2025 Nomination Period
- Development and Evaluation of Exchange Health Plan Quality Initiatives (QRS/QIS)
Project Title: Development and Evaluation of Exchange Health Plan Quality Initiatives (QRS/QIS)
Dates:
- The Call for Technical Expert Panel (TEP) nomination period closed on March 10, 2025.
- The TEP met on May 21, 2025.
Project Overview:
The Centers for Medicare & Medicaid Services (CMS) contracted Booz Allen Hamilton (Booz Allen) to implement the Development and Evaluation of Exchange Health Plan Quality Initiatives (QRS/QIS) in fulfillment of the statutory and regulatory requirements of 1311(c)(3) of the Patient Protection and Affordable Care Act (PPACA). The contract name is Development and Exchange of Health Plan Quality Initiatives (QRS/QIS). The contract number is 75FCMC18D0019. As the organizer of this TEP, Booz Allen convenes groups of stakeholders and experts who contribute direction and thoughtful input on their work and analysis. The QRS/QIS TEP will advise on the continued implementation of the QRS and QIS by providing input on topics such as public engagement efforts, guidance materials, data analysis and methodology, and measure set refinements.
Documents:
You may access the TEP Summary Report, TEP Membership List, and TEP Charter by clicking the title of each document:
- Assessment of Patient Autonomy in ESRD Treatment Decision-Making
Project Title: Assessment of Patient Autonomy in ESRD Treatment Decision-Making
Dates: The Technical Expert Panel (TEP) nomination period closed on January 17th, 2025
Project Overview:
The Centers for Medicare & Medicaid Services (CMS) has contracted with the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) to collect stakeholder feedback for the assessment of patient autonomy in ESRD treatment decision making. The contract number is 775FCMC18D0041, task order number75FCMC23F0001. As part of its measure development process, the University of Michigan Kidney Epidemiology and Cost Center convenes groups of stakeholders who contribute direction and thoughtful input to the measure developer during measure development and maintenance.
In our society, there is a fundamental expectation that health care providers respect patient autonomy or choice in the process of shared decision-making. In practice, clinicians are trained that the informed consent process is one way in which we document our adherence to this critically important ethical principle. Addressing patient autonomy, patient choice, and informed consent during the measure development and maintenance process will be essential if new and pre-existing clinical outcome quality measures are to be truly patient centered and judged valid by the dialysis community.
What is somewhat less emphasized is the principle that informed consent and patient choice is very dependent on the quality and quantity of information provided about the risks, benefits, and alternatives available for treatment. Multiple barriers may affect shared decision making and informed consent, including inadequate education by the healthcare team, healthcare provider bias, limited understanding of medical concepts by the patient due to cognitive or educational limitations, and potential limitations of the provider-patient relationship. These can undermine the development of true informed consent for medical care as well as well-informed patient decisions about their care, and therefore, provide potential challenges to successful adherence to the principle of patient autonomy. In addition, financial or other incentives may sway healthcare providers to direct patients towards a particular type of treatment. It is often very difficult to determine how many of these issues are present in any given treatment choice. When present, it is also difficult to determine if the issue influences the appropriate use of informed consent principles and practice regarding patient autonomy in treatment choices.
Identification of a method for assessing the contribution of patient choice in medical decisions is critical. In addition, quality improvement programs generally provide incentives for providers to deliver ESRD care in ways supported by evidence. These incentives may not be aligned with patient choice for those who choose an alternative treatment paradigm. Many clinicians and patients involved in the consensus endorsement process have voiced concerns that implementation of quality metrics failing to explicitly address patient choice may result in unacceptable consequences for member of the dialysis community.
Technical Expert Panel (TEP) Objectives: The TEP will use existing data and their expert opinion to formulate recommendations to UM-KECC regarding the development of a draft measure that addresses important ways to potentially measure patient choice and decision making regarding treatment for patients with ESRD. Recommended measures should be evidence based, scientifically acceptable (reliable and valid), feasible, and usable by CMS, providers, and the public.
Specifically, the TEP will engage in discussion to develop potential quality measures that could create the best practice of patient autonomy given the lack of high quality evidence to guide specific therapies (e.g. nutritional, pharmacologic, surgical). TEP input will be sought regarding potential sources of data such as the EQRS system and Medicare claims that may provide useful information about patient autonomy diagnoses, diagnostic testing, medication use, and procedures. The TEP should also consider whether risk adjustment strategies will be needed and if any exclusion criteria should be considered so that the measure is usable from both patients’ and providers’ perspectives.
Perspectives/Expertise: We sought individuals with differing perspectives and areas of expertise, such as
- Nephrology providers (physicians, advanced practice providers), nephrology trained social workers, dieticians, and dialysis facility nursing staff
- Consumer/Patient/Family/Care Partner perspective
- Performance measurement experts
- Quality improvement experts
- Medical Ethicists
TEP Expected Time Commitment: 2-3 virtual meetings each being between 2 to 3 hours long. Meetings are tentatively scheduled for May-July, 2025.
Call details can be found on this webpage: https://dialysisdata.org/content/esrd-measures
Documents: You may access the TEP Membership List by clicking the title of the document: