2016 Physician Quality Reporting System Data Collection Form: Hepatitis C (for patients aged 18 and over)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Hepatitis C (for patients aged 18 and over) IMPORTANT: Any measure with a 0% performance rate (100% for inverse measures) is not considered satisfactory reporting. Review your PQRS Submission Summary report, available after entering your data, to ensure this is not an issue. Each measure answer is identified as Performance Met (PM), Performance Not Met (PNM) or Performance Exclusion (PE). More information on this rule is available within the Covisint PQRS Web Application. Patient sample criteria for the Hepatitis C Measures Group are: patients aged 18 years and older, with a specific diagnosis of chronic Hepatitis C accompanied by a specific patient encounter: One of the following diagnosis codes indicating chronic hepatitis C: ICD-10-CM: B18.2 one of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99406, Measure #87 only needs to be reported if initiation of antiviral treatment took place before October of the measurement year (12 weeks before the end of the measurement period) Measure #401 only needs to be reported when the patient also has the following diagnosis code indicating cirrhosis: ICD-10-CM: K70.30, K70.31, K74.60, K74.69 Note: Refer to the Covisint PQRS2016 Applicable Measure Group Codes document which contains a list of diagnosis, encounter, and procedure codes for each measures group. Not all measures groups require all 3 code types. REFER TO THE HEPATITIS C MEASURES GROUP IN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR CLINICAL RECOMMENDATIONS FURTHER INFORMATION

2 Page 2 of 9 Physician Name: Patient Name: Last First MI Date of Birth: / / mm dd yyyy Gender: M F Medical Record Number: Patient Insured - Traditional Medicare*: Medicare Advantage: Other: *Note: A minimum of 11 patients must be Traditional Medicare Part B Appointment Date: / / (1/1/16 12/31/16) mm dd yyyy ICD-10 Diagnosis Code: CPT Encounter (visit) Code: CPT Procedure Code: N/A

3 Page 3 of 9 Physician Quality Reporting Measure # 84 : Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment Percentage of patients aged 18 years and older with a diagnosis of chronic Hepatitis C who started antiviral treatment within the 12-month reporting period for whom quantitative Hepatitis C virus (HCV) ribonucleic acid (RNA) testing was performed within 12 months prior to initiation of antiviral treatment RNA testing for Hepatitis C documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis C Patient starting antiviral treatment for Hepatitis C during the measurement period PM RNA testing for Hepatitis C was not documented as performed within 12 months prior to initiation of antiviral treatment for Hepatitis C, reason not given Patient starting antiviral treatment for Hepatitis C during the measurement period PNM Patient did not start or is not receiving antiviral treatment for hepatitis C during the measurement period - PE

4 Page 4 of 9 Physician Quality Reporting Measure # 85 : Hepatitis C: Hepatitis C Virus (HCV) Genotype Testing Prior to Treatment Percentage of patients aged 18 years and older with a diagnosis of chronic Hepatitis C who started antiviral treatment within the 12-month reporting period for whom Hepatitis C virus (HCV) genotype testing was performed within 12 months prior to initiation of antiviral treatment Patients for whom HCV genotype testing was performed within 12 months prior to initiation of antiviral treatment Hepatitis C genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for Hepatitis C Patient starting antiviral treatment for Hepatitis C during the measurement period PM Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for Hepatitis C during the measurement period (e.g. Genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment) - PE Hepatitis C genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis C, reason not given Patient starting antiviral treatment for Hepatitis C during the measurement period - PNM Patient started antiviral treatment prior to the measurement period, patient not eligible

5 Page 5 of 9 Physician Quality Reporting Measure # 87 : Hepatitis C: Hepatitis C Virus (HCV) Ribonucleic Acid (RNA) Testing Between 4 12 Weeks After Initiation of Treatment Percentage of patients aged 18 years and older with a diagnosis of chronic Hepatitis C who are receiving antiviral treatment for whom quantitative Hepatitis C virus (HCV) ribonucleic acid (RNA) testing was performed between 4-12 weeks after the initiation of antiviral treatment Patients for whom quantitative HCV RNA testing was performed at no greater than 12 weeks from the initiation of antiviral treatment 4-12 Weeks after Initiation Patients for whom testing was performed between 4-12 weeks from the initiation of antiviral treatment will meet the numerator for this measure, acknowledging that there may be different recommended follow-up testing based on the specific antiviral therapy used to treat a particular patient. Measure #87 (patient not eligible) if initiation of antiviral treatment took place before October of the measurement year (12 weeks before the end of the measurement period) Performance Exclusion: (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons) Hepatitis C quantitative RNA testing documented as performed between 4-12 weeks after the initiation of antiviral treatment Patient receiving antiviral treatment for hepatitis C during the measurement period - PM Hepatitis C quantitative RNA testing not performed between 4-12 weeks after the initiation of antiviral treatment for Patient receiving antiviral treatment for Hepatitis C during the measurement period- PE documented in medical chart Clinician documented that patient is not an eligible candidate for quantitative RNA testing; patient not receiving antiviral treatment for Hepatitis C or antiviral treatment started on or after October 1 of the measurement year - PE Hepatitis C quantitative RNA testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given Patient receiving antiviral treatment for Hepatitis C documented - PNM Medical Patient

6 Page 6 of 9 Physician Quality Reporting Measure # 130 : Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. Eligible professional attests to documenting, updating or reviewing a patient s current medications using all immediate resources available on the date of encounter. This list must include ALL known prescriptions, over-the counters, herbals, and vitamin/mineral/dietary (nutritional) supplements must contain the medications name, dosages, frequency and route of administration Not Eligible - A patient is not eligible if the following reason is documented: Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient s health status. Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient s current medications - PM Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional - PE Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given - PNM For definitions and further information refer to the measures groups specifications manual

7 Page 7 of 9 Physician Quality Reporting Measure # 183 : Hepatitis C: Hepatitis A Vaccination Percentage of patients aged 18 years and older with a diagnosis of Hepatitis C who received at least one injection of Hepatitis A vaccine, or who have documented immunity to Hepatitis A Received Includes at least one injection of Hepatitis A vaccine during a current or prior visit, or previous receipt from another provider. Performance exclusion: Medical reason(s) for not administering at least one injection of hepatitis A vaccine (eg, allergy or intolerance to a known component of the vaccine, other medical reasons); Patient reason(s) for not administering at least one injection of hepatitis A vaccine (eg, patient declined, insurance coverage, other patient reasons) Hepatitis A vaccine injection administered or previously received - PM Patient has documented immunity to Hepatitis A - PM Hepatitis A vaccine injection not administered or previously received for documented in medical chart -PE Hepatitis A vaccine injection not received, reason not otherwise specified - PNM Medical Patient Physician Quality Reporting Measure # 226 : Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months who received cessation counseling intervention if identified as a tobacco user Note: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation counseling, choose answer option tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified. Tobacco Use includes any type of tobacco. Cessation Counseling Intervention includes brief counseling (3 minutes or less) and/or pharmacotherapy. Patient screened for tobacco use received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user - PM Current tobacco non-user - PM Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reasons) - PE Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified - PNM

8 Page 8 of 9 Physician Quality Reporting Measure # 390 : Discussion and Shared Decision Making Surrounding Treatment Options Percentage of patients aged 18 years and older with a diagnosis of hepatitis C with whom a physician or other qualified healthcare professional reviewed the range of treatment options appropriate to their genotype and demonstrated a shared decision making approach with the patient. To meet the measure, there must be documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment - PM Treatment options not discussed for documented reasons: (Medical s: Patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons. Patient s: Patient unable or unwilling to participate in the discussion or other patient reasons - PE Medical Patient No documentation of a discussion in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment - PNM

9 Page 9 of 9 Physician Quality Reporting Measure # 401 : Screening for Hepatocellular Carcinoma (HCC) in Patient with Hepatitis C Cirrhosis Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis who underwent imaging with either ultrasound, contrast enhanced CT or MRI for hepatocellular carcinoma (HCC) at least once within the 12 month reporting period. Measure #401 only needs to be reported when the patient also has the following diagnosis code indicating cirrhosis: ICD-10-CM: K70.30, K70.31, K74.60, K74.69 Patient underwent abdominal imaging with ultrasound, contrast enhanced CT or contrast MRI for HCC - PM Screening for HCC not performed for documented reasons (Medical reason: Comorbid medical conditions with expected survival <5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons. Patient reason: Patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment) - PE Medical Patient Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the reporting period - PNM Patient does not have diagnosis indicating cirrhosis not eligible