Gynecology-Oncology Initiative Inaugural Meeting October 14, 2017 Inn

Gynecology-Oncology Initiative Inaugural Meeting October 14, 2017 Inn

Gynecology-Oncology Initiative Inaugural Meeting October 14, 2017 Inn at St. Johns, Plymouth MI Thank you 2 Welcome Jennifer J. Griggs Program Director

Shitanshu Uppal Louise Bedard Emily Mackler Program Co-Director Program Manager Clinical Pharmacist Sam Beusterien Arthi Ramakrishnan

Jennifer Yanchula Project Manager Project Manager Outreach Manager 3 A Few Details

Documents at Seat Group Photo at Break Q & A Opportunities Six Question Evaluation Confidentiality Agreement Food and Beverage Cell Phones 4 Resources MOQC

MOQC Pathway Pathway Measures Measures MOQC-BCBSM MOQC-BCBSM VBR VBR FAQs FAQs ASCO-QOPI ASCO-QOPI material material BCBSM BCBSM Value Value Partnerships/CQI Partnerships/CQI Business Business cards

cards 5 For Your Use On MOQC.org/ Todays Slides: Monday October 16th Todays Videos: November 1st Password: None Point your browser to Inn at St. Johns @MOQCTeam or #moqc Known Knowns

Known Unknowns 7 Known Knowns Known Unknowns Unknown Unknowns

8 Gratitude 9 Dedicated to all the women and their families who have suffered with cancer 10 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 13 14 15 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 Page 16 Michigan Oncology Quality Consortium Colors denotes MOQCs five regions

MOQC Practices Type of Practice 3 Academic Private Practice System or Hospital Owned Group 26 18 Source: MOQC Landscape Survey, 201718 N=47 practices

Number of Practices Practice Size 20 18 16 14 12 10 8 6 4 2 0 16

13 7 1 2 3-5 6 5 6-10 >10

Number of Medical Oncologist FTEs Source: MOQC Landscape Survey, 2017 N=47 practices 19 BCBSM/CQI Value Partnerships Patient & Caregiver Oncology Quality Council (POQC) MOQC Leadership

Steering Committee Coordinating Center/ Team Quality Projects Chemotherapy consent (2017) Advance care planning (2016) Data abstraction (2016) Oral oncolytic (2015) Tobacco cessation (2014) Measures Group

Practices Participate in QI projects Align with CMS & MOC Regional structure for data sharing and collaboration 21 Role of Coordinating Center Four priorities 1. Quality/performance improvement support Training Advisory role Resources

2. Data abstraction 3. Data reporting with statistical analyses 4. Support opportunities for state-wide improvement 22 Role of the Steering Committee 1. 2. 3. 4. 5. 6.

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 7. Review agenda, documents and feedback via email 8. Enhance practice engagement as needed 23 Patient & Caregiver Oncology Diane Drago Mary Duncan

Quality Marilyn Gilin Mike Harrison Council Name Residence Ann Arbor Ionia Waterford Allen Park Cynthia Koch Ann Arbor

Erika Jane Lojko St. Clair Shores Johanna Mabry Ann Arbor William Polkinghorne Houghton Barbara Rau Lake Isabella

Samantha Schadel Sterling Heights Shanna Simpson-Simpson Taylor Derek Singleton Taylor Deborah Stocking Morrice Peggy Taylor-Albaugh

Britton 24 POQC Priorities 1. Improve access to resources for all cancer patients across the State of Michigan 100% 2. Improve patient-provider communication 72% 3. Present the patient- and/or patientcaregiver to MOQC 2018 priorities story will be established

by practices December 2017 36% Regional meetings are identifying opportunities 25 POQC Members participate in these ways Offer patient/patient-caregiver input at meetings - 82% Improve patient outcomes by contributing to a quality initiative - 82%

Tell my story at meetings 55% Review patient materials 72% Why Participate? 27 Why Participate? 1. Receive rewards 2. Receive practice performance data with benchmarks against other statewide & national data

3. Share & acquire best practices 4. Access clinical & performance improvement resources 5. Receive profession and payer quality points 6. Collaborate & influence priorities of the consortium Page 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 Page 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 Page 31 Measures

QOPI Measures Nearly 200 measures MOQC Pathway 17 selected measures MOQC Pathway Domain QOPI Measures CORE

END OF LIFE 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 Pain management 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

Gynecology Oncology Opportunities Initiative Endometrial Cancer: - Sentinel Lymph nodes (SLN) - Dr. Rabbi Hanna (HFH) - Registry SLN outcomes - Outcomes of type II cancers Ovarian Cancer: - Registry to monitor shortterm and long-term outcomes - Underlying layer for homegrown region multicentric clinical trials - Funding opportunities

( sample size) sample size) - Studies with patient reported outcomes Cervical Cancer: - Access to care - Adherence to guideline based care - Access to fertility sparing options 36 Gynecology Oncology Opportunities Initiative 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 Surgical Chemotherapy Surveillance/ Genetics Matrix

End-of-life Access to surgical care Guideline based chemotherapy

Imaging utilization (CT/PET-CT/MRI) in surveillance Aggressive end-of-life care Quality of surgery Time from diagnosis/surgery to initiation of therapy Proportion of patients referred to

genetic counselling Hospice utilization 30-day measure Symptom management Proportion of patients with documented genetic testing Advance care directives

Proportion of patients undergoing debulking surgery Rate of optimal debulking Documentation of residual disease SSI Readmissions 30 & 90 day mortality

Nausea/Vomiting Pain control 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 Measures for Gynecology Oncology 42 Gynecology Oncology Criteria for choosing the measures 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 Criteria for choosing the measures 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 Measures Steering Committee 160 QOPI measures 11 measures

Gynecology oncology specific measures Gynecology Oncology Measures selected for the first year Measures 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 selected for the first year Measures (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) Carboplatin @ AUC 4 Emend is recommended by latest ASCO guidelines 47 Gynecology Oncology Measures selected for the first year Measures End-of-life (Contd.)

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

selected for the first year Measures (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), ICIV 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 52 53 Group Photograph 2018 Set-up 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? 1. Meet eligibility requirements 2. Agree to: Abstract data Share & use data for performance Collaborate with other practices Attend MOQC meetings Biannual meetings (January and June) 3. Participate in a quality project & committee 4. Communicate with Coordinating Center 57

Minimum Requirements What Do You Have to Do? Quality Group Communicate with Coordinati 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 persons name to MOQC

Access one ASCO membership number Register your practice with QOPI (MOQC will assist) Prepare for Spring 2018 round registration 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: ________________________________________________ Fall 2017 Abstraction Round Completed by: ________________________________________________ Practice Name: ________________________________________________ Date Completed: ______________________________________________ Completed by: ________________________________________________ Note: Date All practices

should complete and retain for their files for each abstraction round Completed: ______________________________________________ Note: Count of All practices should complete and retain for their files for each abstraction round Unique MRN Number QOPI Number Last Name First Name Charts 1 Count of

Unique Charts 2 1 3 2 4 5 MRN Number

QOPI Number Last Name First Name DOB DOB 3 4 5 6 7

6 7 8 8 9 9 10 10 73

What Do You Get? Practice MeasureID CORE6e EOL38 CORE13a1 MOQC Measure Description MOQC MOQC - S14-S17

Spring 17 Proportion by De-Identified (aggregated data of Practice Number 6 rounds) QOPI S17 (all oncology practices across country who submitted data) Proportio n Proportion 77%

1799 82% 76% 6083 79% 1172 84% 81%

6% 1166 19% 362 16% 15% . .

479 73% 36 94% 65% 88% 93% 74%

9457 76% 1343 77% 76% 56% 23% 17%

2195 45% 323 54% 41% 106 45 50

Pain addressed appropriately by second office visit and during most recent office visits (defect-free measure, CORE6 and CORE6d) 98% 96% 73% 88% 12381 Pain addressed appropriately (defect-free measure, EOL35,

EOL36a, and EOL37)* 97% 86% 88% 98% 0% 18% 20%

. . Signed patient consent for chemotherapy 100% Tobacco cessation counseling administered or patient referred in past year 100% Oral chemotherapy monitored on visit/contact following start of CORE13oral6 therapy: medication adherence assessed (Test Measure) a

MOQC S17 Denom 53 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) QOPI Denom Proportion

CORE14 CORE22bb 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 (email to be sent to you for modification/use) 77 Minimum Requirements What Do You Have to Do? 1. Meet eligibility requirements (surgeon, PGIP, age of patient) 2. 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) 3. Participate in a quality project and a quality committee 4. Communicate with Coordinating Center 78 Next Steps Save the Dates A physician and practice manager/administrator

MOQC BIANNUAL MEETINGS 2018 Friday January 19 Friday June 22 Inn at St. Johns Location TBD Plymouth Grand Rapids 80 Reminders . . . 1. Practice Participation Agreements & QOPI Registration

Notify contact Assist, if required 2. Steering Committee Member 3. POQC Representatives from Practice 4. Practice Contact Information 81 Closing Comments Email us: first initial, last [email protected] Telephone us: (734) 232-0043 Visit www.moqc.org for updates

Pick up a charger & fidget spinner on way out Complete your Evaluation and deliver at door Travel safely & thank you for coming 82

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