Quality Measures

Review below Centers for Medicare & Medicaid Services (CMS) Five-Star Ratings and US Department of Veterans Affairs QUIET measures for epilepsy.

A number of quality metrics focused on neurological health care have been developed by various national organizations. The measures created by these health care quality entities focus on different aspects of population health management and vary in scope from process-related to clinically-focused metrics, as well as medication adherence and other aspects of health care quality measurement.

Neurological Health Quality Measures

Select a health care quality entity to expand and read more.

  • About Centers for Medicare & Medicaid Services (CMS) Star Ratings

     

    AEDs are a protected class under Medicare* Part D, which means Part D sponsor formularies must include all or substantially all drugs in the following classes:1

    • Anticonvulsants
    • Antidepressants
    • Antipsychotics
    • Antiretrovirals
    • Antineoplastics


    CMS instituted this policy to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans and to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.1


    CMS Five-Star Ratings strategy is aligned with CMS’ Three Aims: better care, healthier people/healthier communities, and lower costs through improvements. CMS Five-Star measures for Medicare plans cover the following categories:

    • Outcomes
    • Intermediate outcomes
    • Patient experience
    • Access
    • Process


    The American Epilepsy Society, American Academy of Neurology and National Association of Epilepsy Centers created a task force with the purpose of developing quality measures for epilepsy care. This ultimately led to the Centers for Medicare and Medicaid Services (CMS) approving and implementing quality measures on January 1, 2012.2

    CMS approved the following measures that would be voluntarily reported followed by a subsequent incentive payment. Physicians who failed to report these measures would be penalized 1 to 3% of Medicare reimbursement after required reporting was implemented.2

    Although eight measures were approved by the task force that developed them, only three were adopted by CMS:2,3

    • The frequency of each seizure type should be reported at each visit
    • The etiology (or epilepsy syndrome) should be reported at each visit
    • All female patients of childbearing potential (12-44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.


    *Medicare does not endorse any specific products. Formulary availability does not guarantee coverage.

  • About QUIET Tool

     

    The Quality Indicators in Epilepsy Treatment Tool (QUIET) was designed to provide standards for the quality of care for adults with epilepsy in the primary care and neurology setting. QUIET addresses the following aspects of care:4

    • Evaluation of seizures

    • Initial diagnosis and treatment

    • Chronic care

    • Chronic care for women

    • Patient-generated concerns

    QUIET Measures were determined by a panel of 10 epilepsy experts composed of general internists, epileptologists, nurses, and health researchers, as well as patient focus groups. The panel evaluated national clinical guidelines and conducted systematic reviews of the literature. This was followed by rating the appropriateness, reliability, and necessity of each quality indicator. The patient focus group (17 patients) formulated the patient-centered care indicators.4


    For a full list of 27 QUIET Measures and to learn more, visit https://www.epilepsy.va.gov/quiet/.


 

References:

  1. Centers for Medicare & Medicaid Services. Part D Drugs and Formulary Requirements. In: Medicare Prescription Drug Benefit Manual. https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf. Accessed January 31, 2018.
  2. 2012 Medicare Physician Fee Schedule Final Rule Summary. https://www.naec-epilepsy.org/wp-content/uploads/MPFS2012FinalRuleSummary.pdf. Accessed February 28, 2018.
  3. American Epilepsy Society. Quality Measures. https://www.aesnet.org/clinical_resources/practice_management/quality_measures. Accessed March 22, 2018.
  4. US Department of Veteran Affairs website. https://www.epilepsy.va.gov/quiet/. Accessed March 22, 2018.