measurement specs: rheumatoid arthritis collaborative · • american college of rheumatology’s...
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Measurement Specs: Rheumatoid Arthritis Collaborative AMGF • Updated April 2015 Measures for AMGF’s RA Collaborative are based on NQF-‐approved measures used for PQRS and other quality reporting programs, but for this improvement collaborative, they have been modified in two important ways:
• Since the diagnosis of RA is often assigned incorrectly by non-‐rheumatologists, the denominator population includes only patients who carry a diagnosis of rheumatoid arthritis after having been seen by a rheumatologist for at least two E&M visits.
• In order to encourage keeping a current, accurate list of medications in the EHR, patients are considered to be “on” a medication only if the med list in the EHR indicates the drug as being active as of the end of the reporting period, or if there is a record of administering the drug within a timeframe so it is still considered effective as of the end of the reporting period. The EHR med list is presumably reviewed periodically with the patient, confirming that the patient is still taking all the medications that are listed as active.
AMGA member organizations participating in AMGF’s RA Collaborative are asked to report three measures, at baseline (if feasible) and quarterly, to show progress during the collaborative:
1. Proportion of patients with RA on disease-‐modifying anti-‐rheumatic drug (DMARD) therapy.
2. Proportion of patients with RA for whom disease activity is assessed periodically.
3. Proportion of patients with RA for whom functional status is assessed periodically. Measurement and Reporting Periods: Rolling 12 months, reported quarterly.
Baseline 2014 Q2 (07/01/2013 – 06/30/2014)
Collaborative 1 2014 Q3 (10/01/2013 – 09/30/2014)
Collaborative 2 2014 Q4 (01/01/2014 – 12/31/2014)
Collaborative 3 2015 Q1 (04/01/2014 – 03/31/2015)
Collaborative 4 2015 Q2 (07/01/2014 – 06/30/2015)
Collaborative 5 2015 Q3 (10/01/2014 – 09/30/2015)
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Measure 1 – Disease Modifying Anti-‐Rheumatic Drug (DMARD) Therapy Based on PQRS measure #108, NQF 0054 Percentage of patients aged 18 years or older by the beginning of the measurement period, with 2 or more E&M visits to a rheumatologist (details below) and a diagnosis of rheumatoid arthritis, who are on a disease-‐modifying anti-‐rheumatic drug (DMARD) as of the end of the reporting period. Denominator: Number of patients aged 18 years or older as of the beginning of the measurement period, with:
• one E&M visit to a rheumatologist during the reporting period, plus
• one earlier E&M visit to a rheumatologist, within 13 months prior to their last visit, and
• a diagnosis of rheumatoid arthritis. For this measure, the following CPT codes are considered an evaluation and management (E&M) visit with a rheumatologist:
• 99201–99205 Office or other outpatient visit, new patient
• 99211–99215 Office or other outpatient visit, established patient
• 99241–99245 Office consultation, new or established patient For this measure, the following ICD-‐9-‐CM codes count as a diagnosis of rheumatoid arthritis (RA):
• 714.0 Rheumatoid arthritis (98.5% of patients with any of these codes in the Anceta data)
• 714.1 Felty’s syndrome (0.3%) Rheumatoid arthritis with splenoadenomegaly and leukopenia
• 714.2 Other RA with visceral or systemic involvement (0.7%) Rheumatoid carditis
• 714 Rheumatoid arthritis (it’s technically incorrect to omit .X as part of the code, but it’s acceptable for this measure) (0.5%)
At least one of the diagnosis codes above (or equivalent) must be found either:
• on a claim for an E&M visit (CPT code list above), on or after the date of the patient’s initial visit (ever) to a rheumatologist, or
• as a currently active problem in the EHR, as of the end of the reporting period. Numerator: Number of patients in the denominator who have at least one DMARD on their active medication list in the EHR, or to whom a DMARD was administered within a timeframe so it is still considered effective as of the end of the reporting period, documented in one of the following places:
• EHR medication list—patient is on a DMARD (see list, with GPI codes, in appendix), shown as currently active as of the end of the reporting period, or
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• J code on a claim for administration of a DMARD, typically by infusion or subcutaneously, timed so the drug is still considered effective as of the end of the measurement period (see table below), or
• Infusion or medication administration records from any facility within your integrated delivery network, timed so the drug is still considered effective as of the end of the measurement period (see table below).
Note 1: Prescription or e-‐prescription during the reporting period does not by itself count as evidence of current DMARD therapy as of the end of the reporting period. Only the types of evidence listed above are acceptable. Note 2: The table below includes J codes for the doses commonly used in RA. For some medications, additional J codes are defined for the larger doses typically used in oncology. The table of J codes for DMARDs on the next page is also provided as an Excel file: AMGF RA collab DMARD J codes admin look-‐back timeframes 2014-‐11.xls The table of GPI codes (Generic Product Identifier, Wolters Kluwer Health) for DMARDS in the appendix is also provided as an Excel file: AMGF RA collab DMARD GPI codes 2014-‐11.xls Exclusions (from denominator and numerator):
• DMARD was not prescribed/dispensed/administered, for medical reasons:
– patient has HIV diagnosis before the end of the reporting period – IDC-‐9-‐CM codes: o 042 – HIV infection o 795.71 – Nonspecific serologic evidence of HIV (inconclusive test) o V08 – Asymptomatic HIV infection status (positive test but asymptomatic)
– patient was pregnant at any time during the reporting period – IDC-‐9-‐CM codes: o 630–679 – Complications of pregnancy, childbirth, and the puerperium o V22 – Normal pregnancy o V23 – Supervision of high-‐risk pregnancy o V27 – Outcome of delivery (mother’s record) o V28 – Encounter for antenatal screening of mother
• Patients who died before the end of the 12-‐month reporting period, or
• Patients under hospice care as of the end of the reporting period.
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Measure 2 – Periodic Assessment of Disease Activity Based on PQRS measure #177 (Registry only) Denominator: Same as for Measure 1, except no exclusion for a medical reason not to give a DMARD (the other two exclusions apply: patients who died or were under hospice care by the end of the reporting period). Numerator: Number of patients in the denominator who had disease activity assessed by one of the following standardized descriptive or numeric scales or composite indices, with a numerical score recorded in the EHR, on ≥ 50% of their E&M visits to a rheumatologist within the 12-‐month reporting period:
• Patient Activity Scale (PAS)
• Patient Activity Scale II (PAS-‐II)
• Routine Assessment of Patient Index Data with 3 measures (RAPID-‐3)
• Clinical Disease Activity Index (CDAI)
• Disease Activity Score with 28-‐joint counts (DAS-‐28) – Including erythrocyte sedimentation rate (ESR), or – Including C-‐reactive protein (CRP)
• Simplified Disease Activity Index (SDAI)
Anderson J, Caplan L, Yazdany J, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care & Research. 2012 May; 64(5): 640-‐647. http://onlinelibrary.wiley.com/doi/10.1002/acr.21649/full
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Measure 3 – Functional Status Assessment Based on PQRS Measure #178 (Registry only) Denominator: Same as for Measure 1, except no exclusion for a medical reason not to give a DMARD (the other two exclusions apply: patients who died or were under hospice care by the end of the reporting period). Numerator: Number of denominator patients for whom a functional status assessment was performed at least once within the 12-‐month reporting period, with one of the following recorded in the EHR:
• standardized descriptive or numeric scale,
• responses on standardized questionnaire, or
• systematic notation of assessment of the impact of RA on patient activities of daily living (see examples below).
Standardized instruments include but are not limited to:
• Health Assessment Questionnaire II (HAQ-‐II),
• Modified HAQ (MHAQ),
• Multi-‐Dimensional HAQ (MDHAQ),
• Patient Reported Outcomes Measurement Information System (PROMIS) physical function/ disability domain – 10-‐item or 20-‐item short forms, or computerized adaptive testing (CAT), or
• American College of Rheumatology’s Classification of Functional Status in Rheumatoid Arthritis. Activities of Daily Living – Examples:
• From PQRS #177 – Assessment could include a description of any of the following: dressing/ grooming, rising from sitting, walking/running/ability to ambulate, stair climbing, reaching, gripping, shopping/running errands, house or yard work.
• From ACR Classification of Functional Status in Rheumatoid Arthritis – Usual self-‐care activities include dressing, feeding, bathing, grooming, and toileting. Avocational (recreational and/or leisure) and vocational (work, school, homemaking) activities are patient-‐desired and age-‐ and sex-‐specific.
https://www.rheumatology.org/practice/clinical/classification/ra/raclass.asp
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Measure Reporting Format and Instructions
Please submit your data using this Excel file:
AMGF RA collab measure reporting template 2014-‐12.xlsx
There is one row for entering data for each of the reporting periods shown on page 1. Enter data for as many reporting periods as you have completed, and send it by email to: [email protected] For subsequent reporting periods, fill the numerators and denominators for an additional row, save the updated file, and send it to the above email address, as soon as possible after the end of each quarter. Please don’t forget to fill in the name of your group, in the first cell that’s shaded blue. Please also add an abbreviated version of your organization’s name to the filename, as you save it after entering data. Note that the Excel spreadsheet includes some edits to prevent you from inadvertently altering any cell other than those intended for entering data. But there’s no password, so if you need to unprotect the sheet, you can. The sheet also includes conditional formatting, explained in the notes at the bottom of the sheet, to alert you to some common data entry errors. This and other files for the collaborative are available on the RA collaborative website:
http://www.amga.org/wcm/PI/Collabs/RA/index_ra.aspx Press the log-‐in button at the bottom of the page to access the members-‐only portion of the site. If you need help with your user ID or password, please contact Danielle Casanova, at 703-‐838-‐0033 x347, or [email protected]. If you have questions about the measures, the reporting instructions, or the spreadsheet, please contact John Cuddeback, at 202-‐297-‐9055 (mobile), or [email protected].
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Appendix – GPI Codes for DMARDs Generic Product Identifier, Wolters Kluwer Health • page 1 of 3
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Appendix – GPI Codes for DMARDs Generic Product Identifier, Wolters Kluwer Health • page 2 of 3
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Appendix – GPI Codes for DMARDs
Generic Product Identifier, Wolters Kluwer Health • page 3 of 3