2016 Physician Quality Reporting System Data Collection Form: Diabetic Retinopathy (for patients aged 18 through 75)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Diabetic Retinopathy (for patients aged 18 through 75) IMPTANT: 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. Note: This measures group contains one or more inverse measures. An inverse measure is a measure that represents a poor clinical quality action as meeting performance for the measure. For these measures, a lower performance rate indicates a higher quality of clinical care. Composite codes for measures groups that contain inverse measures are only utilized when the appropriate quality clinical care is given. Patient sample criteria for the Diabetic Retinopathy Measures Group are: patients aged years with a specific diagnosis of diabetic retinopathy accompanied by a specific patient encounter: One of the following ICD-10-CM diagnosis codes indicating diabetic retinopathy: E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E Accompanied by one of the following patient encounter codes: 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, Measure #19 does not need to be reported (is not applicable) when the reporting provider manages the patient s diabetes care. Measure #317 does not need to be reported (is not applicable) if the patient has an active diagnosis of hypertension. **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 DIABETIC RETINOPATHY MEASURES GROUP WITHIN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS F CLINICAL RECOMMENDATIONS AND FURTHER INFMATION.

2 Page 2 of 11 Physician Name: Patient Name: Last First MI Date of Birth: / / mm dd yyyy Gender: M F Patient Insured - Traditional Medicare*: Medicare Advantage: Other: *Note: A minimum of 11 of the required 20 patients reported must be Traditional Medicare Part B Practice Medical Record Number: 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 11 Physician Quality Reporting Measures # 1 : Diabetes: Most Recent Labs (within the last 12 months) The performance period for this measure is 12 months from date of encounter. Measure #1: Percentage of patients years of age with diabetes who had hemoglobin A1c greater than 9.0% during the measurement period INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control (ie Performance Not Met). When a lower rate indicates better performance a 0% performance rate will be counted as satisfactorily reporting (100% performance rate would not be considered satisfactorily reporting). Record Values or mark Not Done HbA1c % Hemoglobin A1c level was not performed during the measurement period Most recent hemoglobin A1c level >9.0% - PM Hemoglobin A1c level was not performed during the measurement period (12 months) PM Most recent Hemoglobin A1c (HbA1c) level <7.0% - PNM Most recent Hemoglobin A1c (HbA1c) level 7.0 to 9.0% - PNM

4 Page 4 of 11 Physician Quality Reporting Measure #18: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months Definitions: Documentation - The medical record must include: documentation of the level of severity of retinopathy AND documentation of whether macular edema was present or absent. Macular Edema - Acceptable synonyms for macular edema include: macular thickening, intraretinal thickening, serous detachment of the retina, or pigment epithelial detachment. Severity of Retinopathy - Mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy - PM Documentation of medical reason(s) for not performing a dilated macular or fundus examination Documentation of patient reason(s) for not performing a dilated macular or fundus examination - PE Dilated macular or fundus exam was not performed, reason not otherwise specified - PNM

5 Page 5 of 11 Physician Quality Reporting Measure #19: Communication with the Physician Managing Ongoing Diabetes Care Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months Patients with documentation, at least once within 12 months, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient s diabetic care Definitions: Communication May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient s diabetic care a copy of a letter in the medical record to the clinician managing the patient s diabetic care outlining the findings of the dilated macular or fundus exam. Findings Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema. Findings of dilated macular or fundus exam communicated to the physician or other qualified health care professional managing the diabetes care AND Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy - PM Documentation of medical reason(s) patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes AND Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy - PE Dilated macular or fundus exam not performed - PE Findings of dilated macular or fundus exam were not communicated to the physician managing the diabetes care, reason not otherwise specified AND Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema AND level of severity of retinopathy - PNM The reporting provider manages the patient s diabetes care not applicable

6 Page 6 of 11 Physician Quality Reporting Measure # 117 : Diabetes Mellitus: Dilated Eye Exam Percentage of patients years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal or dilated exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period. NOTE: The eye exam must be performed or reviewed by an ophthalmologist or optometrist. Alternatively, results may be read by a qualified reading center that operates under the direction of a medical director who is a retinal specialist. Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed - PM Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed - PM Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed - PM Low risk for retinopathy (no evidence of retinopathy in the prior year) - PM Dilated Eye Exam was not Performed, Reason not Otherwise Specified - PNM

7 Page 7 of 11 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 AND 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

8 Page 8 of 11 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 AND 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 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 AND 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 tobacco cessation intervention not performed, reason not otherwise specified - PNM

9 Page 9 of 11 Physician Quality Reporting Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure (BP) AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated Normal blood pressure reading documented, follow-up not required Pre-Hypertensive or Hypertensive blood pressure reading documented AND the indicated follow-up is documented NOTE: Although recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, a BP screening must be performed once per measurement period. For patients with Normal blood pressure a follow-up plan is not required. When reporting measure #317, eligible professionals must perform the blood pressure screening at the time of a qualifying visit and may not obtain measurements from external sources A patient is not eligible if one or more of the following reasons exist: Patient has an active diagnosis of hypertension Patient refuses to participate (either BP measurement or follow up) Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient s health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated Patient not eligible (e.g. documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation, documentation the patient is not eligible - PE Blood pressure reading not documented, reason not given Pre-hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given Measure #317 does not need to be reported (is not applicable) if the patient has an active diagnosis of hypertension. See following pages for more on this measure

10 Measure #317 - Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Page 10 of 11 NUMERAT: Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive Definitions: Blood Pressure (BP) Classification BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings. Recommended BP Follow-Up The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the Recommended Blood Pressure Follow-Up Interventions listed below. Recommended Lifestyle Modifications The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated: Weight Reduction Dietary Approaches to Stop Hypertension (DASH) Eating Plan Dietary Sodium Restriction Increased Physical Activity Moderation in alcohol (ETOH) Consumption Second Hypertensive Reading: Requires a BP reading of Systolic BP 140 mmhg Diastolic BP 90 mmhg during the current encounter AND a most recent BP reading within the last 12 months Systolic BP 140 mmhg Diastolic BP 90 mmhg Second Hypertensive BP Reading Interventions: The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated: Anti-Hypertensive Pharmacologic Therapy Laboratory Tests Electrocardiogram (ECG) Recommended Blood Pressure Follow-up Interventions: Normal BP: No follow-up required for Systolic BP <120 mmhg AND Diastolic BP < 80 mmhg Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of mmhg diastolic BP of mmhg AND recommended lifestyle modifications referral to Alternate/Primary Care Provider First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmhg diastolic BP >= 90 mmhg: Follow-up with rescreen > 1 day and < 4 weeks AND recommend lifestyle modifications referral to Alternative/Primary Care Provider Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >= 140 mmhg diastolic BP >= 90 mmhg: Follow-up with Recommended lifestyle modifications AND one or more of the Second Hypertensive Reading Interventions referral to Alternative/Primary Care Provider Continued on next page

11 Page 11 of 11 Table 15 - Recommended Blood Pressure Follow-Up BP Classification Systolic BP mmhg Diastolic BP mmhg Recommended Follow-Up (must include all indicated Normal BP Reading < 120 AND < 80 actions for each BP Classification) No Follow-Up required Pre-Hypertensive BP Reading 120 AND AND 89 Rescreen BP within a minimum of 1 year AND Recommend Lifestyle Modifications Referral to Alternative/Primary Care Provider First Hypertensive BP Reading Second Hypertensive BP Reading Rescreen BP within a minimum of > 1 day and < 4 weeks AND Recommend Lifestyle Modifications Referral to Alternative/Primary Care Provider Recommend Lifestyle Modifications AND 1 or more of the Second Hypertensive Reading Interventions (see definitions) Referral to Alternative/Primary Care Provider