Information Gathering 6.
Step 7: Prepare a business case for candidate measures
After the list of potential measures has been presented to the TEP and narrowed to create the list of candidate measures, develop a business case for each candidate measure and document it in the Measure Justification from. Most of the information needed to develop the business case will have been obtained through the initial information gathering. In developing the business case, the measure contractor may need to look for additional information.
Not all topics are associated with financial savings to Medicare; however, a topic may be beneficial for society in general or may be of ethical value. The benefits derived from interventions promoted by the quality measures should be quantified whether in terms of a business case, economic case, or social
case. The following types of information should be systematically evaluated to build the business case. Business case examples are available upon request.
Incidence/prevalence of condition in Medicare population.
The major benefits of the process or intermediate outcome under consideration for measure (e.g., heart attacks not occurring, hospital length of stay decreased) and the expected
magnitude of the benefits.
Untoward effects of process or intermediate outcome and the likelihood of their occurrence (e.g., bleeding from anticoagulation, death from low blood glucose levels).
Cost statistics relating to:
o Cost of implementing the process to be measured. o Savings that result from implementing a process. o Cost of treating complications that may arise.
Current process performance, intermediate outcomes, and performance gaps. Size of improvement that is reasonable to anticipate.
Development of A Framework for Measurement Gap Analysis
Example4
Below is an example of a framework for assessing needed outcomes measures. This framework facilitates selecting outcome measures that include the full scope of services for a cycle of care (moving across the table from left to right), and that assess multiple dimensions of quality for each health system function (moving within columns across the IOM and primary care domains of quality) as required by ACA Section 10303.
Example: Framework for assessing needed outcomes measures
Quality Domain Population at Risk (Outcomes of Primary Prevention) Initial Recognition and Management Management of Acute Event / Surgery Transitional Care (Post-Acute) Management of Chronic Disease / Sustaining Health Status Effective Timely Efficient Safe Patient-Centered - Whole person oriented - Sustained partnership - Continuous - Integrated / coordinated Equitable
Template for Call for Measures Web Page Posting Project Overview: <insert title>
The Centers for Medicare & Medicaid Services (CMS) has contracted with <contractor name> to develop <measure set name or description>. The purpose of the project is to develop measures that can be used to promote quality care to Medicare beneficiaries. As part of its measure development process, CMS may request that interested parties submit candidate or concept measures that may be suitable for this project. If you are submitting fully developed or endorsed measures, attach any additional measure information to the email.
The candidate measures and measure suggestions will be reviewed by CMS, the measure development contractor(s), and Technical Expert Panels convened by the measure contractor. Candidate measures can be access, outcome, process, structure, overuse, underuse, patient experience of care, and care coordination measures. Any measure(s) adapted or adopted for inclusion in the final measure set will reside in the public domain.
Specific objectives include:
<list contract objectives>
The development process includes:
Identifying important quality goals related to topic/condition or setting of focus
Conducting literature reviews and grading evidence
Defining and developing specifications for each quality measure
Obtaining evaluation of proposed measures by technical expert panels
Posting for public comment
Testing measures for reliability, validity, and feasibility
Refining measures as needed
Details about the measure development process can be found in the Measures Management System Blueprint https://www.cms.gov/MMS/19 MeasuresManagementSystemBlueprint.asp#TopOfPage.
Instructions:
Submit the candidate or concept measures on the “Measures Submitted for Consideration” form that is available from the CMS Web site at https://www.cms.gov/MMS/13 CallForMeasures.asp.
If you are submitting fully developed or endorsed measures, attach any additional measure information to the email.
Email the completed form and any attachments to: <insert email address>.
Measures Submitted for Consideration Date Submitted First/Last Name Suffix (MD, PhD, etc.)/Title Organization/Mailing Address Telephone/FAX E-mail
Candidate measure(s) submitted for consideration (if additional measure information is available, send as an attachment to the e-mail)
Measure
Name Description Brief Numerator Statement Denominator Statement
Public Domain Yes/No*
Care
Setting Information Other
*Do you have any commercial, financial or intellectual interest (refer below for definitions) in the candidate measure(s) you are submitting? If yes, please describe the relationship:
Commercial Interest—A “commercial interest” as defined here, consists of any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies.
Financial Relationships—Financial relationships are those relationships in which benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. A minimal dollar amount for relationships to be significant has not been set. Inherent in any amount is the incentive to maintain or increase the value of the relationship. “Relevant” financial
Intellectual Interest—Intellectual interests may be present when the individual is a principle researcher/investigator in a study that serves as the basis for one or more to the potential performance measure under consideration.
Information Gathering Report
Project Name: Submitter Name: Date:
Note: If studies and guidelines do not pertain to a measure set in its entirety, but rather are specific to a measure, please indicate that in the summaries.
Search Methodology
Provide a complete explanation of all research tools used, including all online publication directories, keyword combinations, and Boolean logic used to find studies and clinical practice guidelines.
Summary of Literature Review-Studies (Annotated bibliography)
Provide the following information (by individual measure, or, if directed by CMS, provide the information by measure sets): 1. Complete literature citation
2. Level of evidence, rating scheme used
3. Characteristics of the study (population, study size, data sources, study type and methodology)
4. Name which of the four measure evaluation criteria (importance, scientific acceptability, usability, and feasibility) the study addresses. (Sorting the literature review by these criteria will facilitate the development of the measure justification in the later phases of measure development or reevaluation.)
5. Information gathered to build the business case for the measure a) Incidence/prevalence of condition in Medicare population.
b) Identify the major benefits of the process or intermediate outcome under consideration for the measure. c) Untoward effects of process or intermediate outcome and likelihood of their occurrence.
d) Cost statistics relating to cost of implementing the process to be measured; savings that result form implementing process; and cost of treating complications that may arise.
e) Current performance of process or intermediate outcome and identifying gaps in performance. f) Size of improvement that is reasonable to anticipate.
6. Summary of findings
7. Other pertinent information, if applicable
Summary of Clinical Practice Guidelines
2. Developer 3. Year published
4. Summary of major recommendations 5. Level of evidence
6. If multiple guidelines exist, note inconsistencies and rationale for using one guideline over another
Measures Gap Analysis
Provide a summary of findings and measurement gaps.
Existing Related Measures
List measures identified.
Measure Name
and Description Numerator and Denominator Data Source Care Setting and Unit of Analysis Developer Comments1
Empirical Data Analysis
For new measures:
1. If available, data source(s) used 2. Time period
3. Methodology 4. Findings
For a measure reevaluation contract, refer to the Comprehensive Reevaluation Form. 1. Obtain current performance data on each measure
2. Analyze measure performance to identify opportunities to improve the measure 3. Provide a summary of empirical data analysis findings
1
Comments may include the potential for adaptation or adoption to meet the measure contractor’s requirements.
1. Summarize overall findings from the input received
2. Name of the person(s) interviewed, type of organization(s) represented, date(s) of interview, the interviewee’s area of quality measurement expertise, etc.