ACO QUALITY MEASURES TECHNICAL SPECIFICATIONS

Transcription

1 ACO QUALITY MEASURES TECHNICAL SPECIFICATIONS Measure Source Description Procedural ICD-9 Timely Care, Appts, Info Doctor Communication Rating of Doctor Access to Specialists Health Promotion/Education Shared Decision Making Health/Functional Status All Condition Readmission (Risk Standardized) Ambulatory Admissions: COPD Ambulatory Admissions: Congestive Heart Failure PCPs who successfully qualify for EHR incentive program payment Claims Claims Claims EHR Incentive Program Reporting Patient/Caregiver Experience (7) Care Coordination/Patient Safety (6) Readmission for any cause within 30 days after discharge of the index admissions for patients Discharges with principal diagnosis of COPD or Asthma per 1,000 Discharges with principal diagnosis of CHF per 1,000 Excludes admissions with: In hospital death Without at least 30 days post discharge enrollment in Medicare FFS Transferred to another acute care facility Discharge against medical advice Updated 04/26/2012 1

2 Measure Source Description Procedural ICD-9 Medication Reconciliation after inpatient discharge Screening for Fall risk Patients discharged from any inpatient facility and seen within 60 days following discharge in the office of the physician providing ongoing care who had reconciliation of the discharge medications with the current medication list in the medical documented ( only patients discharged within last 60 days are included in denominator) Patients who were screened for future fall risk at least once within 12 months 1111F- Discharge medications reconciled with current medication list in outpatient medical 1100F- patient screened for future fall risk; documentation of two or more falls in past year 1101F- patient screened for future fall risk; documentation of no falls in past year Documentation of medical reasons for not screening Influenza Immunization who received vaccine from September through Feb of the year prior to measurement year Preventive Health (8) CPT Code: 90656, 90657, 90658, HCPCS Code: G0008 Updated 04/26/2012 2

3 Measure Source Description Procedural ICD-9 Pneumococcal Vaccination Patients who have ever received a pneumococcal vaccine Adult weight screening and Follow-up Tobacco Use Assessment and Tobacco Cessation Intervention Patients with BMI calculated in past 6 months and follow-up plan if BMI is outside of parameters Patients who were screened for tobacco use at least once during the 2 year measurement period AND who received tobacco cessation counseling intervention if identified as tobacco user CPT Code: Smoking/tobacco counseling 3-10 mins Smoking/tobacco counseling greater than 10 mins. (in development) 4XXXF- Screened for tobacco use AND received tobacco cessation counseling, if identified as tobacco user V85.0- V85.5 Patient over/under weight and managed by another provider Has terminal illness Refused BMI measurement Documented reason why BMI was not calculated Patient in urgent or medical condition where time is of essence Documented medical reasons for not screening Updated 04/26/2012 3

4 Measure Source Description Procedural ICD-9 Depression Screening Mammography Screening Colorectal Cancer Screening Proportion of Adults who had Blood Pressure measured within preceding 2 years Hemoglobin A1c Control (<8) screened for clinical depression using standardized tool and follow up plan documented Percentage of women who had a mammogram during the year or the year prior Adults years of age who had an appropriate screening for colorectal cancer: HCPCS: G0444- Annual depression screening, 15 minutes CPT: HCPCS: G0202, G0204, G0206 Colonoscopy: , 44397, 45355, , 45391, FOBT: 82270, FlexSigmoidoscopy: , , Systolic: 3074F, 3075F Diastolic:3078F, 3079F Diabetes Care (all or nothing scoring) (6) Patients with diabetes who have HbA1c < 8 CPT I Code: 83036, F, 3045F, 3046F 87.36, Colonoscopy: 45.22, 45.23, 45.25, 45.42, FlexSigmoido scopy: Patient refuse to participate Patient in urgent or medical condition where time is of essence Situation where patient motivation to improve may impact accuracy of results (i.e. court appointed cases) Patient was referred with diagnosis of depression Patient has been participating in ongoing treatment with screening of clinical depression in prior reporting period Patient has severe mental/physical incapacity Bilateral Mastectomy: CPT 19180, 19200, 19220, 19240, ICD-9 CM 85.42, 85.44, 85.46,85.48 Colorectal Cancer: HCPCS G0213-G0215, G0231 ICD-9 CM 153, 154.0, 154.1, Total Colectomy: CPT , , ICD-9 CM Proc Code: 45.8 Updated 04/26/2012 4

5 Measure Source Description Procedural ICD-9 LDL Control (<100) Patients with diabetes CPT I Code: who have LDL < , 83700, 83701, 83704, F, 3049F, 3050F Blood Pressure <140/90 Tobacco Non Use Aspirin Use Patients with diabetes who have BP reading < 140/90 that are tobacco non user Patients with a diagnosis of Ischemic Vascular Disease (IVD) has documented daily ASA or anti-platelet use anytime during the measurement period Systolic: 3074F, 3075F Diastolic: 3078F, 3079F Medications: Aspirin (ASA) Plavix (clopidogrel) Ticlid (ticlopidine) Aggrenox (aspirin/dipyridamole) Low dose enteric-coated 81 mg ASA (Ecotrin or Bayer) Accepted contraindications: Anticoagulant use, Lovenox (Enoxaparin) or Coumadin (Warfarin) Any history of gastrointestinal (GI)* or intracranial bleed (ICB) Allergy to ASA *Gastroesophogeal reflux disease (GERD) is not automatically considered a contraindication but may be included if specifically documented as a contraindication by the physician. Hemoglobin Poor Control (>9) Patients with diabetes who have HbA1c >9 CPT I Code: 83036, F, 3045F, 3046F The following may be exclusions if specifically documented by the physician: Use of non-steroidal antiinflammatory agents Documented risk for drug interaction Uncontrolled hypertension defined as >180 systolic, >110 diastolic Other provider documented reason for not being on ASA therapy Updated 04/26/2012 5

6 Measure Source Description Procedural ICD-9 Blood Pressure Control Complete Lipid Profile and LDL control (<100) Use of Aspirin or another Antithrombotic with diagnosis of hypertension and whose blood pressure was controlled (<140/90) Hypertension (1) Systolic: 3074F, 3075F Diastolic: 3078F, 3079F Ischemic Vascular Disease (2) The percentage of patients who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) from January 1 November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had each of the following during the measurement year: Complete Lipid Profile LDL-C control <100 mg/dl The percentage of patients 18 years and older with ischemic vascular disease who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) from January 1-November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had the following during the measurement year. -Use of aspirin or another antithrombotic CPT I Code: 80061, 83700, 83701, 83704, F, 3049F, 3050F Updated 04/26/2012 6

7 Measure Source Description Procedural ICD-9 Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) CAD Composite (all or nothing): Drug Therapy for lowering LDL Composite (all or nothing): ACE Inhibitor or ARB Therapy for patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) with a diagnosis of heart failure with a current or prior LVEF < 40% who were prescribed betablocker therapy either within a 12 month period when seen in the outpatient setting or hospital discharge Heart Failure (1) 4006F- Beta- blocker therapy prescribed Medications (Beta Blocker): Bisoporol Carvedilol Metoprolol succinate extended release (metoprolol CR/XL) Coronary Artery Disease (all or nothing scoring) (2) with diagnosis of CAD seen within 12 month period who have a LDL result <100 OR patients who have a LDL >=100 and have a documented plan of care to achieve LDL <100, including at a minimum prescription of a statin with a diagnosis of CAD seen within a 12 month period who also have diabetes or a current or prior LVEF < 40% who were prescribed ACE inhibitor or ARB therapy 3048F- Most recent LDL < F- Most recent LDL F- Most recent LDL >= 130 -AND- 05XXF1- Lipid lowering therapy plan of care documented -AND- 4002F- Statin therapy prescribed Medications (Statins): Lovastatin Pravastatin Simvastatin Fluvastatin Atorvastatin Rosuvastatin 4009F- ACE inhibitor or ARB therapy prescribed Documentation of medical reasons for not prescribing betablocker therapy reasons for not prescribing a statin reasons for not prescribing a statin reasons for not a statin (i.e. financial reasons) reasons for not prescribing ACE/ARB reasons for not prescribing ACE/ARB reasons for not a ACE/ARB (i.e. lack of drug available) Updated 04/26/2012 7