MARK YOUR CALENDAR: PQA Annual Meeting is Set for June 1-3, 2011 in Washington, DC

This is the meeting you don't want to miss! The PQA 5th Annual Meeting will kick-off on Wednesday, June 1st at 1PM at the Omni Shoreham in Washington, DC with healthcare leaders presenting the state of the industry from a variety of perspectives. There will be interactive panel discussions as well as time for questions and answers. Following a networking reception, PQA will host its inaugural Quality Awards Dinner. More information will be forthcoming on this exciting event.

The second day of the meeting will include the very popular breakout sessions covering important and relevant issues in healthcare quality and the impact of PQA on the quality performance measurement enterprise. A key goal is to provide attendees opportunities to tap into the resources and network with the experts in quality and performance measurement.  Ample time will be provided for networking and for renewing or building relationships with the diverse group of professionals and healthcare stakeholders in attendance.

New this year, the PQA Annual meeting will be directly followed by a jointly-hosted PQA/URAC Medication Adherence Summit that begins at 1:30 PM on June 2nd. This unique event will feature presentations focusing on understanding the payer's perspective, the patients trigger points and the science behind improving medication adherence. That evening will also include a networking reception. The next morning, experts will delve into the evidence surrounding medication adherence and the impact of pharmacist interventions on patient's behavior. The meeting concludes at 12 Noon on June 3rd.

Another first...this year the meeting will feature exhibit space for 14 companies to highlight their products and services. This is not your typical trade show and is designed to give each exhibitor maximum visibility at both the Annual Meeting and the Adherence Summit.

A preliminary agenda and registration form will be available on the PQA website (www.pqaalliance.org) as of February 1st along with details on sponsorships and exhibits. For additional information please direct email inquiries to Jackie Green at jgreen@PQAalliance.org

PQA Chair, Judy Cahill, Appointed to NQF's Measure Applications Partnership Coordinating Committee

The National Quality Forum (NQF) currently serves as the consensus-based entity under contract with the Department of Health and Human Services (HHS) and as such may be tasked with carrying out a new consultative process in its role as neutral convener. The Affordable Care Act (ACA) assigns new duties to the consensus based entity, including convening multi-stakeholder groups to provide input to the Secretary of HHS on the selection of measures for public reporting and payment programs.

NQF's Board adopted a plan for the Measure Applications Partnership (MAP) and sought nominations for the MAP Coordinating Committee.

PQA is pleased to have supported the nomination of Judith Cahill, Executive Director of the Academy of Managed Care Pharmacy, who was appointed to the MAP Coordinating Committee as a voting organizational member. Other PQA organizations that were appointed as organizational (voting) members include AARP - as a consumer stakeholder - and America's Health Insurance Plans (AHIP). Additionally, CMS, AHRQ, CDC and several other government agencies serve on the MAP as non-voting, ex-officio members.

NQF also has a call for nominations for organizations and individual subject matter experts for the MAP Advisory Workgroups and this call is open through February 7th at 6 PM ET. All PQA members are encouraged to visit www.qualityforum.org to submit all nominations and supporting documents.  Back to Top

PQA Quality Forum Lecture Series: An Update on Medicare Part D Performance Measures

PQA is pleased to announce that the Quality Forum topic for February 2011. Vikki Oates will present "An Update on Medicare Part D Performance Measures." Ms. Vikki Oates, M.A.S., is Director of the Division of Clinical and Operational Performance, Medicare Drug Benefit and C & D Data Group for CMS.

The presentation will take place on February 10, 2011 from 1-2pm ET. Please RSVP to LectureRegistration@PQAalliance.org no later than 5PM EST on Tuesday, February 8 if you would like to join PQA for this informative, no-cost lecture.

Ms. Oates will provide an overview of the Medicare Part D performance measurement system including the Plan Ratings, display measures, and patient safety website. She will also share insights on the Contract Year 2011 Medicare Plan Ratings and discuss how future Plan Ratings may affect Quality Bonus Payments to Medicare Advantage plans.  Back to Top

NACDS Foundation Issues Request for Proposal to Study & Reduce Primary Medication Non-Adherence Rates

Shortly after the New Year, the National Association of Chain Drug Stores (NACDS) Foundation released a Request for Proposal (RFP) to study what is termed "primary medication non-adherence" or PMN, which occurs when a patient fails to fill or pick-up their newly prescribed prescription medication.  The NACDS Foundation has set aside funding for qualified researchers to measure PMN rates, and to develop, test and evaluate the effectiveness of PMN interventions in the community pharmacy setting.

The NACDS Foundation's Request for Proposal seeks to examine primary medication non-adherence rates and ways in which the healthcare system - through the collaborative integration, engagement and intervention of pharmacists, physicians and other healthcare providers, and the proper and effective use of health information technology - can be utilized to improve overall patient health outcomes and medication adherence rates.

The NACDS Foundation will host a conference call for interested stakeholders on Tuesday January 25th at 2:00 p.m. (EST). Proposals must be submitted by 5:00 p.m. (EST) on Tuesday March 15, 2011.  To view the entire RFP, please visit: http://www.NACDSFoundation.org.  Back to Top

PQA Hosts Inaugural Leadership Summit: Discussions Target 2011 Initiatives & Priorities

Despite severe weather around the country, over 30 invited healthcare industry executives attended the PQA Leadership Meeting on December 13th.  Representatives from the health plan and prescription benefits management sector, pharmacy associations, pharmaceutical and technology companies, academicians, health outcomes researchers, health IT vendors, the Center for Medicare & Medicaid Services (CMS) along with retail pharmacy executives, came together to review PQA's strategic objectives as well as agree on key areas of focus identified by the stakeholders of PQA to be addressed in 2011.  PQA extends its special thanks to Merck for their support of this Inaugural Leadership Summit and to Executive Committee Member, Thomas Menighan for hosting this summit at APhA's historic headquarters.

Laura Cranston reviewed the success that PQA has had in establishing itself as the leader in the medication use measurement space.  Ms. Cranston highlighted the latest announcement by CMS on their Medicare Part D and Safety website regarding the addition of the PQA Adherence measures. Cranston emphasized the effect these measures will have on health plans as they begin to understand the impact improved adherence will have on their bottom line as reflected via the CMS star ratings program. She also recognized the importance and value of the PQA membership and the insights and expertise that those in attendance and others from within member companies provide to PQA to help it achieve the association's goals.

In discussions regarding areas of focus for 2011, feedback from the group identified a greater need for educating the pharmacist on quality measures in improving medication use.  For pharmacists/pharmacy providers to establish themselves as healthcare providers in the new quality arena promoted in the Accountable Care Act, pharmacists/pharmacies must demonstrate their value in the cost equation.  The PQA measures provide a means to documenting and measuring their ability to move the needle on meaningful measures of appropriate medication use.

The lunch hour offered up a very interactive session entitled "Have Measures, Now What About Payment?" led by Gary Young, PhD, JD, Professor in and Chair of the Dept. of Health Policy and Management at Boston University, School of Public Health. Dr. Young provided an opportunity for the group to investigate various pay for performance (P4P) options through the eyes of the health plan and the pharmacy.

The afternoon focused on workgroup challenges and opportunities, the 2011 infrastructure for PQA, as well as interactive discussions to gain member feedback on areas for new workgroups such as specialty pharmacy.  The breakout discussions focused on educational activities that could be provided by PQA including connecting pharmacists and physicians; creating an excellence/recognition award to be given by PQA, and a session focusing on promoting the uptake of the PQA measures. More information and the 2011 Workgroups will be announced at the end of January.  Back to Top

PQA Workgroups Highly Productive in 2010: A Recap of the Activities

Much of the PQA's success is attributed to the expertise and efforts of members participating in high functioning workgroups.  In 2010, eleven PQA workgroups met through conference calls to accomplish numerous goals.  Workgroups conducted surveys, authored papers, created communication tools, prioritized measures for uptake, conducted gap analysis, and made lots of recommendations to PQA.  To view a list of the 2010 workgroups and a summary of their accomplishments, simply use this link. PQA 2010 Workgroups Summary.

The PQA leadership would like to thank all those individuals that contributed their time, energy and talents to the drive the success of these workgroups over the previous year!  Back to Top

Hot Off the Press: Rapid Reviews of Key Quality Publications
by David Nau, PhD, RPh, CPHQ, Senior Director, Research & Performance Measurement, PQA

During the healthcare reform debate, there was frequent discussion about the differential payments by the federal government for Medicare Advantage (MA) and Medicare Fee-for-Service (FFS).  Although the debate centered on the up-front costs for these two models of Medicare benefits, there was little evidence regarding the difference in quality between these two models.  In March 2011, the Medicare Payment Advisory Commission (MedPAC) issued detailed recommendations for making comparisons of quality across MA and FFS.  Scholars from the Brookings Institution and Harvard University recently published a comparison of MA and FFS that followed the recommendations of MedPAC. (1)   

The study by Brennan and Shepherd used Medicare data from 2006 and 2007 to compare quality of care for MA and FFS beneficiaries.  The authors used 11 measures from NCQA's HEDIS measure set including five measures that involved medications. Patients were included from the FFS sector if they were enrolled in Parts A, B and D.  Thus, only about 50% of FFS beneficiaries were included since many FFS beneficiaries are not enrolled in Part D (in many cases due to use of other modes of "creditable coverage" such as an employer retirement plan).  The authors attempted to control for underlying differences in geography and other characteristics between MA and FFS enrollees.

The results showed that MA plans scored better than FFS on 8 measures, slightly better on 1 measure, and worse on 2 measures.  The two measures were FFS scored better than MA plans were: 1) beta-blocker persistence, and 2) annual monitoring of persistent medications.  The differences between MA and FFS on these 2 measures were not very large.  The MA plans scored much better than FFS on breast cancer screening, antidepressant medication management, and measures for monitoring of patients with cardiovascular disease of diabetes.

Why This Study is Relevant

As the debate continues on the relative merits of MA and FFS, there will be a need to examine differences in the quality of medication use across MA drug plans (MAPD) and stand-alone prescription drug plans (PDP).  The Medicare Part D performance data is publicly available and was recently updated with 2011 plan ratings.  The data can be downloaded from the CMS website at: https://www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp#TopOfPage

Two PQA-supported measures of medication safety are included in the Medicare Part D star ratings (high-risk medications in the elderly; appropriate hypertension medications in patients with diabetes), and several more PQA measures are used in the Display Measure Set.  A quick perusal of the average scores for the 2 medication safety measures in the star ratings indicates the MAPD plans perform slightly better than PDPs.  However, of greater importance for quality improvement is the high variation across all plans on the medication safety and adherence measures.  There also appears to be variation within plans across the medication safety measures.  For example, several plans scored well on the high-risk medication measure but very poorly on the measure of hypertension treatment in patients with diabetes.   To date, there has been no published research to identify reasons for the high variation in medication safety measures across, or within, the plans.  PQA strongly encourages researchers to use the publicly-available data from CMS, along with other data on plan characteristics, to examine the factors associated with high, or poor, performance on the Medicare Part D performance measures.

Highlighted Article:
1. Brennan N, Shepherd M.  Comparing Quality of Care in the Medicare Program.  Am J Manag Care. 2010;16:841-48.  Back to Top

Pharmacy e-Health Information Technology Collaborative Defines Structure and Available Membership Categories

The Pharmacy e-Health Information Technology (eHIT) Collaborative recently released information regarding the organization's newly crafted structure and membership categories. The Collaborative structure is designed to expand opportunities for participation by a broader set of stakeholders to pursue a standard for pharmacists' participation in electronic health records.

Formed in the fall of 2010, the Collaborative is focused on improving patient care quality and outcomes, through the integration of pharmacists' patient care services into the national electronic health record infrastructure. The group is pursuing Electronic Health Record (EHR) standards that effectively support the delivery, and documentation of, and billing for, pharmacist-provided patient care services across all care settings. The Collaborative influences Health Information Technology (HIT) policy through unified, consistent communications to the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health Information Technology (ONC) and other HIT organizations about pharmacist-provided patient care services and pharmacists' contributions to the CMS and ONC defined meaningful use of EHR.

There are three levels of membership available to organizations that wish to join:

• Collaborative Council Member: Not-for-profit, national pharmacy organizations that support the practice of pharmacy. Members vote on governance issues and are aligned with the Collaborative mission.
• Collaborative Associate Member: For profit or not-for-profit organizations that can contribute to the overall mission of the Collaborative.
• Petitioner: A subcategory of membership for organizations that wish to support the Collaborative objectives, but do not meet the established criteria for membership.

Organizations interested in joining the Collaborative should visit the Membership section of the website http://pharmacye-hit.org/membership or contact Shelly Spiro, Director, Pharmacy e-HIT Collaborative at shelly@pharmacye-hit.org or 703-599-5051.

The eHIT Collaborative is focused on influencing the structure, development and implementation of the U.S. health information technology (HIT) infrastructure so that the profession's HIT needs are addressed and integrated into the national HIT framework. Founded by nine pharmacist organizations, the Collaborative seeks to ensure that pharmacist-provided clinical services are represented in the electronic health record. The founding organizations of the Collaborative represent pharmacists working in all patient care settings within the health care system, in addition to many other facets of pharmacy including pharmacy education and pharmacy education accreditation. For more information, visit http://pharmacye-hit.org/home.  Back to Top

Quality Measures for Medicaid-eligible Adults Published for Public Comment: Core set includes PQA Measures for Patient Adherence

Public notice of the initial core set of quality measures was given on December 30 in the Federal Register.  The public is invited to comment on the measures, including how to facilitate States use of the measures, and what priority areas may need additional measure development.  Public comment will be received until March 1, 2011.  Included in the 51 recommended measures is the PQA measure Proportion of Days Covered Measure for 5 Therapeutic Categories.  The full notice can be accessed at http://edocket.access.gpo.gov/2010/pdf/2010-32978.pdf.  Back to Top

CMS Launches First Phase of Physician Compare Web Site

The Centers for Medicare & Medicaid Services (CMS) recently enhanced the Physician Directory tool at www.medicare.gov with new information about physicians and other healthcare workers in their communities and the services those professionals provide.  The new feature, called Physician Compare, expands and updates CMS' Healthcare Provider Directory, which has helped millions of beneficiaries find Medicare-participating doctors online for over a decade. The new tool expands the doctor-specific information into the suite of informational tools for Medicare beneficiaries and other consumers. 

"The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other healthcare workers," said Donald Berwick, M.D., CMS administrator.  "This helps to pave the way for consumers to have similar information about their physicians as they have for nursing homes, home health agencies and health and drug plans."

The new CMS site is located at www.medicare.gov/find-a-doctor and was required by the Affordable Care Act of 2010. It contains information about physicians enrolled in the Medicare program, which include Doctors of Medicine, Osteopathy, Optometry, Podiatric Medicine, and Chiropractic. The site also contains information about other types of health professionals who routinely care for Medicare beneficiaries, including nurse practitioners, clinical psychologists, registered dietitians, physical therapists, physician assistants, and occupational therapists.  In future years, the Physician Compare Web site will be expanded with information about the quality of care Medicare beneficiaries receive from physicians and the other healthcare professionals profiled on the site. 

PQA Executive Director, Laura Cranston indicated, "This is a very important event. It is only a matter of time before pharmacies will also be measured and compared based on the quality of care they provide to customers."

The Physician Compare Web Site is designed to be consumer friendly and help all patients - whether on Medicare or not - locate health professionals in their communities. The tool can also help Medicare beneficiaries identify which physicians participate in the Medicare program.  In addition to information about the physician's practice, Physician Compare also shows consumers whether the practice reported certain data to CMS through the Physician Quality Reporting System, formerly known as the Physician Quality Reporting Initiative (PQRI). Currently, the PQRI reporting system is a voluntary reporting program that rewards physicians and other eligible healthcare professionals for reporting data on quality measures related to services furnished to Medicare beneficiaries.  These quality measures are based on the best available medical evidence and designed to help professionals improve care for patients. In 2009, over 200,000 professionals reported data to CMS through the Physician Quality Reporting System.

Later in 2011, CMS plans a second phase of the Web site which will indicate whether professionals chose to participate in a voluntary effort with the Agency to encourage doctors to prescribe medicines electronically, rather than through traditional paper-based prescription methods.  Back to Top

Evaluation of PQA Draft Measures of MTM Performance

The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 required Medicare Part D sponsors to have a medication therapy management (MTM) program.  During 2009-10, the Pharmacy Quality Alliance (PQA) identified four potential performance measures to evaluate the quality and/or impact of MTM services.  These measures were developed so that they could be implemented using only drug claims data and the date of MTM consultations for patients.  This approach minimizes the burden of data collection for drug plans that seek to assess their MTM programs.

Of the 634,261 MTM-eligible Medicare members identified in 2009, 32,917 (5.2%) received a CMR by a pharmacist. There were 7,556 unique member/high-risk medication combinations identified prior to MTM consultation, of which 49% were no longer present in the post-consultation period.  Of the 2,204 diabetic members who did not receive an ACEI/ARB prior to MTM consultation, 15.4% received an ACEI/ARB in the post-consultation period. A small number of uncontrolled asthmatic members (N=36) were identified with no controller therapy prior to MTM consultation, of which 5.6% began use of a controller therapy medication in the post-consultation period.

The opt-out approach to MTM eligibility used by Humana is consistent with the latest requirements of CMS; however, the opt-out approach also reveals that relatively few patients that are eligible for MTM actually receive a CMR. Reports from other Medicare Part D plans indicate that the CMR rate found by Humana was consistent with other plans that use an opt-out approach. The CMR rate measure is easy to calculate and gives a high-level assessment of the proportion of MTM-eligible patients that receive a CMR. 

The 3 measures related to change in a patient's drug regimen subsequent to MTM consultation indicate that two of the measures may be appropriate for estimating the impact of MTM interventions in the Medicare population.  The measures that track the discontinuation of a high-risk medication or the addition of an ACEI/ARB to diabetic patients regimens, show that many patients experience changes in their drug regimen.  The rates for each of these measures will be most useful when used in tandem with an assessment of the underlying rate of high-risk medications or ACEI/ARBs in patients with diabetes.  Thus, the rates may be useful for quality improvement within a specific drug plan, but may not be appropriate for comparison of different MTM programs unless the underlying rates for high-risk medications or ACEI/ARB utilization in each plan are considered.  The asthma measure could not be fully evaluated using the data from Humana due to a low rate of asthma patients being targeted for MTM. Further testing of this measure in a non-Medicare population is needed.

In conclusion, the calculation of the four draft measures of MTM performance was feasible for a drug plan with MTM program data, drug claims and the technical specifications from PQA.  Additional research is underway to further assess the appropriate use of these measures in evaluating MTM services.  The results of this project will also be presented at the AMCP Spring 2011 meeting in Minneapolis.

PQA thanks Melea Ward and Yihua Xu at Competitive Health Analytics for their contributions to this article.  Back to Top

PEER Portal Launched To Capture Pharmacists' Experiences with Electronic Prescribing

The Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization (PSO), announced today the re-launch of a Web portal designed to enable pharmacies to document their encounters with electronic prescribing and provide critical feedback to improving the process.  Electronic prescribing, or e-prescribing, is the electronic transmission of prescription information from the provider's computer to the pharmacy's computer, eliminating the need for handwritten prescriptions. Originally developed in collaboration with SureScripts, the revised Pharmacy and Provider e-Prescribing Experience Reporting (PEER) Portal uses an enhanced, streamlined web-based questionnaire to collect the data necessary to address the continuing challenges in e-prescribing encountered by pharmacists and providers.  Data submitted across the country through the PEER Portal will be aggregated and analyzed to provide impetus for further improvements in training, certification standards and technology.

"E-prescribing is on the rise as more providers are tapping into this new technology to improve the safety, quality and efficiency of the prescribing process and take advantage of government incentives," said Tara Modisett, Executive Director of APMS. "However, when you have new technology and prescribers on the learning curve, new challenges arise.  We are committed to using the reported data to identify and quantify the recurring issues so that we can advocate measures to improve the safety and quality of e-prescribing.  Thanks to a grant from the Community Pharmacy Foundation, we will be able to use the detailed information collected in the PEER Portal to make a difference in patients' lives."

APMS and state pharmacy associations have teamed up to encourage pharmacists and providers to regularly enter their e-prescribing experiences and improvement suggestions into the PEER Portal.  Widespread use of the PEER Portal will provide the data to drive essential changes. The PQA encourages pharmacists and prescribers to participate in this valuable reporting process.

APMS was established by the National Alliance of State Pharmacy Associations (NASPA) and is listed as a PSO with the Agency for Health Research and Quality (AHRQ).　 The mission of APMS is to foster a culture of quality within the profession of pharmacy that promotes a continuous systems analysis to develop best practices that will reduce medication errors, improve medication use and enhance patient care. For more information about APMS, visit http://www.medicationsafety.org.  Back to Top