Download Quality Measures Quality Measures

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