MTM Quality Metrics & Outcome Assessment 2 — Questions and Answers
Question 1: Which CMS quality measure tracks the percentage of Medicare beneficiaries with diabetes who received an ACE inhibitor or ARB?
- Diabetes Care – Blood Pressure Control
- Renin-Angiotensin System Antagonist Use in Diabetic Nephropathy (Correct answer)
- Statin Use in Persons with Cardiovascular Disease
- Medication Adherence for Diabetes Medications
Correct answer: Renin-Angiotensin System Antagonist Use in Diabetic Nephropathy
The RAS antagonist measure specifically tracks ACE inhibitor or ARB use in diabetic patients to reduce nephropathy progression.
Question 2: In MTM outcome tracking, a 'surrogate endpoint' is best described as:
- A patient-reported symptom substituted for clinical data
- A measurable biomarker expected to predict a clinical outcome (Correct answer)
- An administrative claims metric used instead of lab values
- A physician-rated functional status score
Correct answer: A measurable biomarker expected to predict a clinical outcome
Surrogate endpoints are biomarkers (e.g., HbA1c, LDL-C) that are reasonably expected to predict true clinical outcomes like hospitalizations or mortality.
Question 3: A pharmacy calculates its Medication Adherence for Hypertension (RAS antagonists) star rating measure. The denominator includes patients who:
- Filled at least one RAS antagonist prescription during the measurement year
- Had a hypertension diagnosis and received at least two fills of a RAS antagonist
- Were enrolled in Part D for the full measurement year and had a RAS antagonist claim (Correct answer)
- Received an MTM comprehensive medication review during the year
Correct answer: Were enrolled in Part D for the full measurement year and had a RAS antagonist claim
The denominator for Part D adherence star measures requires continuous Part D enrollment and evidence of medication use via claims.
Question 4: The 'proportion of days covered' (PDC) is preferred over 'medication possession ratio' (MPR) for adherence measures primarily because:
- PDC is easier to calculate from prescription labels
- PDC prevents days covered from exceeding 100% by capping at the follow-up period (Correct answer)
- MPR accounts for early refills more accurately than PDC
- PDC is mandated by the FDA for all adherence studies
Correct answer: PDC prevents days covered from exceeding 100% by capping at the follow-up period
PDC caps the numerator at the observation window length, preventing inflation above 100% when patients stockpile refills early.
Question 5: During a quarterly MTM quality review, a pharmacist finds that 30% of enrolled patients have a PDC below 0.80 for their statin. The FIRST action should be to:
- Remove non-adherent patients from the MTM program
- Conduct targeted medication reviews to identify adherence barriers (Correct answer)
- Switch all non-adherent patients to combination products
- Report the finding to the state board of pharmacy
Correct answer: Conduct targeted medication reviews to identify adherence barriers
Identifying root causes of non-adherence through targeted reviews allows individualized interventions to improve outcomes.
Question 6: Which of the following best defines 'clinical significance' in the context of MTM outcome measures?
- A p-value less than 0.05 on a statistical test
- A change in a measure large enough to be meaningful to patient health or function (Correct answer)
- Any improvement documented in the medical record
- An outcome reported by the patient as important
Correct answer: A change in a measure large enough to be meaningful to patient health or function
Clinical significance refers to the magnitude of change that produces a real and meaningful difference in patient health, distinct from statistical significance.
Question 7: A HEDIS measure reports a 'rate' of 72% for comprehensive diabetes care – eye exam. This percentage represents:
- The proportion of patients who refused an eye exam
- The proportion of eligible diabetic members who received a retinal eye exam during the measurement period (Correct answer)
- The average number of eye exams per diabetic patient per year
- The percentage of pharmacies that documented the eye exam recommendation
Correct answer: The proportion of eligible diabetic members who received a retinal eye exam during the measurement period
HEDIS rates express the proportion of eligible members who received the specified service within the measurement period.
MTM Quality Metrics & Outcome Assessment 2
Which CMS quality measure tracks the percentage of Medicare beneficiaries with diabetes who received an ACE inhibitor or ARB?