensure that measure scores are informative and accurate.


Development and Implementation of Quality Rating System (QRS) Measures for Qualified Health Plans

Project Duration: 2015–2018
Contract With: IMPAQ International/Centers for Medicare & Medicaid Services (CMS)

The CMS Quality Rating System (QRS) delivers meaningful information to health insurance consumers considering an array of qualified health plans in the Health Insurance Marketplaces established under the Affordable Care Act. IMPAQ International, LLC, subcontracted with HSAG on this project to identify measurement gaps in the QRS and to adapt and develop measures that will enhance the information available to consumers. HSAG led the information gathering, measure development, and measure testing aspects of the project, including measure specifications and convening of a technical expert panel.

Maintenance and Development of Medication Measures Special Innovation Project

Project Duration: 2011–2014
Contract With: Centers for Medicare & Medicaid Services (CMS)

HSAG developed, tested, and maintained clinical quality measures related to medication management and adverse events for potential use in national quality improvement and public reporting programs. The team conducted an environmental scan and measurement gap analysis, recruited and convened a national technical expert panel, led formative and field testing of new measures using large CMS administrative data sets and hospital-based electronic health record data, and provided technical support to CMS for measure implementation. The project resulted in 11 quality measures endorsed by the National Quality Forum (NQF), including the first two de novo electronic clinical quality measures (eCQMs) to receive such endorsement.

Claims-Based Risk Prediction Model for Anticoagulant-Related Bleeding

Project Duration: 2019–2022
This project is funded by the Gordon and Betty Moore Foundation.

Anticoagulants are a recommended medication therapy to prevent blood clots associated with atrial fibrillation and venous thromboembolism that can cause thromboembolic events. These conditions have a high risk of morbidity and mortality and are significant health concerns. Yet the use of anticoagulants carries a risk of serious bleeding, including intracranial and gastrointestinal bleeding, which result in high mortality and healthcare costs. HSAG was awarded a research grant to develop a risk prediction model that can be automated on administrative claims data to assess bleeding risk for patients taking anticoagulants. To build and test such a model, we incorporated information on clinical events and prescription drug use for individual patients from claims data and used this information to predict the probability of a visit to the hospital precipitated by an anticoagulant-related bleeding event. The project offered an opportunity to explore risk variables and the relationships between the variables that could not be examined by previous studies. The algorithm can be shared broadly with stakeholders to identify patients at highest risk of serious bleeding, allow continuous risk monitoring, and potentially prevent adverse drug events. HSAG is preparing a manuscript to report the findings of the completed study.

Diagnostic Coding Validation of Hypoglycemia Events Associated with the Use of Diabetes Agents

Project Duration: 2017–2019
Contract With: Centers for Disease Control and Prevention (CDC)

Hypoglycemia is a common side effect of diabetes agents, and serious hypoglycemia, which requires the assistance of another person, is associated with increased morbidity and mortality. To advance surveillance strategies for adverse drug events, the National Action Plan for Adverse Drug Event Prevention recommends to "assess the adequacy of diagnostic and procedural coding for identifying hypoglycemic events." Current coding practices for patients presenting with hypoglycemia are not well understood, and a clear need exists to develop an ICD-10 algorithm and investigate whether U.S. administrative data can be a valid source for hypoglycemia surveillance. HSAG was contracted to conduct a multi-hospital retrospective cohort study using structured medical record review to validate and optimize an ICD-10 code algorithm for identifying hypoglycemic events associated with outpatient use of diabetes agents. The objective of the project was to determine whether administrative data can serve as a reliable data source, which may facilitate development of more robust surveillance for hypoglycemia. Medical Care published the study findings in 2022.


Validation of ICD-10 Codes for Bleeding Events Associated with Anticoagulant Exposure

Project Duration: 2016–2017
Contract With: Centers for Disease Control and Prevention (CDC)

Anticoagulants are consistently identified among the leading classes of medications implicated in adverse drug events (ADEs) resulting in harm to older patients. Several federal agencies have developed surveillance systems to identify anticoagulant-related bleeding; however, existing systems lack standard definitions for the bleeding events. With the emergence of new oral anticoagulants that require less monitoring and the conversion of ICD-9-CM to ICD-10-CM that took effect October 1, 2015, there is a need to understand the extent to which administrative data coded in ICD-10-CM can estimate the frequency of anticoagulant-related harms. HSAG was contracted to conduct a multi-hospital retrospective cohort study using structured medical record review to validate and optimize an ICD-10 code algorithm for identifying bleeding events associated with anticoagulant exposure. The main objective of the project was to develop a validated set of ICD-10 codes that may be used in quality measurement, in public health surveillance, and in post-marketing safety assessment. Pharmacoepidemiology and Drug Safety published the study findings in 2019.


Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO)

Project Duration: 2003–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

11th Statement of Work, 2014–2019

As the QIN-QIO for four states and the U.S. Virgin Islands, HSAG provided technical assistance, convened learning and action networks to share best practices, and collected and analyzed data to improve clinical care delivered to patients at local and regional levels. Our team supported this QIN-QIO work by designing and directing quality improvement interventions related to medication safety and prevention of adverse drug events (ADEs), researching and identifying tools and resources for the treatment of opioid use disorder and other behavioral health conditions, devising recruitment strategies to partner with community healthcare providers and managed care organizations, and providing technical support for data analyses and implementation of interventions.

10th Statement of Work, 2011–2014

Working with hospitals, nursing homes, physician offices, home health agencies, and Medicare Advantage organizations from 2011 to 2014, HSAG conducted quality improvement activities that required multilevel data analyses to determine baseline and remeasurement rates, assess effectiveness of interventions, and monitor progress toward project goals. For the Reducing Adverse Drug Events Project, we worked with community healthcare providers to deliver clinical pharmacy services to high-risk beneficiaries. During the project, we provided ongoing support to the communities for process improvement and data collection.

Critical Access Hospital Medication Error Reduction

Project Duration: 2003–2011
Contract With: Florida Department of Health, Office of Rural Health

HSAG partnered with the University of Florida to work with Florida’s critical access hospitals on a patient safety initiative to reduce medication errors. The team led a learning and action network of participating facilities, hosted an annual meeting on patient safety, and identified rural-appropriate interventions that resulted in quality improvement of medication management within critical access hospitals.