dental emeasures rfp

7/28/2019 Dental eMeasures RFP

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Request for Proposal: Assuring feasibi lity, reliability, validity and usability ofeMeasures

Project Information

Project Name: Testing Dental Quality Alliance (DQA) eMeasures

Deadline for receipt of proposals: June 30, 2013

(Please submit a letter of intent by June 1, 2013. While not mandatory it will help us plan our review process)

Earliest Possible Award Date: J uly 30, 2013

Expected Completion Date: November 15, 2013

Primary Contact: Dr. Krishna Aravamudhan

Project Plan

Project Goal

Propose and test an efficient/ sustainable process to assure validity, reliability and feasibility ofeMeasures in dentistry.

Establish feasibility, reliability, validity and usability of two DQA eMeasures (Run report level:Practice site )

Project Deliverables

Protocol for testing eMeasures in dentistry [Through this effort we would like to establish a

sustainable cost-effective process for eMeasure validation and identify existing resources thatcan be used to validate additional measures in future.] Reports on feasibility, reliability and validity of two DQA e-measures using proposed

methodology Final specifications and complete value sets Bi-weekly updates to DQA Committee (This partnership ensures that knowledge gathered

through the testing process is used in refining and finalizing the measure specifications.Measure specifications provided may be considered as draft. We do not want to be in asituation where the testing is completed based on the draft provided and then we have tomodify the specifications to address feasibility issues resulting in significant modifications to themeasures such the reliability and validity data are no longer useful. Feasibility should be testedas and when specifications are iterated. Please think about an integrated approach to validation

rather than looking at feasibility/ reliability and validity as separate phases. The Appendix hadinformation on what the DQA has already accomplished. So please do not duplicate effort.)

Presentation of findings at next DQA meeting Assistance with National Quality Forum (NQF) application


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Background materials to develop proposal

DQA document onexploring feasibility of e-Measures in dentistry

National Quality Forum (NQF)Guidance for testing methodology

Investigator / Contractor Qualifications

Required

Previous experience testing eMeasures or conducting similar research

Informatics expertise (within project team; not necessarily PI; dental preferred)

Ability to test/ generate reports in Meaningful Use certified EHR/ EDR product

Optional (Additional Credits)

Access to existing test bed/ data repository with known values of critical elements

Ability to test/ generate reports in multiple certified EHR products/ practice locations

Ability to test in an integrated (medical/dental) product/setting

Guidelines for information to be included in proposals

Name and Contact Information of principal investigator (PI)

Biographical sketches of PI and proposed co-investigators

Proposed methodology with sampling methodologies and statistical tests that will be used (notto exceed 10 page double spaced with 1 margins. Use Appendices for biosketches, referencesetc.)

Description of EHR systems/ test beds used within the proposal

Detailed budget (Note: A budget limit has not been provided. The proposed methodologyshould justify the resources being sought. Indirect rates are not applicable. This will be acompetitive selection process based on the criteria below with one funded proposal)

Proposed timeline with milestones based on suggested start and end dates

Letters of support from co-investigators, vendors and practice sites etc.

Conflict of Interest declarationOnly complete proposals will be reviewed

Proposal Evaluation Criteria
http://www.ada.org/sections/dentalPracticeHub/pdfs/ARCHIVE_1214_FINAL_DQA_E-Measure_Working_Document.pdfhttp://www.ada.org/sections/dentalPracticeHub/pdfs/ARCHIVE_1214_FINAL_DQA_E-Measure_Working_Document.pdfhttp://www.ada.org/sections/dentalPracticeHub/pdfs/ARCHIVE_1214_FINAL_DQA_E-Measure_Working_Document.pdfhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.ada.org/sections/dentalPracticeHub/pdfs/ARCHIVE_1214_FINAL_DQA_E-Measure_Working_Document.pdf


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Investigators and experience (20%)

Proposed methodology (50%)

Budget (20%)

Timeline (10%)

Terms

Neither this RFP nor any responses hereto shall be considered a binding offer or agreement. If the DQA (through the ADA) and any

responding Respondent decide to pursue a business relationship for any or all of the services or equipment specified in this RFP, the

parties will negotiate the terms and conditions of a definitive, binding written agreement which shall be executed by the parties. Until

and unless a definitive written agreement is executed, DQA shall have no obligation with respect to any Respondent in connection with

this RFP. (NOTE: The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT

(ONC) is interested in pursuing dental eMeasures for the Meaningful Use program. Funding for this project is contingent upon an award

to the DQA from CMS/ONC.)

This RFP is not an offer to contract, but rather an invitation to a Respondent to submit a bid. Submission of a proposal or bid in

response to this RFP does not obligate the DQA to award a contract to a Respondent or to any Respondent, even if all requirements

stated in this RFP are met. The DQA (through the ADA) reserves the right to contract with a Respondent for reasons other than lowest

price. Any final agreement between ADA (on behalf of the DQA) and Respondent will contain additional terms and conditions regarding

the provision of services or equipment described in this RFP. Any final agreement shall be a written instrument executed by duly

authorized representatives of the parties.

Respondents RFP response shall be an offer by Respondent which may be accepted by the DQA. The pricing, terms, and conditions

stated in Respondents response must remain valid for a period of one hundred twenty (120) days after submission of the RFP to the

DQA.

This RFP and Respondents response shall be deemed confidential DQA information. Any discussions that the Respondent may wish

to initiate regarding this RFP should be undertaken only between the Respondent and DQA. Respondents are not to share any

information gathered either in conversation or in proposals with any third parties, including but not limited to other business

organizations, subsidiaries, partners or competitive companies without prior written permission from the DQA.

The DQA reserves the right to accept or reject a Respondents bid or proposal to this RFP for any reason and to enter into discussions

and/or negotiations with one or more qualified Respondents at the same time, if such action is in the best interest of the DQA.

The DQA reserves the right to select a limited number of Respondents to make a Best and Final Offer for the services or equipment

which are the subject of this RFP. Respondents selected to provide a Best and Final Offer shall be based on Respondent

qualifications, the submitted proposal and responsiveness as determined solely by the DQA.

All Respondents costs and expenses incurred in the preparation and delivery of any bids or proposals (response) in response to this

RFP are Respondents sole responsibility.

Applicants should limit the budget to direct costs. Indirect and F & A costs are not allowed.

The DQA reserves the right to award contracts to more than one Respondent for each of the services identified in this RFP.


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All submissions by Respondents shall become the sole and exclusive property of the DQA (through the ADA) and will not be returned

by the DQA or ADA to Respondents.


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Assuring Feasibi li ty, Validi ty, Reliabi li ty and Usabi lity of eMeasures in Dentist ry

This document provides guidance regarding the testing of e-measures developed by the Dental Quality

Alliance (DQA). The sections below provide an overview of the information that needs to be gathered to test

the feasibility, validity, reliability, and usability of e-measures.

Feasibility

A measure will be considered feasible if the data necessary to score the measure are readily available. 1The

National Quality Forum recently published a document regarding the feasibility of eMeasures

athttp://www.qualityforum.org/Projects/e-

g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&p. The DQA has conducted a

preliminary assessment of feasibility for the two measures identified in this RFP. Appendix 1 provides the

results of this assessment.

Reliability

Reliability is the degree to which the measure is free from random error. 2 Reliability testingdemonstrates the

measure data elements are repeatable, producing the same results a high proportion of the time when

assessed in the same population in the same time period and/or that the measure score is precise. 3 Good

reliability testing allows for meaningful comparisons across states, programs, individual providers or

institutional providers.

Validity

Validity demonstrates extent to which a measure truly measures that which it is intended and designed to

measure. Face validity can be established though expert consensus. Evidence from the literature for

comparable measurements can provide additional support.

Usability

Assessing usability assures that the information produced by the measure is meaningful, understandable, and

useful to the intended audience. More information is available from the NQF

athttp://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70845.

1Mangione-Smith R, Schiff J , Dougherty D. Identifying children's health care quality measures for Medicaid and CHIP: an evidence-informed, publicly

transparent expert process. Acad Pediatr. 2011 May-J un;11(3 Suppl):S11-212 Mangione-Smith R, Schiff J , Dougherty D. Identifying children's health care quality measures for Medicaid and CHIP: an evidence-informed, publiclytransparent expert process. Acad Pediatr. 2011 May-J un;11(3 Suppl):S11-213National Quality Forum. Measure Testing task Force Report Accessed athttp://www.qualityforum.org/docs/measure_evaluation_criteria.aspx
http://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70845http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70845http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70845http://www.qualityforum.org/docs/measure_evaluation_criteria.aspxhttp://www.qualityforum.org/docs/measure_evaluation_criteria.aspxhttp://www.qualityforum.org/docs/measure_evaluation_criteria.aspxhttp://www.qualityforum.org/docs/measure_evaluation_criteria.aspxhttp://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70845http://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&p


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Assuring Scient if ic Soundness: NQF Guidel ines

In order to meet the criteria for scientific soundness (reliability and validity), acceptable protocols for testing

must provide information to, at a minimum, achieve the Moderate evaluation rating for validity and reliability.

(REFER complete NQF recommendations

athttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspx)

Rating Reliability Description and Evidence Validity Description and Evidence

High

All EHR measure specifications areunambiguous+and include only data elementsfrom the Quality Data Model (QDM)* includingquality data elements, code lists, and measurelogic; OR new data elements are submitted forinclusion in the QDM;

ANDEmpirical evidence of reliability of both dataelementAND measure score within

acceptable norms: Data elem en t: reliab ility (repeatability)assured with computer programmingmusttest data element validity

AND

Mea sure score: appropriate method, scope ,

and reliability statistic within acceptable norms

The measure specifications (numerator, denominator, exclusions, riskfactors) reflect the quality of care problem (1a,1b) and evidence cited insupport of the measure focus (1c) under Importance to Measure andReport;

ANDEmpirical evidence of validity of both data elementsAND measure scorewithin acceptable norms: Data element: validity demonstrated by analysis of agreement betweendata elements electronically extracted and data elements visually

abstracted from the entire EHR with statistical results within acceptablenorms; OR complete agreement between data elements and computedmeasure scores obtained by applying the EHR measure specifications to asimulated test EHR data set with known values for the critical dataelements;

AND Mea su re s core: app ropriate m ethod, s cope , and validity tes ting res ult

within acceptable norms;

ANDIdentified threats to validity (lack of risk adjustment/stratification, multipledata types/methods, systematic missing or incorrect data) are empiricallyassessed and adequately addressed so that results are not biased

Moder-ate

All EHR measure specifications are

unambiguous+and include only data elementsfrom the QDM;* OR new data elements aresubmitted for inclusion in the QDM;

ANDEmpirical evidence of reliability withinacceptable norms for either data elements ORmeasure score as noted above

The measure specifications reflect the evidence cited under Importance to

Measure and Report as noted above;ANDEmpirical evidence of validity within acceptable norms for either dataelements OR measure score as noted above; ORSystematic assessment of face validity of measure score as a qualityindicator (as described in Table A-3) explicitly addressed and foundsubstantial agreement that the scores obtained from the measure asspecified will provide an accurate reflection of quality and can beused to distinguish good and poor qualityANDIdentified threats to validity noted above are empirically assessed andadequately addressed so that results are not biased

The above referenced NQF document on guidance for measure testing also provides examples for:

Table A-1: Examples of Reliability Testing at the Level of the Computed Performance Measure Score

Table A-2: Examples of Reliability Testing at the Level of the Data Elements

Table A-3: Examples of Validity Testing at the Level of the Computed Performance Measure Score

Table A-4: Examples of Validity Testing at the Level of Data Elements

Table A-5: Examples of Testing Related to Threats to Validity

Table A-6: Examples of Interpretation of Statistical Results
http://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspxhttp://www.qualityforum.org/Publications/2011/01/Measure_Testing_Task_Force.aspx


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Research Objectives

The testing effort must help in finalizing the measure specifications and values sets (Appendix 1); and generate

data required for a successful NQF application. As noted in the guidance provided by NQF some aspects of

validity and reliability can be assessed in a simulated test EHR data set (data repositories) with known values

for the critical data elements. Such a test data set may provide a viable option to establish a cost-effective

sustainable option for testing the some aspects of validity and reliability of eMeasures. Respondents are

encouraged to evaluate feasibility of using such a data set.

The table below provides a list of the questions that must be answered through the testing effort with empirical

data generated through this project. The proposal must provide details of how the researchers plan to

address each of these questions .

Process Question

MeasureIntent/conceptvalidity

Is there an opportunity for quality improvement?Is the health care construct underlying the measure associated with important health careprocesses and/or outcomes?Are all individuals in the denominator equally eligible for inclusion in the numerator?Have all the data elements required to compute the numerator/denominator and exclusionsbeen identified within the technical specifications?How well do the measure specifications capture the event that is the subject of themeasure?Is the measure result under control of those whom the measure evaluates?Is the data captured during the typical course of clinical care?Will the measure rationale and results be easily understood by users of the measure and

resulting data?Technical/ DataElementFeasibility

Is the data element coded using a nationally accepted terminology standards?Are the appropriate Quality Data Model (QDM) elements available to construct the measurelogic?Are the value sets valid?Are the data elements necessary to define numerator/denominator and exclusions readilyavailable in a structured format across EHR systems?To what extent does capturing the data element fit the typical EHR workflow for thatuser/system?Is the data element accurate i.e. is it generally captured by the most appropriate personinvolved in the clinical workflow?Are there differences between medical and dental systems that need to be accounted for in

the logic?ImplementationFeasibility/ DataElementReliability &Validity

Will there be interpretation issues if vendors rely on the human readable logic alone toprogram into their systems? Will the systems generate the correct score for a test data set?(Data element validity requires demonstration that there is complete agreement betweendata elements and computed measure scores obtained by applying the measurespecifications to a simulated test EHR data set with known values for the critical dataelements)Can a performance report be generated?Are the results from the measure repeatable between systems? (Especially needs testing if


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vendors use the human readable form of the measure to program into their systems).What is percentage of missing or invalid data for each data element? Does this vary bysystem?

Measure Scorereliability

Does the measurement score truly represent what it is intended to measure? Does thescore have reliability statistic within accepted norms?Does the measure provide for fair comparisons of the performance of providers or

facilities?Does the measure allow for adjustment of the measure to exclude patients whenappropriate? Are there additional exclusions not included in the specifications that impactthe measure score?Do data elements for exclusions score low on feasibility?To what extent do the exclusions due to missing or invalid data impact the measurementscore? (The National Quality Forum provides additional guidance on testing for threats tovalidity from missing or incorrect data or exclusions (selection/attrition bias)(http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116).Sensitivity analyses with and without the exclusion, and variability of exclusions acrossmeasured entities can be used to determine the impact of missing or incorrect data on theresulting measure.

Final e-MeasureUsability To what extent are the measure rationale and results easily understood by the providers,vendors, and other users of the measure and resulting data?To what extent are the measure results reportable in a manner useful to health careorganizations and other interested stakeholders?

In developing the draft specifications and this RFP the DQA has completed some preliminary work towards

answering the questions listed above. Please ensure that your proposal DOES NOT dupl icate any of this

effort. The work accomplished by the DQA includes:

1. Measure Intent: Performance gaps using claims data for the same measure concepts.

2. Technical/ Data Element Feasibility: Phase 1 feasibility survey(Appendix 2)
http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=59116


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Appendix 1: DRAFT specifications to develop the e-Measures

E-Measure: Care Continuity

Measure Concept: Children who receive a comprehensive or periodic oral evaluation in two consecutive years

Measure intentin plain language

This measure is based on the evidence that kids should at least have an annual exam.

The initial patient population captures all kids under age 21 who had a visit. The first visit should start at

1 year. So the kids need to be 1 year in the year prior to the measurement year i.e. 2 years at start of

measurement year.

The denominator is the children who had an exam in the measurement year.

The numerator then captures the kids who had an oral exam in the measurement year and in the year

prior to the measurement year. Note that with a true electronic patient record that follows a patient

through the healthcare system continuity of care across practices can be determined. When the

patients record does not follow them and they switch providers, this measure will only capture

patients who were provided an oral evaluation by the same provider/practice over two years.

There are no exclusions.

This measure is usable in a dental setting as well as in a pediatricians office. Pediatricians usually

provide comprehensive oral exam for young children.

Measurement period =a year

Description: Percentage of children who were seen by a practitioner during the measurement period who

received a comprehensive or periodic oral evaluation in the year prior to the measurement year who also

received a comprehensive or periodic evaluation in the measurement year.

Numerator: Unique number of children under age 21 who received a comprehensive or periodic oral

evaluation in the measurement year and in the year prior to the measurement year.

Denominator: Unique number of children under age 21 who received a comprehensive or periodic oral

evaluation in the measurement year.

Exclusions/Exceptions: None.

Stratifications:

1. Race

2. Ethnicity

3. Payer Type


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E-Measure Specification: Care ContinuityPopulation and Data Criteria

Initial Patient Population = Include all patients who meet the following criteria

Age >=2 years starts before start of Measurement Start Date AND Age =2 year(s) starts before start of "Measurement Start Date"AND: "Patient Characteristic Birthdate: birth date"


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E-Measure: Prevent ion: Sealants for 6-9 year olds

Measure Concept: Children aged 6-9 years who receive sealants in the first permanent molar

Measure intentin plain language

This measure is based on strong evidence that use of sealants reduces the incidence of caries/cavities.

The measure applies to dental practices only. However there are practices such as those within an

FQHC setting which might thought to be integrated with a medical practice. This measure would apply

to such practices.

The initial patient population captures all children between age 6 - 9 who had a preventive visit/ oral

evaluation

The denominator captures all children between ages 6 9 years who at high risk for cavities

The numerator captures kids who meet the denominator criteria and have received sealants in their

permanent first molar tooth. We all have 4 permanent first molars and this measure does not

discriminate between the teeth but only intends to capture if a kid received sealant in any one of the

four permanent first molars.

Capturing risk can be done in two ways in the normal clinical workflow. It can just be done using

professional judgment and recorded as a diagnosis using a SNOMED code or some EHRs have a

risk assessment tool built into the EHR workflow. The risk assessment tools are not standardized and

hence we need to allow for different options to capture risk. Risk should be captured during the

measurement year and remain an active diagnosis until procedure is performed. Risk status is usually

reconciled at each examination visit. The status could have been diagnosed prior to the measurement

year.

The exclusions used are whether the procedure was not performed due to patient or system reasons.

The intent to just use these as radio buttons within the EHR rather than have more granular reasons

captured. The exclusion should be related to the sealant rather than something else in the treatment

plan during the visit.

Description: Percentage of children between 6-9 years seen by the practitioner for an oral evaluation

during the measurement period who are at elevated risk who received a sealant on a one or more first

permanent molar tooth within the measurement period.

Numerator: Unique number of children aged 6-9 atelevatedrisk who received a sealant on one or more first

permanent molar tooth in the measurement period


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DRAFT Value Sets for Measures

Value set, (previously referred to as code list), is a set of values that contain specific codes derived from a

particular taxonomy. With respect to value sets, a value is a specific code defined by a given taxonomy. Values

are included in value sets. The National Library of Medicine (NLM), in collaboration with the Office of theNational Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services

(CMS), has launched the NLM Value Set Authority Center (VSAC) and thus coordinates the data elements and

vocabularies included within the value sets for clinical quality measures within the Meaningful Use program.

Presented below are the value sets for the concepts used within the specifications of this measure set. For

each concept, codes from vocabularies specified as standards within the Meaningful Use regulation are

included within the tables.

Sealant

QDM Category Code System Code System Version Code Descriptor

Procedure CDT 2013 D1351

Oral Evaluation


Encounter/ Procedure CDT 2013 D0120



Elevated Caries Risk: Diagnos is


Diagnosis SNOMED 2013 TBD TBD (available May 2013)Diagnosis SNOMED 2013 TBD TBD (available May 2013)

Diagnosis SNOMED 2013 TBD TBD (available May 2013)

Elevated Caries Risk: Procedure with finding


Procedure CDT 2013 TBD TBD (available May 2013)

Procedure CDT 2013 TBD TBD (available May 2013)

First Permanent Molar


Attribute SNOMED 2013 304565009 Entire permanent first molar tooth

Face to Face Interaction (NCQA)

QDMCategory

CodeSystem

Code SystemVersion

Code Descriptor

Encounter SNOMEDCT 2012-07 12843005 Subsequent hospital visit by physician (procedure)

Encounter SNOMEDCT 2012-07 18170008 Subsequent nursing facility visit (procedure)

Encounter SNOMEDCT 2012-07 185349003 Encounter for "check-up" (procedure)

Encounter SNOMEDCT 2012-07 185463005 Visit out of hours (procedure)

Encounter SNOMEDCT 2012-07 185465003 Weekend visit (procedure)

Encounter SNOMEDCT 2012-07 19681004 Nursing evaluation of patient and report (procedure)


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Encounter SNOMEDCT 2012-07 207195004 History and physical examination with evaluation and managementof nursing facility patient (procedure)

Encounter SNOMEDCT 2012-07 270427003 Patient-initiated encounter (procedure)

Encounter SNOMEDCT 2012-07 270430005 Provider-initiated encounter (procedure)

Encounter SNOMEDCT 2012-07 308335008 Patient encounter procedure (procedure)

Encounter SNOMEDCT 2012-07 390906007 Follow-up encounter (procedure)

Encounter SNOMEDCT 2012-07 406547006 Urgent follow-up (procedure)

Encounter SNOMEDCT 2012-07 439708006 Home visit (procedure)

Encounter SNOMEDCT 2012-07 4525004 Emergency department patient visit (procedure)Encounter SNOMEDCT 2012-07 87790002 Follow-up inpatient consultation visit (procedure)

Encounter SNOMEDCT 2012-07 90526000 Initial evaluation and management of healthy individual (procedure)

Preventive Care - Established Offi ce Visit, 0 to 17 (NCQA)

QDMCategory

CodeSystem

CodeSystemVersion

Code Descriptor

Encounter CPT 2012 99391 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; infant (age younger than 1year)

Encounter CPT 2012 99392 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; early childhood (age 1through 4 years)

Encounter CPT 2012 99393 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; late childhood (age 5 through11 years)

Encounter CPT 2012 99394 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; adolescent (age 12 through17 years)

Preventive Care- Initial Office Visit , 0 to 17 (NCQA)

QDMCategory

CodeSystem

CodeSystemVersion

Code Descriptor

Encounter CPT 2012 99381 Initial comprehensive preventive medicine evaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)

Encounter CPT 2012 99382 Initial comprehensive preventive medicine evaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4years)

Encounter CPT 2012 99383 Initial comprehensive preventive medicine evaluation and management of an

individual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11years)

Encounter CPT 2012 99384 Initial comprehensive preventive medicine evaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17years)


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Preventive Care Services - Established Office Visit, 18 and Up (NCQA)

QDMCategory

CodeSystem

CodeSystemVersion

Code Descriptor

Encounter CPT 2012 99395 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; 18-39 years

Encounter CPT 2012 99396 Periodic comprehensive preventive medicine reevaluation and management of an

individual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; 40-64 years

Encounter CPT 2012 99397 Periodic comprehensive preventive medicine reevaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, established patient; 65 years and older

Preventive Care Services-Initial Office Visit, 18 and Up (NCQA)

QDMCategory

CodeSystem

CodeSystemVersion

Code Descriptor

Encounter CPT 2012 99385 Initial comprehensive preventive medicine evaluation and management of anindividual including an age and gender appropriate history, examination,

counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; 18-39 yearsEncounter CPT 2012 99386 Initial comprehensive preventive medicine evaluation and management of an

individual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; 40-64 years

Encounter CPT 2012 99387 Initial comprehensive preventive medicine evaluation and management of anindividual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the orderingof laboratory/diagnostic procedures, new patient; 65 years and older

Performed: Offi ce Visit (NCQA)

QDM

Category

Code

System

Code

SystemVersion

Code Descriptor

Encounter CPT 2012 99201 Office or other outpatient visit for the evaluation and management of a new patient,which requires these 3 key components: A problem focused history; A problemfocused examination; Straightforward medical decision making. Counseling and/orcoordination of care with other providers or agencies are provided consistent with thenature of the problem(s) and the patient's and/or family's needs. Usually, thepresenting problem(s) are self limited or minor. Physicians typically spend 10 minutesface-to-face with the patient and/or family.

Encounter CPT 2012 99202 Office or other outpatient visit for the evaluation and management of a new patient,which requires these 3 key components: An expanded problem focused history; Anexpanded problem focused examination; Straightforward medical decision making.Counseling and/or coordination of care with other providers or agencies are providedconsistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the presenting problem(s) are of low to moderate severity. Physicians typically

spend 20 minutes face-to-face with the patient and/or family.Encounter CPT 2012 99203 Office or other outpatient visit for the evaluation and management of a new patient,

which requires these 3 key components: A detailed history; A detailed examination;Medical decision making of low complexity. Counseling and/or coordination of carewith other providers or agencies are provided consistent with the nature of theproblem(s) and the patient's and/or family's needs. Usually, the presenting problem(s)are of moderate severity. Physicians typically spend 30 minutes face-to-face with thepatient and/or family.

Encounter CPT 2012 99204 Office or other outpatient visit for the evaluation and management of a new patient,which requires these 3 key components: A comprehensive history; A comprehensiveexamination; Medical decision making of moderate complexity. Counseling and/or


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coordination of care with other providers or agencies are provided consistent with thenature of the problem(s) and the patient's and/or family's needs. Usually, thepresenting problem(s) are of moderate to high severity. Physicians typically spend 45minutes face-to-face with the patient and/or family.

Encounter CPT 2012 99205 Office or other outpatient visit for the evaluation and management of a new patient,which requires these 3 key components: A comprehensive history; A comprehensiveexamination; Medical decision making of high complexity. Counseling and/orcoordination of care with other providers or agencies are provided consistent with thenature of the problem(s) and the patient's and/or family's needs. Usually, thepresenting problem(s) are of moderate to high severity. Physicians typically spend 60minutes face-to-face with the patient and/or family.

Encounter CPT 2012 99212 Office or other outpatient visit for the evaluation and management of an establishedpatient, which requires at least 2 of these 3 key components: A problem focusedhistory; A problem focused examination; Straightforward medical decision making.Counseling and/or coordination of care with other providers or agencies are providedconsistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the presenting problem(s) are self limited or minor. Physicians typically spend10 minutes face-to-face with the patient and/or family.

Encounter CPT 2012 99213 Office or other outpatient visit for the evaluation and management of an establishedpatient, which requires at least 2 of these 3 key components: An expanded problemfocused history; An expanded problem focused examination; Medical decision makingof low complexity. Counseling and coordination of care with other providers oragencies are provided consistent with the nature of the problem(s) and the patient'sand/or family's needs. Usually, the presenting problem(s) are of low to moderate

severity. Physicians typically spend 15 minutes face-to-face with the patient and/orfamily.Encounter CPT 2012 99214 Office or other outpatient visit for the evaluation and management of an established

patient, which requires at least 2 of these 3 key components: A detailed history; Adetailed examination; Medical decision making of moderate complexity. Counselingand/or coordination of care with other providers or agencies are provided consistentwith the nature of the problem(s) and the patient's and/or family's needs. Usually, thepresenting problem(s) are of moderate to high severity. Physicians typically spend 25minutes face-to-face with the patient and/or family.

Encounter CPT 2012 99215 Office or other outpatient visit for the evaluation and management of an establishedpatient, which requires at least 2 of these 3 key components: A comprehensive history;A comprehensive examination; Medical decision making of high complexity.Counseling and/or coordination of care with other providers or agencies are providedconsistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the presenting problem(s) are of moderate to high severity. Physicians

typically spend 40 minutes face-to-face with the patient and/or family.

Exclusion Reasons


Attribute SNOMED-CT 07/2011 105480006 refusal of treatment by patient (situation)

Attribute SNOMED-CT 07/2011 184081006 patient has moved away (finding)

Attribute SNOMED-CT 07/2011 183964008 treatment not indicated (situation)

Race (ONC Standard)

QDM Category Code System Code System Version Code Description

Patient Characteristic CDCREC 1.0 1002-5 American Indian or Alaska Native

Patient Characteristic CDCREC 1.0 2028-9 Asian

Patient Characteristic CDCREC 1.0 2054-5 Black or African American

Patient Characteristic CDCREC 1.0 2076-8 Native Hawaiian or Other Pacific Islander

Patient Characteristic CDCREC 1.0 2106-3 White

Patient Characteristic CDCREC 1.0 2131-1 Other Race


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Ethnici ty (ONC Standard)

QDM Category Code SystemCode SystemVersion

Code Description

Patient Characteristic CDCREC 1.0 2135-2 Hispanic or Latino

Patient Characteristic CDCREC 1.0 2186-5 Not Hispanic or Latino

Payer Type (ONC Standard)

QDM CategoryCodeSystem

Code SystemVersion

Code Description

Patientcharacteristic

SOP 5.0 611 BC Managed Care - HMO


SOP 5.0 612 BC Managed Care - PPO


SOP 5.0 613 BC Managed Care - POS


SOP 5.0 619 BC Managed Care - Other


SOP 5.0 62 BC Indemnity


SOP 5.0 63 BC (Indemnity or Managed Care) - Out of State

Patientcharacteristic SOP 5.0 64 BC (Indemnity or Managed Care) - Unspecified


SOP 5.0 69 BC (Indemnity or Managed Care) - Other


SOP 5.0 7MANAGED CARE, UNSPECIFIED (to be used only if one can'tdistinguish public from private)


SOP 5.0 71 HMO


SOP 5.0 72 PPO


SOP 5.0 73 POS


SOP 5.0 79 Other Managed Care, Unknown if public or private

Patient

characteristicSOP 5.0 8

NO PAYMENT from an Organization/Agency/Program/Private Payer

ListedPatientcharacteristic

SOP 5.0 81 Self-pay


SOP 5.0 82 No Charge


SOP 5.0 821 Charity


SOP 5.0 822 Professional Courtesy


SOP 5.0 823 Research/Clinical Trial


SOP 5.0 83 Refusal to Pay/Bad Debt


SOP 5.0 84 Hill Burton Free Care


SOP 5.0 85 Research/Donor


SOP 5.0 89 No Payment, Other


SOP 5.0 9 MISCELLANEOUS/OTHER


SOP 5.0 91 Foreign National


SOP 5.0 92 Other (Non-government)

Patient SOP 5.0 93 Disability Insurance


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characteristic


SOP 5.0 94 Long-term Care Insurance


SOP 5.0 95 Worker's Compensation


SOP 5.0 951 Worker's Comp HMO


SOP 5.0 953 Worker's Comp Fee-for-Service

Patientcharacteristic SOP 5.0 954 Worker's Comp Other Managed Care


SOP 5.0 959 Worker's Comp, Other unspecified


SOP 5.0 96 Auto Insurance (no fault)


SOP 5.0 98 Other specified (includes Hospice - Unspecified plan)


SOP 5.0 99 No Typology Code available for payment source


SOP 5.0 9999 Unavailable / Unknown


SOP 5.0 1 MEDICARE

Patient

characteristicSOP 5.0 11 Medicare (Managed Care)


SOP 5.0 111 Medicare HMO


SOP 5.0 112 Medicare PPO


SOP 5.0 113 Medicare POS


SOP 5.0 119 Medicare Managed Care Other


SOP 5.0 12 Medicare (Non-managed Care)


SOP 5.0 121 Medicare FFS


SOP 5.0 122 Medicare Drug Benefit


SOP 5.0 123 Medicare Medical Savings Account (MSA)


SOP 5.0 129 Medicare Non-managed Care Other


SOP 5.0 19 Medicare Other


SOP 5.0 2 MEDICAID


SOP 5.0 21 Medicaid (Managed Care)


SOP 5.0 211 Medicaid HMO


SOP 5.0 212 Medicaid PPO

Patientcharacteristic SOP 5.0 213 Medicaid PCCM (Primary Care Case Management)Patientcharacteristic

SOP 5.0 219 Medicaid Managed Care Other


SOP 5.0 22 Medicaid (Non-managed Care Plan)


SOP 5.0 23 Medicaid/SCHIP


SOP 5.0 24 Medicaid Applicant


SOP 5.0 25 Medicaid - Out of State


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SOP 5.0 29 Medicaid Other


SOP 5.0 3OTHER GOVERNMENT (Federal/State/Local) (excluding Departmentof Corrections)


SOP 5.0 31 Department of Defense


SOP 5.0 311 TRICARE (CHAMPUS)


SOP 5.0 3111 TRICARE Prime-HMO


SOP 5.0 3112 TRICARE Extra-PPO


SOP 5.0 3113 TRICARE Standard - Fee For Service


SOP 5.0 3114 TRICARE For Life--Medicare Supplement


SOP 5.0 3115 TRICARE Reserve Select


SOP 5.0 3116 Uniformed Services Family Health Plan (USFHP) -- HMO


SOP 5.0 3119 Department of Defense - (other)


SOP 5.0 312 Military Treatment Facility

Patientcharacteristic SOP 5.0 3121 Enrolled Prime-HMO


SOP 5.0 3122 Non-enrolled Space Available


SOP 5.0 3123 TRICARE For Life (TFL)


SOP 5.0 313 Dental --Stand Alone


SOP 5.0 32 Department of Veterans Affairs


SOP 5.0 321 Veteran care--Care provided to Veterans


SOP 5.0 3211 Direct Care--Care provided in VA facilities

Patient

characteristicSOP 5.0 3212 Indirect Care--Care provided outside VA facilities


SOP 5.0 32121 Fee Basis


SOP 5.0 32122 Foreign Fee/Foreign Medical Program(FMP)


SOP 5.0 32123 Contract Nursing Home/Community Nursing Home


SOP 5.0 32124 State Veterans Home


SOP 5.0 32125 Sharing Agreements


SOP 5.0 32126 Other Federal Agency


SOP 5.0 322 Non-veteran care


SOP 5.0 3221 Civilian Health and Medical Program for the VA (CHAMPVA)


SOP 5.0 3222 Spina Bifida Health Care Program (SB)


SOP 5.0 3223 Children of Women Vietnam Veterans (CWVV)


SOP 5.0 3229 Other non-veteran care


SOP 5.0 33 Indian Health Service or Tribe

Patient SOP 5.0 331 Indian Health Service - Regular


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SOP 5.0 43 Corrections Local


SOP 5.0 44 Corrections Unknown Level


SOP 5.0 5 PRIVATE HEALTH INSURANCE


SOP 5.0 51 Managed Care (Private)


SOP 5.0 511 Commercial Managed Care - HMO


SOP 5.0 512 Commercial Managed Care - PPO


SOP 5.0 513 Commercial Managed Care - POS


SOP 5.0 514 Exclusive Provider Organization


SOP 5.0 515 Gatekeeper PPO (GPPO)


SOP 5.0 519 Managed Care, Other (non HMO)


SOP 5.0 52 Private Health Insurance - Indemnity


SOP 5.0 521 Commercial Indemnity

Patientcharacteristic SOP 5.0 522 Self-insured (ERISA) Administrative Services Only (ASO) plan


SOP 5.0 523 Medicare supplemental policy (as second payer)


SOP 5.0 529 Private health insurance-other commercial Indemnity


SOP 5.0 53Managed Care (private) or private health insurance (indemnity), nototherwise specified


SOP 5.0 54 Organized Delivery System


SOP 5.0 55 Small Employer Purchasing Group


SOP 5.0 59 Other Private Insurance

Patient

characteristicSOP 5.0 6 BLUE CROSS/BLUE SHIELD


SOP 5.0 61 BC Managed Care


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Appendix 2: Dental Quali ty Alliance eMeasures Phase I Feasibilit y Assessment:Summary of findings

This information was compiled from the following individuals/teams through semi-structured surveys and phone

interviews. Respondents include vendors, IT programmers in large group practices, IT programmers in

FQHCs/ CHCs, and practitioners.

The vendors we surveyed all have dental systems. One vendor answered the survey for an ambulatory produc

in addition to their dental product. In that product many of these data elements and standard vocabularies such

as even CDT code will not be feasible.

The table below provides the summary from the dental systems/ practices. We did not survey a practices/

vendors that have a truly integrated/ interoperable EHR.

DATA ELEMENTS

Concept DataAvai labil it y

asstructured

dataelements*

(NQFScore)

4

Workflow:Typicallycaptured

during routineclinical care

anddocumentation

(NQF Score)

Dataaccuracy:

Whocaptures

thisinformation?(NQF Score)

Storedusing

standardtaxonomies

such asCDT,

SNOMED,RxNorm,

LOINC (NQFScore)

If interfaceterminologies

are used atthe provider

end, arevalidated

mapsavailable to

standardtaxonomies?

Does the system useencounters to embed

procedure codes or arethey indexed by visit date

Procedure - oralevaluation

Yes (3) Yes (3) Dentist orteammemberchair side (3)

CDT (3) Interface notused

Dental systems index byvisit date and dont embedin encounters. It is possiblefor vendors to artificially

link a procedure toencounter within thesystem. FQHCs that arereimbursed based onencounter rates also recordprocedures by visit date.Each visit date isconsidered an encounter.This does not fit into thedescription of encounterused in the QDM. One ofthe respondent participatedin MU2 testing. They usedthe human readableversion to program their

system and pulled databased on visit date ignoringany written logic.One vendor requested thatif the logic only stipulatesthe use of encounters theDQA should define these

Procedure -sealant

Yes (3) Yes (3) Dentist orteammemberchair side (3)

CDT (3) Interface notused

4 The National Quality Forum recently published a document regarding the feasibility of eMeasures athttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&p.
http://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&phttp://www.qualityforum.org/Projects/e-g/eMeasure_Feasibility_Testing/eMeasure_Feasibility_Testing.aspx#t=2&s=&p


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appropriately andstandardize. The use of theProcedure performedclause will alleviate thisconcern for these twomeasures.

Diagnosis/ CariesRisk assessment

pat ient level

OnlySometimesbut can be

implementedfor 2016 MU3. From 2014this can becaptured as aCDT code aswell.(Current: 2;Future 3)Note:DiagnosistypicallyremainsACTIVEunless

manuallyresolved

No but do notanticipate toomuch burden.

(Current: 2;Future 3)

Dentist orteammember

chair side (3)

Currentlystored ascustom

codes.(SNOMEDcodes andCDT underdevelopment.Can beimplementedfor 2016)(Current: 2;Future 3)

EZ Code proposedSNOMED:

Validated mapavailable. 1:1map for thisdata element

ExclusionReasons

Some systems have pop ups while others have a specific UI for capturingexclusions. In systems that have the UI, all the exclusion concepts are listed indrop down menus against the measure name and providers have the ability toselect a reason for exclusion of that patient when closing out the record.Other systems typically include logic to search for specific items in the chartincluding text search of clinical notes.Providers would like some of the major exclusions addressed without burden to theworkflow. Further testing is required to understand impact of exclusions.

Tooth number Yes (3) Yes (3) Dentist orteammemberchair side (3)

ToothNumberingSystem initself isconsidered

standardtaxonomy.That isuniversallyusedalthoughSNOMEDcodes areavailable.Again no oneusesSNOMED(Current: 2;Future 3)

Visit Date/ Date ofService

Yes (3) Yes (3) Office staff(3)

Patient Date ofBirth

Yes (3) Yes (3) Office staff(3)

Race(STRATIFICATIONVARIABLE: Not acritical dataelement)

Onlysometimesbut can beincluded(Current: 2;Future 3)

Sometimes(Current: 2;Future 3)

Office staff

(3)

So far thedentalvendors arenot using theONC valuesets exceptone

Custom codesused. Mapvalidityunknown


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Ethnicity(STRATIFICATIONVARIABLE: Not acritical dataelement)



Office staff

(3)

So far thedentalvendors arenot using theONC valuesets exceptone



Dental Benefitplan /Insurancetype(STRATIFICATIONVARIABLE: Not acritical dataelement)



Office staff

(3)

So far thedentalvendors arenot using theONC valuesets exceptone(Current: 2;Future 3)


MEASURE LOGIC AND VALUE SETS

Interpretation issues w ithhuman readable format

Implementability ofmeasures

Automated report for measure

Care continuit y No issues identified upon eye-ball review of logic and valuesets. As mentioned the ONCstandard value sets were new tosome.

Can be implemented butuncertain whether MATgenerated HQMF will beusable

Can be implemented. Not donecurrently. Some have CrystalReports but not easy to use.

Sealants No issues identified upon eye-ball review of logic and valuesets. As mentioned the ONC

standard value sets were new tosome.

Can be implemented butuncertain whether MATgenerated HQMF will be

usable

Can be implemented. Not donecurrently. Some have CrystalReports but not easy to use.

dental emeasures rfp

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