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Pharmacy and Quality Measurement Division

Diverse Support Group Patient with Doctor

The HSAG Pharmacy and Quality Measurement Division provides clinical and analytical expertise for quality measure development, healthcare policy and evaluation, and medication safety. To support our customers, HSAG's multidisciplinary team draws on extensive experience in healthcare administration and research, clinical quality measure development, clinical care, medication management, electronic health records, data analysis, and project management. HSAG convenes nationally recognized experts across a wide array of clinical specialties, together with patient and caregiver representatives, to guide these efforts to improve health outcomes.

Inpatient Psychiatric Facility (IPF) Outcome and Process Measure
Development Project

Project Duration: 2014–2018
Contract With: Centers for Medicare & Medicaid Services (CMS)

Inpatient psychiatric facilities play a critical role in the care of individuals with complex mental illnesses such as depression, schizophrenia, bipolar disorder, and substance use disorder. HSAG supports the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program and the overall CMS quality mission by developing, maintaining, and implementing measures for facilities using the IPF Prospective Payment System. These quality measures evaluate the care provided by each IPF during the inpatient stay, including the discharge process that prepares patients and their caregivers for the transition to the outpatient setting. HSAG engages with patients, providers, and other key stakeholders during measure conceptualization and development to ensure that measure scores are informative and accurate.


Development and Implementation of Quality Rating System (QRS) Measures for Qualified Health Plans

Project Duration: 2015–2018
Contract With: IMPAQ International/Centers for Medicare & Medicaid Services (CMS)

The CMS Quality Rating System (QRS) delivers meaningful information to health insurance consumers considering an array of qualified health plans in the Health Insurance Marketplaces established under the Affordable Care Act. IMPAQ International, LLC, subcontracts with HSAG on this project to identify measurement gaps in the QRS and to adapt and develop measures that will enhance the information available to consumers. HSAG leads the information gathering, measure development, and measure testing aspects of the project, including measure specifications and convening of a technical expert panel.

Maintenance and Development of Medication Measures Special Innovation Project

Project Duration: 2011–2014
Contract With: Centers for Medicare & Medicaid Services (CMS)

HSAG developed, tested, and maintained clinical quality measures related to medication management and adverse events for potential use in national quality improvement and public reporting programs. The team conducted an environmental scan and measurement gap analysis, recruited and convened a national technical expert panel, led formative and field testing of new measures using large CMS administrative data sets and hospital-based electronic health record data, and provided technical support to CMS for measure implementation. The project resulted in 11 quality measures endorsed by the National Quality Forum (NQF), including the first two de novo electronic clinical quality measures (eCQMs) to receive such endorsement.


Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality and Efficiency Measures

Project Duration: 2014–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

Every three years, CMS conducts and publishes an assessment of the quality and efficiency impact of the use of endorsed measures in CMS programs, as required by statute. This report comprehensively evaluates the impact of CMS quality measurement and reporting programs and informs policy to promote quality improvement in health care nationwide. Key components of the work include an analysis of hospital processes and patient outcomes, patient-reported experiences, overall trends and disparities, unintended consequences of measurement, costs averted, and alignment and adoption of measures.

The 2018 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report addressed a set of research questions developed in consultation with a multidisciplinary technical expert panel and the Federal Assessment Steering Committee. HSAG and its research partner, the RAND Corporation, surveyed hospital and nursing home quality leaders to explore how providers are responding to CMS quality measurement and their perspectives on the challenges that inhibit performance improvement. HSAG is continuing to collect and analyze data across a wide array of CMS quality programs for the next assessment.


CMS Quality Measure Development Plan (MDP)

Project Duration: 2015–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), section 102, established new Medicare payment and delivery methods to reward physicians and other eligible clinicians for providing high-quality healthcare. HSAG’s team developed the CMS Quality Measure Development Plan (MDP) as a strategic framework to support the new Quality Payment Program established by MACRA, consisting of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). HSAG prepared the draft plan, coordinated a call for public comment, and advised CMS and federal partners on incorporating stakeholder perspectives into the final plan, assuring timely CMS/HHS clearance for posting on the website on May 2, 2016. Through subsequent updates and annual progress reports by HSAG, the Measure Development Plan will guide the development of quality measures to advance healthcare delivery system reform and achieve the goal of delivering higher-quality care without paying more.


CMS Quality Measure Index (QMI)

Project Duration: 2017–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

CMS uses clinical quality measures in quality improvement and reporting programs to drive improvement in health care and empower patients to make informed decisions. Evaluating the impact and effectiveness of quality measures aids CMS in streamlining the measure portfolio with the goal of reducing reporting burden so that clinicians can focus on providing high-quality healthcare to their patients. CMS is contracting with HSAG to develop an index that will quantitatively evaluate quality measures for the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). HSAG will identify measure scoring approaches in published literature and consult stakeholders, as well as a technical expert panel, in formulating and testing the index for validity and reliability. The Quality Measure Index (QMI) will facilitate a standardized, repeatable, and transparent process of measure evaluation that will allow CMS to identify gaps in measurement for each clinician specialty or subspecialty.

Diagnostic Coding Validation of Hypoglycemia Events Associated with the Use of Diabetes Agents

Project Duration: 2017–2018
Contract With: Centers for Disease Control and Prevention (CDC)

Hypoglycemia is a common side effect of diabetes agents, and serious hypoglycemia, which requires the assistance of another person, is associated with increased morbidity and mortality. To advance surveillance strategies for adverse drug events, the National Action Plan for Adverse Drug Event Prevention recommends to "assess the adequacy of diagnostic and procedural coding for identifying hypoglycemic events." Current coding practices for patients presenting with hypoglycemia are not well understood, and a clear need exists to develop an ICD-10 algorithm and investigate whether U.S. administrative data can be a valid source for hypoglycemia surveillance. HSAG has been contracted to conduct a multi-hospital retrospective cohort study using structured medical record review to validate and optimize an ICD-10 code algorithm for identifying hypoglycemic events associated with outpatient use of diabetes agents. The project will determine whether administrative data can serve as a reliable data source and may facilitate development of more robust surveillance for hypoglycemia.

Validation of ICD-10 Codes for Bleeding Events
Associated with Anticoagulant Exposure

Project Duration: 2016–2017
Contract With: Centers for Disease Control and Prevention (CDC)

Anticoagulants are consistently identified among the leading classes of medications implicated in adverse drug events (ADEs) resulting in harm to older patients. Several federal agencies have developed surveillance systems to identify anticoagulant-related bleeding; however, existing systems lack standard definitions for the bleeding events. With the emergence of new oral anticoagulants that require less monitoring and the conversion of ICD-9-CM to ICD-10-CM that took effect October 1, 2015, there is a need to understand the extent to which administrative data coded in ICD-10-CM can estimate the frequency of anticoagulant-related harms. HSAG was contracted to conduct a multi-hospital retrospective cohort study using structured medical record review to validate and optimize an ICD-10 code algorithm for identifying bleeding events associated with anticoagulant exposure. The main objective of the project was to develop a validated set of ICD-10 codes that may be used in quality measurement, in public health surveillance, and in post-marketing safety assessment.

Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO)

Project Duration: 2003–2019
Contract With: Centers for Medicare & Medicaid Services (CMS)

11th Statement of Work, 2014–2019

As the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for four states and the U.S. Virgin Islands, HSAG provides technical assistance, convenes learning and action networks to share best practices, and collects and analyzes data to improve clinical care delivered to patients at local and regional levels. Our team supports this QIN-QIO work by designing and directing quality improvement interventions related to medication safety and prevention of adverse drug events (ADEs), devising recruitment strategies to partner with community healthcare providers and managed care organizations, and providing technical support for data analyses and implementation of interventions.

10th Statement of Work, 2011–2014

Working with hospitals, nursing homes, physician offices, home health agencies, and Medicare Advantage organizations from 2011 to 2014, HSAG conducted quality improvement activities that required multilevel data analyses to determine baseline and remeasurement rates, assess effectiveness of interventions, and monitor progress toward project goals. For the Reducing Adverse Drug Events Project, we worked with community healthcare providers to deliver clinical pharmacy services to high-risk beneficiaries. During the project, we provided ongoing support to the communities for process improvement and data collection.

Critical Access Hospital Medication Error Reduction

Project Duration: 2003–2011
Contract With: Florida Department of Health, Office of Rural Health

HSAG partnered with the University of Florida to work with Florida’s critical access hospitals on a patient safety initiative to reduce medication errors. The team led a learning and action network of participating facilities, hosted an annual meeting on patient safety, and identified rural-appropriate interventions that resulted in quality improvement of medication management within critical access hospitals.