Click the plus sign (+) for each current technical expert panel (TEP) to learn how to get involved.

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 opens on December 19, 2024 and closes on January 20, 2025. Submit all nomination materials by the closing date.

Project Overview:

The Centers for Medicare & Medicaid Services (CMS) contracted 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 name is Kidney Disease Quality Measure Development, Maintenance, and Support. The contract number is 75FCMC18D0041 and the task order number is 75FCMC23F0001. As part of its measure development process, University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) 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 members of the dialysis

Seeking the Following Perspectives/Expertise:

We are seeking individuals with differing perspectives and areas of expertise, such as

• Patients 18 years or older who are receiving long-term dialysis in the United States/ US Territory;
• Dialysis care providers including nephrologists, nurses, social workers, and administrative staff;
• Individuals with consumer/patient/family perspective and consumer and patient advocates; specifically, patients with long-term dialysis; 
• Individuals with perspectives on healthcare disparities in ESRD; 
• Expertise in performance measurement and quality improvement;
• Expertise in patient reported outcomes and instrument development or implementation;
• Expertise in medical ethics 

TEP Expected Time Commitment:

Attend 2-3 virtual meeting, approximately 2-3 hours in duration. The meeting will take place between February- March, 2025. 

The meeting will be held virtually, via a Zoom video conferencing platform. 

Next Steps:

Please read the TEP Charter and complete the TEP Nomination Form. You may access these documents by selecting the title of each document:

• TEP Charter
• TEP Nomination Form

Behavioral Health Measures Development & Inpatient and Outpatient Measures Maintenance 

Project Title: Behavioral Health Measures Development & Inpatient and Outpatient Measures Maintenance 

Dates: The Technical Expert Panel (TEP) nomination period opens on November 12, 2024, and closes on January 15, 2025. Submit all nomination materials by the closing date. 

Project Overview: 

The Centers for Medicare & Medicaid Services (CMS) contracted Mathematica to develop measures for select quality reporting and payment programs. The contract name is Behavioral Health Measures Development and Inpatient and Outpatient Measure Maintenance (BHIOMM). The contract number is 75FCMC18D0032 and the task order number is 75FCMC24F0136. 

As the organizer of this TEP, Mathematica convenes groups of interested parties and experts who contribute guidance and thoughtful input on Mathematica’s work and analysis. TEP meetings are conducted virtually and will focus on soliciting review, prioritization, and feedback on new measure concepts, draft measure specifications and results from alpha and beta testing and public comment. 

Seeking the Following Perspectives/Expertise: 

We are seeking individuals with differing perspectives and areas of experience or expertise in inpatient psychiatric facilities, hospitals, or hospital outpatient settings, such as: 

• Patients and caregivers 
• Consumer/patient advocates 
• Health care providers 
• Health system and hospital representatives 
• Policymakers 
• Epidemiologists and other researchers 
• Rural providers and/or providers who can help advance CMS’s Rural Health Strategy [1,2] by applying a rural lens to the work, keeping in mind the objectives of the Rural Health Strategy that are relevant to quality measures.[3] 
• State health, mental health, and substance use agency representatives 
• Experts in measurement science and data sources used to support measurement 
• Experts in health information technology and interoperability including EHR and data vendors 

TEP Expected Time Commitment:

TEP members will participate in quarterly working meetings throughout each year of the contract (2024-2029). Workgroup meetings of 90-120 minutes each will be scheduled based on need and TEP member availability. Review of materials prior to meetings may be necessary and will take no more than 30 minutes. All TEP meetings will be conducted virtually and audio recorded.

Next Steps:

Please read the TEP Charter and complete the TEP Nomination Form. You may access these documents by selecting the title of each document:

• BHIOMM TEP Charter
• BHIOMM TEP Nomination Form

References

1. https://www.cms.gov/newsroom/press-releases/cms-announces-agencys-first-rural-health-strategy
2. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Rural-Strategy-2018.pdf
3. Objectives of CMS’s Rural Health strategy that are relevant to quality measures include reducing reporting burden for rural providers, and ensuring that measure sets are streamlined, outcomes-based, and meaningful to rural providers and patients.