1. Gynecology-Oncology Initiative
Inaugural Meeting
October 14, 2017
Inn at St. John’s, Plymouth MI

2. Thank you

3. Welcome Jennifer J. Griggs Program Director
Shitanshu Uppal Program Co-Director
Louise Bedard Program Manager
Emily Mackler Clinical Pharmacist
Welcome the MOQC Team
Please stand up so that the audience can see you
We also have several additional people that will be assisting us with today’s event.
I would like to introduce:
Joann Chung, our photographer today. Joanne graduated from Visual Design at University of Michigan this past Spring.
Chris Smith is our audio person from the Inn at St. John’s
Get name of videographer from Jennifer (sorry I do not know his name)
Sam Beusterien Project Manager
Arthi Ramakrishnan
Project Manager
Jennifer Yanchula
Outreach Manager

4. A Few Details Documents at Seat Group Photo at Break
Q & A Opportunities
Six Question Evaluation
Confidentiality Agreement
Food and Beverage
Cell Phones
You will find two documents at each seat – agenda and a list of GYN ONC measures that we will discuss later this morning.
Explain group photo – Jennifer Yanchula will direct people to location
The speakers will take questions throughout the presentation, and at the end.
Meeting is very informal, and we would like you to ask questions, provide comments.
The evaluation of the meeting will be paper – based. It will be passed out just after lunch and you cannot pass through the “doors” without handing to Sam or one of the MOQC people. Thanks in advance for this.
When you registered you all agreed to abide by a confidentiality agreement. This is part of any CQI meeting and is necessary to establish trust amongst all of us so that we can learn from each other and improve care
Lunch will be buffet, just outside the room. Beverages will be out for the entire meeting.
Please help yourselves whenever you wish. If you need to talk a call, please step out so that we can continue our meeting

5. Resources MOQC Pathway Measures MOQC-BCBSM VBR FAQs ASCO-QOPI material
BCBSM Value Partnerships/CQI
Business cards
You will notice a table at the back of the room.
This is a resource table with material that you are welcome to pick up and take with you.
We will reference some of this information during today’s agenda
Please review what is on the table with Jennifer or Arthi before the meeting

6. Point your browser to “Inn at St. John’s”
For Your Use
On MOQC.org/
Today’s Slides: Monday October 16th
Today’s Videos: November 1st
Password: None
Point your browser to “Inn at St. John’s”
We will have the slides we use today on our website on Monday
We have a new website, and we are working hard to make it easy for you to use, and to service yourself.
Feedback – negative or positive – would be helpful because we want you to be self sufficient and not frustrated if you are looking for material for your practice, for a meeting that we can assist with
The wifi today is free. You can certainly do work but I much rather you listen and add to our collective learning and dialogue today.
If you are a tweet-er, please go ahead and tweet #moqc
@MOQCTeam or #moqc

7. Known Knowns
Known Unknowns

8. Known Knowns
Known Unknowns
Unknown Unknowns

9. Gratitude

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

11. 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

12. I will introduce you to Jennifer Griggs, who is the Program Director for MOQC
Shitanshu – I will attach JJG’s CV as a reference.

16. 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
I will mention that I was Chair and member of the Clinical Practice Guidelines Committee from and will be a member of the ASCO Quality Committee and Chair of the Measures Task Force (starting with Chair Elect this June).
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17. Michigan Oncology Quality Consortium
Colors denotes MOQC’s five regions

18. MOQC Practices Type of Practice Source: MOQC Landscape Survey, 2017
N=47 practices

19. Practice Size Number of Medical Oncologist FTEs Number of Practices
Source: MOQC Landscape Survey, 2017
N=47 practices

20. Patient & Caregiver Oncology Quality Council (POQC)
BCBSM/CQI Value Partnerships
Patient & Caregiver Oncology Quality Council (POQC)
MOQC Leadership
Steering Committee
Coordinating Center/Team
Measures Group
Quality Projects
Practices
Chemotherapy consent (2017)
Advance care planning (2016)
Data abstraction (2016)
Oral oncolytic (2015)
Tobacco cessation (2014)
Participate in QI projects
Align with CMS & MOC
Regional structure for data sharing and collaboration

21. Role of Coordinating Center
Four priorities
Quality/performance improvement support
Training
Advisory role
Resources
Data abstraction
Data reporting with statistical analyses
Support opportunities for state-wide improvement

22. Role of the Steering Committee
Support MOQC leadership in decision-making
Set priorities of the Collaborative
Ensure broad multidisciplinary representation
Select speakers & help set agendas
Attend Biannual Meetings
Participate in teleconference meetings
30 – 60 minutes
3-4 times a year
Review agenda, documents and feedback via
Enhance practice engagement as needed

23. Patient & Caregiver Oncology Quality Council
Name
Residence
Diane Drago
Ann Arbor
Mary Duncan
Ionia
Marilyn Gilin
Waterford
Mike Harrison
Allen Park
Cynthia Koch
Erika Jane Lojko
St. Clair Shores
Johanna Mabry
William Polkinghorne
Houghton
Barbara Rau
Lake Isabella
Samantha Schadel
Sterling Heights
Shanna Simpson-Simpson
Taylor
Derek Singleton
Deborah Stocking
Morrice
Peggy Taylor-Albaugh
Britton

24. POQC Priorities
Improve access to resources for all cancer patients across the State of Michigan – 100%
Improve patient-provider communication – 72%
Present the patient- and/or patient-caregiver story to MOQC practices – 36%
2018 priorities will be established by December 2017
Regional meetings are identifying opportunities

25. POQC Members participate in these ways
Improve patient outcomes by contributing to a quality initiative - 82%
Offer patient/patient-caregiver input at meetings - 82%
Tell my story at meetings
55%
Review patient materials 72%

26. Why Participate?

27. Why Participate? Receive rewards
Receive practice performance data with benchmarks against other statewide & national data
Share & acquire best practices
Access clinical & performance improvement resources
Receive profession and payer quality “points”
Collaborate & influence priorities of the consortium
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28. 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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29. Expectations Data Collection Physician Participation
Practice Participates in Quality Improvement

30. 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
I will mention that I was Chair and member of the Clinical Practice Guidelines Committee from and will be a member of the ASCO Quality Committee and Chair of the Measures Task Force (starting with Chair Elect this June).
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31. Measures QOPI Measures MOQC Pathway Nearly 200 measures
17 selected measures

32. 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
Dyspnea management
Death on hospice
Palliative care/hospice services or documented discussion

33. 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 or moderate emetic risk chemotherapy (cycle 1)

34. Vision and Direction

35. Gynecology Oncology Initiative
Opportunities
Ovarian Cancer:
Registry to monitor short-term and long-term outcomes
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

36. Gynecology Oncology Initiative
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

37. Goals for First Year What is Reasonable to Achieve Year One?
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

38. Ovarian Cancer Quality Matrix
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

39. Steering Committee Team 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

40. Measures

41. Measures for Gynecology Oncology

42. Gynecology Oncology Measures
Criteria for choosing the 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

43. Gynecology Oncology Measures
Criteria for choosing the 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

44. Gynecology oncology specific measures
Gynecology Oncology Measures
160 QOPI measures
Steering Committee
11 measures
Gynecology oncology specific measures

45. Gynecology Oncology Measures
Measures selected for the first year
Core measures
CORE6e1 - Pain addressed appropriately by second office visit and during most recent office visits
CORE13a1 - Chemotherapy administered to patients with performance status 3, 4 or undocumented (Lower score better)
CORE14 - Signed patient consent for chemotherapy
Core 22bb1 - Tobacco cessation counseling administered or patient referred in past year

46. Gynecology Oncology Measures
Measures selected for the first year (Contd.)
Symptom management
SMT33 - Infertility risk discussed prior to anti-neoplastic treatment with patients of reproductive age
SMT28a - Aprepitant/Fosaprepitant or Netupitant prescribed with Cycle 1 of low or moderate emetic risk chemotherapy (Lower score better)
AUC ≥4  Emend is recommended by latest ASCO guidelines

47. Gynecology Oncology Measures
Measures selected for the first year (Contd.)
End-of-life
EOL38* - Pain addressed appropriately
EOL41 - Dyspnea addressed appropriately
EOL44 - Hospice enrollment within 3 days of death (Lower score better)
EOL47* - Hospice enrollment, palliative care referral/services, or documented discussion (combined measure EOL43 or EOL46)
EOL43 - Hospice enrollment or palliative care referral/services
EOL46 - For patients not referred, hospice or palliative care discussed within the last two months of life​

48. Gynecology Oncology Measures
Measures selected for the first year (Contd.)
Surgical
GYNONC90 - Operative report with documentation of residual disease (Optimal/Suboptimal)
Chemotherapy
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

49. 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

50. Ovarian Cancer Longitudinal Registry

51. Future Areas of Focus

53. Group Photograph

54. 2018 Set-up

55. 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 leave today
Provide “heads up”

56. Minimum Requirements What Do You Have to Do?
Meet eligibility requirements
Agree to:
Abstract data
Share & use data for performance
Collaborate with other practices
Attend MOQC meetings
Biannual meetings (January and June)
Participate in a quality project & committee
Communicate with Coordinating Center

57. Minimum Requirements What Do You Have to Do? Quality Group
Communicate with Coordinating Center

58. Set-Up QOPI Account 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

59. ASCO and QOPI
The Moon Door

60. Log On

61. New Account

62. Registration
Practice & Round
XXXXX
XXXXX
XXXXX

63. Patient Selection

64. Patient Selection

65. Enter a Chart
Enter Round

66. Summary of Progress

67. Add Chart

68. Patient Characteristics
ICD-10 Code and Number Assignment

69. Diagnosis

70. Chart Assigned to Measures

71. Sample Data Entry Screen

72. 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
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

73. What Do You Get? Practice MOQC QOPI MeasureID MOQC Measure Description
Spring 17 Proportion by De-Identified Practice Number
MOQC - S14-S17 (aggregated data of 6 rounds)
MOQC S17
QOPI S17 (all oncology practices across country who submitted data) 53
106 45 50
Denom
Proportion
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%
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 36
94%
65%
CORE14
Signed patient consent for chemotherapy
100%
93%
74%
9457
1343
CORE22bb
Tobacco cessation counseling administered or patient referred in past year
56%
23%
17%
2195
45%
323
54%
41%

74. Graphic Presentation

75. 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

76. 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 leave today
Provide “heads up” communication ( to be sent to you for modification/use)

77. Minimum Requirements What Do You Have to Do?
Meet eligibility requirements (surgeon, PGIP, age of patient)
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)
Participate in a quality project and a quality committee
Communicate with Coordinating Center

78. Next Steps

79. MOQC BIANNUAL MEETINGS 2018
Save the Dates
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
Our Biannual Meetings for 2018 are the following dates
A physician from your practice has to attend two meetings
MOQC is open to working with you on participation requirements

80. Reminders . . . Practice Participation Agreements & QOPI Registration
Notify contact
Assist, if required
Steering Committee Member
POQC Representatives from Practice
Practice Contact Information

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