Clinical Outcome Measures and Future Directions for Multiple Sclerosis Care Centers


To prepare for coming changes at the CMS driven by the Affordable care Act, multiple sclerosis care centers should begin to develop MS-specific electronic health record templates that record clinical outcome measures.

Multiple sclerosis care centers provide patient care, advocacy, service, education, and research. The clinicians at these centers provide multidisciplinary care that includes pharmacologic and nonpharmacologic interventions while educating patients about their disease. Barbara Bumstead, ANPc, a multiple sclerosis certified nurse practitioner with the Comprehensive Care Center at South Shore Neurologic Associates discussed the current situation and needed future directions incorporating MS outcome measures into the Affordable Care Act (ACA) at CMSC-ACTRIMS 2013.

The ACA seeks to help healthcare practitioners improve quality of care while making health insurance more affordable. Ultimately the greatest national medical cost burden involves chronic diseases such as MS. Bumstead said that the problem with MS is that it is not currently recognized as a chronic care indicator by the Centers for Medicare and Medicaid Services (CMS).

MS is a chronic disease by definition since it lasts more than three months as a chronic illness. However, Bumstead pointed out that MS is not recognized by the CMS as a chronic disease because it is a low-volume disease; only 400,000 people have MS as compared to other recognized chronic diseases such as diabetes, which affects 25.8 million people, heart disease (26.5 million), and stroke (3.3 million).

However, Bumstead said that MS is distinctive among these four chronic health diseases in that MS generally affects younger people, which increases the lifetime burden of the disease. Bumstead stressed that MS should become recognized as a chronic disease by the CMS so that the data can be used to improve patient care and improve affordability.

Bumstead highlighted the Physician Compare Initiative website created by the CMS, which is designed to help consumers make informed choices about the healthcare they receive through Medicare. By 2014 this website will also include physician quality reporting system (PQRI) data. Currently, PQRI data does not cover MS. Instead it only covers diabetes, hypertension, coronary heart disease, heart failure, ischemic vascular disease, care coordination/patient safety, and preventative care. However, with time MS should also be incorporated.

Currently the CMS only reports on a limited set of clinical outcome measures, such as blood pressure, weight, and tobacco screening, but the number of CMS-reported outcomes is dynamic and increasing. Bumstead emphasized that MS care centers should begin to develop MS-specific electronic health record templates that record clinical outcome measures. The most common clinical outcome measures considered with MS involve MRI, OCT, EDSS, and scales of fatigue, depression, and others. Other outcomes may include disease activity free status, cognition, and more quality of life measures.

She encouraged members of the audience to participate in and offer their suggestions to the CMS Innovation Center. This is a healthcare community-focused website that is focused on testing new payment and service models, while evaluating results and assessing proposed best practices.

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