CMS-1631-FC 859 TABLE 37: CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP FOR 2016 AND BEYOND
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1 CMS-1631-FC 859 TABLE 37: CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP FOR 2016 AND BEYOND 0134/ / / / / / /168 Coronary Artery Bypass Graft (CABG): Use Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft surgery who received an Internal Mammary Artery graft. Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery: Percentage isolated Coronary Artery Bypass Graft (CABG) surgeries for patients aged 18 years and older who received a beta-blocker within 24 hours prior to surgical incision. Coronary Artery Bypass Graft (CABG): Prolonged Intubation: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft (CABG) surgery who require postoperative intubation > 24 hours. Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft surgery who, within 30 days postoperatively, develop deep sternal wound infection involving muscle, bone, and/or mediastinum requiring operative intervention. Coronary Artery Bypass Graft (CABG): Stroke: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft surgery who have a postoperative stroke (i.e., any confirmed neurological deficit abrupt onset caused by a disturbance in blood supply to the brain) that did not resolve within 24 hours. Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft surgery (without pre-existing renal failure) who develop postoperative renal failure or require dialysis. Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration: Percentage patients aged 18 years and older undergoing isolated Coronary Artery Bypass Graft surgery who require a return to the operating room (OR) during the current hospitalization for mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction, or other cardiac reason. Society Thoracic Quality Insights Society Thoracic Society Thoracic Society Thoracic Society Thoracic Society Thoracic We proposed to amend the Dementia Measures Group for reporting in the beginning in 2016 by adding Preventive Care and Screening: Screening for Clinical Depression and Follow- Up Plan (# 134) and removing Dementia: Screening for Depressive Symptoms ( #285). We solicited and received the following public comment on this measures group. Comment: One commenter encouraged CMS to retain the nine dementia-specific measures included in the Dementia Measures Group for continued use in the program even though measures that are not NQF-endorsed are typically removed. The commenter stated that these measures address gaps in the measure set, reflect the services furnished by a particular specialty, impact chronic conditions, and have a high impact on health care and
2 CMS-1631-FC 860 support CMS priorities for improved care quality and efficiency and should be retained in future program years. Response: In response to the comment requesting CMS retain the nine measures the Dementia Measures Group, please note CMS proposed to remove only one measure but retain the remaining eight dementia measures in this group. CMS is finalizing its proposal to remove #285 Dementia: Screening for Depressive Symptoms as CMS believes it is duplicative #134 Preventive Care and Screening: Screening for Clinical Depression and Followup, which includes screening for depression and is a more robust measure. For this reason, we are finalizing the proposed changes to this measures group for reporting in the beginning in 2016, as proposed. The final Dementia Measures Group is shown on Table 38.
3 CMS-1631-FC 861 TABLE 38: DEMENTIA MEASURES GROUP FOR 2016 AND BEYOND CMS is finalizing its proposal to add # 134 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan and delete #285 Dementia: Screening for Depressive Symptoms from this measures group. 0326/ /134 N.A/280 N/A/281 N/A/282 N/A/283 N/A/284 N/A/286 N/A/287 N/A/288 Care Plan: Percentage patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan: Percentage patients aged 12 years and older screened for clinical depression on the date the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date the positive screen. Dementia: Staging Dementia: Percentage patients, regardless age, with a diagnosis dementia whose severity dementia was classified as mild, moderate or severe at least once within a 12 month period. Dementia: Cognitive Assessment: Percentage patients, regardless age, with a diagnosis dementia for whom an assessment cognition is performed and the results reviewed at least once within a 12 month period. Dementia: Functional Status Assessment: Percentage patients, regardless age, with a diagnosis dementia for whom an assessment functional status is performed and the results reviewed at least once within a 12 month period. Dementia: Neuropsychiatric Symptom Assessment: Percentage patients, regardless age, with a diagnosis dementia and for whom an assessment neuropsychiatric symptoms is performed and results reviewed at least once in a 12 month period. Dementia: Management Neuropsychiatric Symptoms: Percentage patients, regardless age, with a diagnosis dementia who have one or more neuropsychiatric symptoms who received or were recommended to receive an intervention for neuropsychiatric symptoms within a 12 month period. Dementia: Counseling Regarding Safety Concerns: Percentage patients, regardless age, with a diagnosis dementia or their caregiver(s) who were counseled or referred for counseling regarding safety concerns within a 12 month period. Dementia: Counseling Regarding Risks Driving: Percentage patients, regardless age, with a diagnosis dementia or their caregiver(s) who were counseled regarding the risks driving and the alternatives to driving at least once within a 12 month period. Dementia: Caregiver Education and Support: Percentage patients, regardless age, with a diagnosis dementia whose caregiver(s) were provided with education on dementia /American Medical Medicare & Medicaid Services/ Mathematica/ Quality Insights
4 CMS-1631-FC 862 disease management and health behavior changes AND referred to additional sources for support within a 12 month period. We proposed to amend the Diabetes Measures Group for reporting in the beginning in 2016 by adding Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy Neurological Evaluation ( #126) and removing Diabetes: Foot Exam ( #163). We solicited and received the following public comment on this measures group. Comment: One commenter supported the proposed changes to the Diabetes Measures Group. Response: Based on the comments and rationale provided, we are finalizing the proposed changes to this measures group for reporting in the beginning in 2016, as proposed. The final Diabetes Measures Group is shown in Table 39.
5 CMS-1631-FC 863 TABLE 39: DIABETES MEASURES GROUP FOR 2016 AND BEYOND CMS is finalizing its proposal to add #126 Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy and delete #163 Diabetes: Foot Exam from this measures group. 0059/ / / / / /226 Diabetes: Hemoglobin A1c Poor Control: Percentage patients years age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. Preventive Care and Screening: Influenza Immunization: Percentage patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt an influenza immunization. Diabetes: Eye Exam: Percentage patients years age with diabetes who had a retinal or dilated eye exam by an eye care pressional during the measurement period or a negative retinal or dilated eye exam (no evidence retinopathy) in the 12 months prior to the measurement period. Diabetes: Medical Attention for Neuropathy: The percentage patients years age with diabetes who had a nephropathy screening test or evidence nephropathy during the measurement period. Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy Neurological Evaluation: Percentage patients aged 18 years and older with a diagnosis diabetes mellitus who had a neurological examination their lower extremities within 12 months. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: Percentage patients 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. American Podiatric Medical We proposed to amend the Preventative Care Measures Group for reporting in the beginning in 2016 by adding Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (NQF #2152) and removing Preventive Care and Screening: Unhealthy Alcohol Use Screening ( #173). We solicited and received the following public comment on this measures group. Comment: One commenter supported the proposed changes to the Preventative Care Measures Group. Response: Based on the comments and rationale provided, CMS is finalizing the proposed changes to this measures group for reporting in the beginning in 2016, as proposed. The final Preventative Care Measures Group is shown in Table 40.
6 CMS-1631-FC 864 TABLE 40: PREVENTIVE CARE MEASURES GROUP FOR 2016 AND BEYOND CMS is finalizing its proposal to add NQF #2152 Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling and delete #173 Preventive Care and Screening: Unhealthy Alcohol Use Screening from this measures group for /039 N/A/ / / / / / / /226 Screening for Osteoporosis for Women Aged Years Age: Percentage female patients aged years age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis. The title and description this measure has been updated since appearing in the CY 2016 PFS proposed rule (originally entitled Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older in Table 29D at 80 FR 41877) and conforms to the measure steward s most current measure specification. Urinary Incontinence: Assessment Presence or Absence Urinary Incontinence in Women Aged 65 Years and Older: Percentage female patients aged 65 years and older who were assessed for the presence or absence urinary incontinence within 12 months. Preventive Care and Screening: Influenza Immunization: Percentage patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt an influenza immunization. Pneumonia Vaccination Status for Older Adults: Percentage patients 65 years age and older who have ever received a pneumococcal vaccine. Breast Cancer Screening: Percentage women 50 through 74 years age who had a mammogram to screen for breast cancer within 27 months. Colorectal Cancer Screening: Percentage patients years age who had appropriate screening for colorectal cancer. Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Percentage patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside normal parameters, a follow-up plan is documented during the encounter or during the previous six months the encounter Normal Parameters: Age 65 years and older BMI 23 and < 30 kg/m2 ; Age years BMI 18.5 and < 25 kg/m2. Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan: Percentage patients aged 12 years and older screened for clinical depression on the date the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date the positive screen. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: Percentage patients 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. /American Medical /American Medical Mathematica/ Quality Insights Mathematica/ Quality Insights
7 CMS-1631-FC /431 Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling: Percentage patients aged 18 years and older who were screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND who received brief counseling if identified as an unhealthy alcohol user. This is a new measure described in Table 22. We proposed to amend the Rheumatoid Arthritis Measures Group for reporting in the beginning in 2016 by adding Tuberculosis Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier ( #337). We solicited and received no public comment on this measures group. Therefore, based on the rationale provided, we are finalizing the proposed changes to this measures group for reporting in the beginning in 2016, as proposed. The final Rheumatoid Arthritis Measures Group is shown in Table 41.
8 CMS-1631-FC 866 TABLE 41: RHEUMATOID ARTHRITIS MEASURES GROUP FOR 2016 AND BEYOND CMS is finalizing its proposal to add #337 Tuberculosis Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier to this measures group for / / /131 N/A/176 N/A/177 N/A/178 N/A/179 N/A/180 N/A/337 Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy: Percentage patients aged 18 years and older who were diagnosed with rheumatoid arthritis and were prescribed, dispensed, or administered at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD). Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Percentage patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside normal parameters, a follow-up plan is documented during the encounter or during the previous six months the encounter. Normal Parameters: Age 65 years and older BMI 23 and < 30 kg/m2 ; Age years BMI 18.5 and < 25 kg/m2 Pain Assessment and Follow-Up: Percentage visits for patients aged 18 years and older with documentation a pain assessment using a standardized tool(s) on each visit AND documentation a follow-up plan when pain is present. Rheumatoid Arthritis (RA): Tuberculosis Screening: Percentage patients aged 18 years and older with a diagnosis rheumatoid arthritis (RA) who have documentation a tuberculosis (TB) screening performed and results interpreted within 6 months prior to receiving a first course therapy using a biologic disease-modifying anti-rheumatic drug (DMARD). Rheumatoid Arthritis (RA): Periodic Assessment Disease Activity: Percentage patients aged 18 years and older with a diagnosis rheumatoid arthritis (RA) who have an assessment and classification disease activity within 12 months. Rheumatoid Arthritis (RA): Functional Status Assessment: Percentage patients aged 18 years and older with a diagnosis rheumatoid arthritis (RA) for whom a functional status assessment was performed at least once within 12 months. Rheumatoid Arthritis (RA): Assessment and Classification Disease Prognosis: Percentage patients aged 18 years and older with a diagnosis rheumatoid arthritis (RA) who have an assessment and classification disease prognosis at least once within 12 months. Rheumatoid Arthritis (RA): Glucocorticoid Management: Percentage patients aged 18 years and older with a diagnosis rheumatoid arthritis (RA) who have been assessed for glucocorticoid use and, for those on prolonged doses prednisone 10 mg daily (or equivalent) with improvement or no change in disease activity, documentation glucocorticoid management plan within 12 months. Tuberculosis Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier: Percentage patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient s history to determine if they have had appropriate management for a recent or prior positive test. Mathematica/ Quality Insights Quality Insights Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology Rheumatology e. Measures Available for Reporting in the Web Interface We finalized the measures that are available for reporting in the Web Interface for 2015 and beyond in the CY 2015 PFS final rule (79 FR through 67902). The current measures
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