1. Tales from the Front Lynn Pezzullo, RPh
Senior Director, Quality Innovation

2. PQA’s Multiple Sclerosis eCQM Development
Background
Measure gap
Meaningful measures needed for neurologist reporting
PQA focus: medication-related measures
Multiple sclerosis: Treatment & Monitoring
White Paper: “Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment”
Findings:
Measurement gaps span the breadth of MS care, including assessment of imaging and physical examinations, access to therapists, monitoring of disease progression, and medication management and adherence.
MRI: Magnetic Resonance Imaging
RRMS: Relapsing remitting multiple sclerosis

3. Four Draft eCQMs
Use of Disease Modifying Therapy (DMT) in Persons with Relapsing Forms of Multiple Sclerosis (MS)
Magnetic Resonance Imaging:
Prior to Initiating or Switching DMT in Patients with
Relapsing Forms of MS
To Establish a New Baseline After Initiating or Switching
DMT in Patients with Relapsing Forms of MS
For Follow-Up in Patients with Relapsing Forms of MS
Being Treated with DMT
Use of disease modifying therapy (DMT) to treat RRMS
MRI to assess DMT efficacy and subclinical disease activity

4. Multi-stakeholder Task Force
Patients with MS
Neurologists w/ primary focus in MS
Professional Societies
Payers
Neuro-Radiologists
Advocacy Organizations
Ensuring all perspectives/interest are represented

5. Engaging the Task Force
Successes
Challenges
In-person kick-off meeting
Alignment of objectives
“Team-building”
Patient representatives
Other measure developers
Collaboration
Subgroup to expedite MRI measure development
Learning curve
Guideline- vs. measure- development
Balancing project timeline with clinician availability
Address our approach; when we convened the TF
2 patients on the TF; brought AAN in early
How we addressed challenges
Speak to what we would do differently

6. Measure Testing Successes Challenges
Existing relationship with primary contact
Four (4) practices using two (2) EHRs
Draft eCQMs aligned with MS Improvement Collaborative objectives
Timeline delays due to contracting
Practices new to testing
Communications
Speak to what we would do differently

7. Submission to JIRA – MUC List
Challenges
Perceived vs. actual requirements
What we learned
CMS feedback
Provide MAT output for all eCQMs
Submit eCQMs once testing is completed
What I wish I had known
Speak to what we would do differently (need to have testing results prior to submitting)
Review CMS requirements

8. Measure Maintenance and Updates
Measure Update Panel
Reviews PQA-endorsed measures and consider revisions to ensure:
Alignment with current evidence, guidelines and standards
Accurate medication lists
Clarity and consistency

9. Implementation Opportunities
Objective: Measures included in Merit-Based Incentive Payment System (MIPS)
Meet with key stakeholders
CMS Spotlight Series
CMMI
Approach
Raise awareness; stimulate interest
Highlight measures and status with CMS
Partner with complementary initiatives

10. Collaboration to Support Adoption
PQA Clinical Quality Measure Development
(Use of DMT and MRI)
NQF Measure IncubatorTM
(PRO Project)
MS-Advance Study
(Single-Center, Patient-Centered Specialty Practice Pilot)
MS CQI Collaborative
(Multi-Center Research)
Identify and Address Gaps in
MS Care

11. Next Steps Activity Timeline Feasibility Testing
3-4 MS practices; 2 EHR systems; ~100 patients
Nov - Dec 2017
Validity and Reliability Testing
Jan Feb 2018
Review by PQA Quality Metrics Expert Panel
March 2018
PQA Endorsement Consideration
PQA membership vote
Q2 2018
Submission into JIRA Issue and Project Tracking System
CMS evaluates for potential addition to the Medicare Measures under Consideration (MUC) List (summer 2018)
Q2 2018*
Implementation Goal
Adoption into Merit-Based Incentive Payment System (MIPS)
2019
Also consider NQF endorsement
*By June 30 deadline