CMS (Centers for Medicare & Medicaid Services) has contracted with FMQAI (Florida’s Medicare Quality Improvement Organization) to provide services for the Medication Measures Special Innovation Project, the purpose of which is to develop measures that can be used to support quality healthcare delivery to Medicare beneficiaries. The project currently has a portfolio of eight National Quality Forum endorsed measures for the ambulatory care setting, NQF 0543, NQF 0545, NQF 0555, NQF 0556, NQF 1879, NQF 1880, NQF 2362, NQF 2363, NQF 2379, NQF 2467, NQF 2468.
Quality health care is a high priority for the President, the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS). CMS implements quality initiatives to assure quality health care for Medicare Beneficiaries through accountability and public disclosure. CMS uses quality measures in its various quality initiatives that include quality improvement, pay for reporting, and public reporting.
Quality measures are tools that help to measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include effective, safe, efficient, patient-centered, equitable and timely care.
CMS has contracted with FMQAI (Florida’s Medicare Quality Improvement Organization) to provide services for the Medication Measures Special Innovation Project, the purpose of which is to develop measures that can be used to support quality healthcare delivery to Medicare beneficiaries.
The key objectives of the project are to:
– Develop new and maintain previously developed medication measures with the potential for National Quality Forum (NQF) endorsement.
– Adapt/specify existing NQF-endorsed medication measures and develop new measures for implementation in CMS reporting programs, such as
– Hospital Inpatient Quality Reporting (IQR) Program
– Hospital Outpatient Quality Reporting (OQR) Program
– Physician Quality Reporting System (PQRS)
– Others as directed by CMS, such as long-term care settings and ambulatory care settings.
– Continue to develop new medication measures that address the detection and prevention of adverse medication-related patient safety events that can be used in future Quality Improvement Organization (QIO) Statements of Work and in CMS provider reporting programs; and
– Identify and specify up to five new adverse event measures (non-medication-related) that could be used in future QIO programs and CMS provider reporting programs in the hospital setting (inpatient and/or emergency department).
In addition to maintenance of previously developed medication measures, the new measures to be developed under this special project support QIO patient safety initiatives by addressing topics, such as the detection and prevention of medication errors, adverse drug reactions, and other patient safety events. Under this Special Innovation Project, existing measures, as well as new measures, are being refined and specified for implementation in provider reporting programs.
The project currently has a portfolio of eight NQF-endorsed measures for the ambulatory care setting, five of which (i.e., NQF 0545, NQF 0555, NQF 0556, NQF 2467, NQF 2468) are undergoing NQF comprehensive review and have received recommendations for re-endorsement. In addition, one measure (i.e., NQF 2379) for the ambulatory care setting and two electronic clinical quality measures (i.e., NQF 2362 and NQF 2363) for the inpatient care setting have been submitted to NQF and have received recommendations for endorsement.
– NQF 0543: Adherence to Statin Therapy for Individuals with Coronary Artery Disease
– NQF 0545: Adherence to Statins for Individuals with Diabetes Mellitus
– NQF 0555: INR Monitoring for Individuals on Warfarin
– NQF 0556: INR for Individuals Taking Warfarin and Interacting Anti-infective Medications
– NQF 1879: Adherence to Antipsychotic Medications for Individuals with Schizophrenia
– NQF 1880: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder
– NQF 2362: Glycemic Control – Hyperglycemia
– NQF 2363: Glycemic Control – Severe Hypoglycemia
– NQF 2379: Adherence to Antiplatelet Therapy after Stent Implantation
– NQF 2467: Adherence to ACEIs/ARBs for Individuals with Diabetes Mellitus
– NQF 2468: Adherence to Oral Diabetes Agents for Individuals with Diabetes Mellitus
The maintenance of these measures requires the specifications to be updated annually.
– Measure Description: Percentage of individuals at least 18 years of age as of the beginning of the measurement period with bipolar I disorder who had at least two prescription drug claims for mood stabilizer medications and had a Proportion of Days Covered (PDC) of at least 0.8 for mood stabilizer medications during the measurement period (12 consecutive months).
– Measure Updates – Adherence to Mood Stabilizers For Bipolar I Disorder NQF 1880:
– 2011 Updates
– Updated NDCs as of October 28, 2011.
– Added new 2011 CPT visit type codes, 99224-99226, as of November 2011.
– Added new 2011 CPT J-codes for depot injections to be excluded, paliperidone palmitate (J2426), and updated J-code for olanzapine (S0166, J2358).
– Added new drug paliperidone palmitate for injectables to be excluded.
– 2012 Updates
– Updated NDCs as of October 31, 2012.
– Modified age requirement to at least 18 years of age at the beginning of the measurement period.
– Modified codes used to identify encounter type to align with NQF 1879.
– Removed the exclusion for depot injections.
– Included antipsychotic depot drugs as part of the mood stabilizer NDC list.
– 2013 Updates
– Updated NDCs as of November 6, 2013.
– 2014 Updates
– Updated NDCs as of December 10, 2014.
– Removed CPT visit type codes 90801, 90802, 90804-90819, 90821-90824, 90826-90829, 90857, and 90862, and added the replacement codes 90791, 90792, 90832, 90834, and 90837.
– Added CPT code 90839 for psychotherapy for crisis.
– Added CPT add-on codes for psychotherapy 90833, 90836, 90838, 90863, and 90840.
– Removed perphenazine-amitriptyline from the list of Mood Stabilizer Medications.
– Added aripiprazole extended-release to the list of Long-Acting Injectable Antipsychotic Medications.