Industry Insight

Telehealth Surge Triggers Changes to Quality Measures

The Board of Directors of the National Committee for Quality Assurance (NCQA) approved a sweeping set of adjustments to 40 of its widely used Healthcare Effectiveness Data and Information Set (HEDIS) measures—in support of health plans, clinicians, and patients who rely on telehealth services in record numbers as a result of the disruption brought on by the COVID-19 pandemic.

The changes will apply to the measurement of health care quality, starting this year. They align with recent telehealth guidance from the Centers for Medicare & Medicaid Services and other federal and state regulators.

“You cannot drive quality improvement if your measures don’t take into account what has quickly become the fastest-growing modality for providing health care services,” says NCQA President Margaret E. O’Kane. “The timely approval by our board of these changes signals that we understand the important role telehealth has played in making care available amid an unprecedented national lockdown and that it will continue to be an important part of the health care system going forward.”

The 40 HEDIS measures that have new accommodations for telehealth are the following:

• Prevention and Screening: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents, Breast Cancer Screening, Colorectal Cancer Screening, and Care for Older Adults;

• Respiratory: Use of Spirometry Testing in the Assessment and Diagnosis of COPD, and Asthma Medication Ratio;

• Cardiovascular Conditions: Controlling High Blood Pressure, Persistence of Beta-Blocker Treatment After a Heart Attack, Statin Therapy for Patients with Cardiovascular Disease, and NEW MEASURE: Cardiac Rehabilitation;

• Diabetes: Comprehensive Diabetes Care, NEW MEASURE: Kidney Health Evaluation for Patients with Diabetes, and Statin Therapy for Patients with Diabetes;

• Musculoskeletal Conditions: Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis - Scheduled for Retirement, Osteoporosis Management in Women Who Had a Fracture, and NEW MEASURE: Osteoporosis Screening in Older Women;

• Behavioral Health: Antidepressant Medication Management, Follow-up Care for Children Prescribed ADHD Medication, Follow-up After Hospitalization for Mental Illness, Follow-up After Emergency Department Visit for Mental Illness, Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication, Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia, Diabetes Monitoring for People with Diabetes and Schizophrenia, and Adherence to Antipsychotic Medications for Individuals with Schizophrenia;

• Care Coordination: Transitions of Care, and Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions;

• Access/Availability of Care: Prenatal and Postpartum Care, and Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics;

• Utilization: Well-Child Visits in the First 30 Months of Life, Child and Adolescent Well Care Visits, and Mental Health Utilization;

• Risk-Adjusted Utilization: Plan All-Cause Readmissions, Hospitalization Following Discharge from a Skilled Nursing Facility, Acute Hospital Utilization, Emergency Department Utilization, and Hospitalization for Potentially Preventable Complications; and

• Measures Reported Using Electronic Clinical Data Systems: Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults, Depression Screening and Follow-Up for Adolescents and Adults, Postpartum Depression Screening and Follow-Up, Prenatal Depression Screening and Follow-Up, Breast Cancer Screening, Colorectal Cancer Screening, and Follow-Up Care for Children Prescribed ADHD Medication.

Updates to these 40 measures will be reflected in HEDIS Volume 2 Technical Specifications, to be published on July 1, 2020. Telehealth revisions will be outlined in each measure specification’s “Summary of Changes” section.

Changes to all NCQA programs resulting from the pandemic are summarized at www.ncqa.org/covid.

NCQA will continue to evolve HEDIS and other products to reflect and reinforce new technology.

— Source: National Committee for Quality Assurance

 

AAOS to Collect COVID-19 Data via ICD-10 Code

Effective immediately, the American Academy of Orthopaedic Surgeons’ (AAOS) Registry Program will begin collecting COVID-19 data through the capture of the ICD-10 code for COVID-19 confirmed diagnosis, U07.1. The new code is enabled across each of the AAOS registries, including the American Joint Replacement Registry, the world’s largest national registry of hip and knee joint replacement data by annual procedural count; the Shoulder & Elbow Registry; the Musculoskeletal Tumor Registry, and the American Spine Registry, a collaborative effort between the American Association of Neurological Surgeons and the AAOS.

Why Now?
The AAOS has taken swift action to understand COVID-19’s current and future impact on musculoskeletal care. With more than 1.97 million procedures across four registries, the AAOS Registry Program already collects clinical data to support orthopaedic surgeons, hospitals, health systems, and ambulatory surgery centers in providing the highest quality musculoskeletal care. Now more than ever, it is critical to collect data that will provide additional insights on the quality of care and outcomes of orthopaedic patients in the COVID-19 environment.

What Will the Data Reveal?
By adding the ICD-10 code to the AAOS Registry Program, sites that contribute the data will have the ability to monitor the impact of COVID-19 on patients undergoing future joint replacement procedures. Tracking COVID-19 data will help analyze the impact of COVID-19 on outcomes, trends of surgery based on the pause in elective surgery, and the trends of patient-reported outcomes due to delayed procedures. It will also track the potential impact on value-based payment models and coverage for patients recovering from COVID-19. On a broader scale, long-term data from the registries may allow for future insights into COVID-19 and its impact on clinical outcomes.

Key learnings from the AAOS’ Registry Program will be delivered to participants, the orthopaedic community, and the broader public throughout the coming years.

How Are Current and New Registry Participants Impacted?
Hospitals, health care systems, practice groups, and ambulatory surgery centers already participating in the registries will not need to join a new registry or engage in a new way to submit their data. Capturing this code will not change the site’s workflow since it was added as an accepted value for existing diagnosis or comorbidity code files. The ICD-10 code can be submitted as a preoperative comorbidity or prior diagnosis present on admission and as a reason for readmission.

Participants who have questions about submitting the new code can reach out to AAOS Registry Support at RegistrySupport@aaos.org for assistance. To enroll in a registry, contact an AAOS Registry engagement associate via e-mail RegistryEngagement@aaos.org or phone 847-292-0530.

— Source: American Academy of Orthopaedic Surgeons

 

CTA Launches Standard for AI in Health Care

More than 50 organizations—from major tech giants to startups and health care industry leaders—convened by the Consumer Technology Association (CTA) have developed the first-ever ANSI-accredited standard for the use of artificial intelligence (AI) in health care. This standard, part of CTA’s new initiative on AI, is the first in a series that will set a foundation for implementing medical and health care solutions built on AI.

“This standard creates a firm base for the growing use of AI in our health care—technology that will better diagnose diseases, monitor patients’ recoveries, and help us all live healthier lives,” says Gary Shapiro, president and CEO of CTA. “This is a major first step—convening some of the biggest players in the digital health world—to help create a more efficient health care system and offer value-based health care to Americans.”

AI-related terms are used in different ways, leading to confusion—especially in the health care industry, including telehealth and remote patient monitoring. To address this problem, CTA announced the working group with 30 members a year ago, which now includes a wide range of decision makers from 52 organizations and member companies to develop a standard built on consensus. The standard—11 definitions and characteristics—provides a framework for better understanding AI technologies and common terminology so consumers, tech companies, and care providers can better communicate, develop, and use AI-based health care technologies.

A broader AI committee at CTA also published an ANSI-accredited standard that addresses the pervasiveness of AI-enabled technology across the entire consumer technology industry. The standard defines more than 30 terms including machine learning, model bias, artificial neural network, and trustworthiness.

“So far, common terminology has defined the intent of use—and that’s one of the most significant challenges in developing standard application of AI,” says Rene Quashie, vice president of policy and regulatory affairs, digital health at CTA. “As health systems and providers use AI tools such as machine learning to diagnose, treat, and manage disease, there’s an urgent need to understand and agree on AI concepts for consistent use. This standard does exactly that.” As the health care system deals with clinician shortages, an aging population, and the persistence of chronic diseases in the United States, technologically driven solutions, such as AI, will increasingly be used to meet clinician and patient needs, the group notes.

Among the definitions, the standard includes highly debated terms such as “assistive intelligence,” which the group defined as a category of AI software that “informs” or “drives” diagnosis or clinical management of a patient, however the health care provider makes the ultimate decisions before clinical action is taken.

“AI will play a major role in driving efficiency in health care and will support clinicians in making more precise diagnosis, offer personalized treatment and better guidance towards improved outcomes,” says Pat Baird, regulatory head of global software standards at Philips and cochair of the working group. “This implies that AI will be used for decision support and decision making, which stresses the need for professionals to be able to take ownership, apply judgment, and empathy. Transparency and a common language will be key to enable the proper and safe functioning of AI.”

Other definitions include terms such as deidentified data, synthetic data, remote patient monitoring, and patient decision support system.

— Source: Consumer Technology Association

 

PatientKeeper Appoints John M. Kelly Chief Technology Officer

PatientKeeper recently announced the appointment of John M. Kelly as Chief Technology Officer (CTO). As CTO, Kelly will lead PatientKeeper’s engineering organization, comprising the software development, quality assurance, dev-ops, and UI/UX teams.

Kelly has more than 20 years of experience creating and aligning organizations to develop innovative software solutions for a range of industries including health care. He joins PatientKeeper from Cigna, where he most recently held the title of IT managing director, serving as chief technologist for multiple business lines over 11 years. Previously, Kelly held technology leadership positions at Matria Healthcare and WinningHabits.com.

“Joining PatientKeeper gives me an opportunity to have a direct impact on the delivery of health care, at a time when clinicians are demanding that information technology serves them better and provider organizations are hungry for solutions,” Kelly says. “PatientKeeper has a long history of technology innovation and is well positioned to meet the evolving needs of providers and other members of the extended care team.”

— Source: PatientKeeper