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Ischemic Vascular Disease Measure Target Population Complete Lipid Profile and LDL control (<100) Patients 18 years & older with ischemic vascular disease (IVD): AMI, CABG or PCI Lipid Profile with LDL-C<100 CPT I Code: 80061, 83700, 83701, 83704, 83721 CPT II Code: 3048F, 3049F, 3050F Patients 18 years & older with ischemic vascular disease (IVD): AMI, CABG or PCI Recommended use of aspirin for adults who are at increased risk for coronary heart disease. Discussion should address both the potential benefits and harms of aspirin therapy. Document daily ASA or anti-platelet use anytime during the measurement period. Medications: Aspirin (ASA), Plavix (clopidogrel), Ticlide (ticlopidine), Aggrenox (aspirin/ dipyridamole), Low dose enteric-coated 81 mg ASA (Ecotrin or Bayer) Use of Aspirin or Another Antithrombotic How the Measure can be Improved Frequency Annually Ongoing once diagnosed Heart Failure Measure Target Population Beta Blocker Therapy Patients 18 years & older for Left Ventricular with a diagnosis of heart failure with a current or Systolic Dysfunction prior LVEF <40% (LVSD) How the Measure can be Improved Frequency Prescribe beta-blocker therapy either within a 12 month period when seen in the outpatient setting or hospital discharge. CPT II Code: 4006F Beta-blocker therapy prescribed. Beta-blocker therapy: should include bisoprolol, carvedilol, or sustained release metoprolol Annually Coronary Artery Disease Measure Target Population Lipid Control Patients 18 years & older with CAD ACE inhibitor or ARB Therapy Patients with CAD and diabetes and/or current or prior LVEF <40% How the Measure can be Improved Frequency Lipid Profile with LDL-C<100 CPT I Code: 80061, 83700, 83701, 83704, 83721 CPT II Code: 3048F, 3049F, 3050F Annually Prescribe ACE inhibitor or ARB therapy at one or more visits in the measurement period OR Documentation in medical record if patient is already taking ACE inhibitor or ARB therapy CPT II Code: 4009F—ACE inhibitor or ARB therapy prescribed Annually Patient Safety Measure Medication Reconciliation Reducing the Risk of Falling Target Population How the Measure can be Improved Frequency Patients 65 years or older discharged from any inpatient facility and seen within 30 days following discharge in the office by the physician providing on-going care Document the visit as a post discharge follow up from the hospital/SNF and that the medication list from that facility has been reviewed. Conduct a medication review: 1. Based on the medication list from the hospital/SNF discharge, were any new medications added or discontinued? 2. Based on the medication list from the hospital/SNF discharge, should any medication be discontinued or altered? 3. Have any new medications been added today? At the visit within 30 days post-discharge Patients 65 years & older Screen patients at risk for falling (problem falling, walking or balancing). Complete fall risk assessment checklist. CPT II Code: 1100F—2 or more falls. 1101F—No fall or only 1 fall w/o injury in the past year Annually Chronic Conditions Measure Target Population How the Measure can be Improved Rheumatoid Arthritis Management Patients 65 years & older with rheumatoid arthritis Cholesterol Screening Patients 18 - 75 years with diabetes LDL-C test and control < 100mg/dL CPT I Code: 80061, 83700, 83701, 83704, 83721 CPT II Code: 3048F, 3049F, 3050F Annually Controlling Blood Pressure Patients 18 - 85 years with hypertension Diagnosis of hypertension and target blood pressure <140/90 (Systolic: 3074F, 3075F - Diastolic: 3078F, 3079F) At each visit Prescribe a disease modifying anti-rheumatic drug (DMARD) Frequency Ongoing once diagnosed A POCKET GUIDE Quality Measures Quality measures were established to improve care delivered to Medicare patients. This pocket guide details 30+ measures and provides actionable information for you to impact your patients’ care. The guide lists target population, how the measure can be improved and frequency of testing for each measure. Prevention Measure Target Population How the Measure can be Improved Perform health risk assessment, acquire Annual Wellness Visit medical history, and furnish appropriate Patients 65 years & older prevention and treatment plan to patient. (AWV) HCPCS: G0438, G0439 BMI Screening and Follow-up Patients 18 - 74 years Record both Weight & Body Mass Index (BMI) (Kg/height) in medical records. If outside of normal parameters, offer counseling and/or behavioral interventions to promote sustained weight loss. Normal Parameters: Age 65 and older BMI >23 and <30. Age 18-64 years BMI >18.5 and <25. CPT II Code: 3008F- BMI documented in the chart Frequency Annually At each visit V Code: V85.0 - V85.5x Blood Pressure Screening Breast Cancer Screening Colorectal Cancer Screening Depression Screening and Follow-Up Plan Glaucoma Testing Influenza Vaccine Pneumonia Vaccine Tobacco Screening and Cessation Intervention Perform blood pressure screening CPT II Code: BP<140/90mm/hg: Patients 18 years & older Systolic: 3074F, 3075F Diastolic: 3078F BP>140/90mm/hg: Systolic: 3077F Diastolic: 3080F -ORDocumentation in patient medical records Patients 40 - 74 years Mammogram CPT: 77055-77057 or HCPCS: G0202, G0204, G0206 Patients 50 - 75 years • Fecal Occult Blood Test (FOBT): 82270, 82274 • FlexSigmoidoscopy: 45330-45335, 45337-45342, 45345 • Colonoscopy: 44388-44394, 44397, 45355, 45378-45387, 45391, 45392 Discuss patients' current mental health occurred in the past year. Perform annual depression screening using Patients 18 years & older standardized tool (PHQ-2, PHQ-9) and document follow-up plan. HCPCS: G0444 — Annual depression screening,15 minutes without a history of glaucoma Patients 65 years & older Patientsbe examined by an eye doctor should Routine annual influenza vaccine is recommended for all persons ages 18 years and older who do not have contraindications Patients 18 years & older to vaccination. CPT Code: 90656, 90658, 90660 or HCPCS Code: G0008 Documentation in medical record Pneumococcal vaccine for all immunocompetent individuals who are 65 Patients 65 years & older and older or otherwise at increased risk pneumococcal disease is recommended. Screen for tobacco use. Provide tobacco cessation counseling intervention if Patients 18 years & older identified as tobacco user. CPT Code: 99406 Smoking/tobacco counseling 3-10mins 99407 Smoking/tobacco counseling >10 mins At each visit Every 2 yrs •FOBT Annually •Sigmoidoscopy 5 years •Colonoscopy 10yrs Annually Annually Annually Once in person’s lifetime At each visit Care of Older Adults Measure Osteoporosis Screening in Women who had a Fracture Improving Bladder Control Monitoring Physical Activity Target Population Patients 67 years or older Patients 65 years & older Patients 65 years & older How the Measure can be Improved Frequency Female patients with history of fracture Within 6 months perform a bone density test or Rx to of fracture treat mineral depletion Screen all patients for urinary Annually incontinence and treat if positive Advise to start, increase, or maintain As needed patient’s level of exercise or physical activity Diabetes Care Measure Target Population How the Measure can be Improved Frequency LDL-C Control <100mgdL (All or Nothing Scoring) Patients 18 - 75 years with diabetes LDL-C test and control <100mg/dL CPT I Code: 80061, 83700, 83701, 83704, 83721 CPT II Code: 3048F, 3049F, 3050F Annually Blood Pressure Control <140/90 (All or Nothing Scoring) Patients 18 - 75 years with diabetes Target blood pressure <140/90 CPT II Code: Systolic: 3074F, 3075F Diastolic: 3078F, 3079F Use of Aspirin or Patients 18 - 75 years Another Antithrombotic with diabetes and ischemic (All or Nothing Scoring) vascular disease (IVD) Tobacco Non-Use (All or Nothing Scoring) Patients 18 - 75 years with diabetes Hemoglobin A1c Poor Control (>9%) Patients 18 - 75 years with diabetes Eye Exam Kidney Disease Monitoring Patients 18 - 75 years with diabetes Patients 18 - 75 years with diabetes Use of aspirin as a secondary prevention strategy in those with diabetes with a history of CVD. Consider aspirin therapy as a primary preventin strategy in those with type 1 or 2 diabetes at increased cardiovascular risk. Document daily ASA or anti-platelet use anytime during the measurement period. Medications: Aspirin (ASA), Plavix (clopidogrel), Ticlide (ticlopidine), Aggrenox (aspirin/ dipyridamole), Low dose entericcoated 81 mg ASA (Ecotrin or Bayer) Screen for tobacco use. Provide tobacco cessation counseling intervention if identified as tobacco user. Documentation in medical record Intensive management of hemoglobin (A1c) HbA1c lab test during the year that showed average blood sugar is <9% CPT I Code: 83036, 83037 CPT II Code: 3044F, 3045F, 3046F Retinal or dilated eye exam to check for damage from diabetes Urine microalbumin test At each visit Ongoing once diagnosed Annually Annually Annually Annually Care Coordination Measure Target Population How the Measure can be Improved Frequency Getting Needed Care All Patients Monitor timely referrals to specialists As needed Getting Appointments and Care Quickly All Patients Assist patients in getting appointments quickly As needed Overall Rating of Healthcare Quality All Patients Ratings reflect patient perception of quality of care, doctor/patient communication, and physician knowledge of treatment plan and specialist care At each visit Care Coordination All Patients Discuss and document lab test results, talk about prescription medications that patient is taking and recommendations from specialist in a timely manner At each visit