Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series

Transcription

1 Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series Preventive Care and Screening (PREV-6): Measure 19 Colorectal Cancer Screening ACO_QRM19PPTv9_0518_IA Approved

2 Measure 19: Colorectal Cancer Screening Objectives: Understand acceptable documentation required to successfully satisfy the Colorectal Cancer Screening measure Understand the following: Appropriate age parameter Types of colorectal cancer screenings Two acceptable exclusions 2

3 Measure 19: Colorectal Cancer Screening Measure Description: Percentage of beneficiaries aged years who had the appropriate screening for colorectal cancer. Age Parameter: For this measure, beneficiaries are to be years old as of January 1,

4 Measure 19: Measure Qualification Determine if the patient is qualified for the measure. The measure qualification answer is Yes unless prior approval is received to select: No Other CMS Approved Reason This answer is only acceptable with approval from the Centers for Medicare & Medicaid Services (CMS) 4

5 Measure 19: Measure Qualification If the measure qualification answer is Yes, does the patient meet one of the following three accepted exclusions? Total colectomy Colorectal cancer Patients age 65 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS (Place of Service) code 32, 33, 34, 54 or 56 any time during the measurement period Note: All SNF patients are NOT excluded from these measures they must be nursing home / custodial care residents or in a residential treatment facility. Acceptable long-term care facilities are: nursing facilities, custodial care facilities, hospice, intermediate care facilities for individuals with intellectual disabilities or psychiatric residential treatment centers. 5

6 Measure 19: Colorectal Cancer Screening 1. Is patient colorectal cancer screening current and required results documented in the medical record? Yes Documentation of one or more of the following in the medical record with required results, performed and dated within the noted timeframes: Fecal Occult Blood Test (FOBT) during 2018 Flexible sigmoidoscopy during Colonoscopy during Computed Tomography (CT) Colonography Fecal Immunochemical DNA Test (FIT-DNA) No No documentation of a colorectal cancer screening within the required timeframes 6

7 Measure 19: Quick Tips The following are five appropriate screenings and associated timeframes: Fecal Occult Blood Test (FOBT): 2018 FOBT includes Fecal Immunochemical Tests (FIT), Note: FOBT tests performed in an office setting or performed on a sample collected via digital rectal exam (DRE) are NOT acceptable for this measure Flexible Sigmoidoscopy: Colonoscopy: Computed Tomography (CT) Colonography Fecal Immunochemical DNA Test (FIT-DNA) May be self-reported by beneficiary. Date and test must be noted. Date may be year only. Documentation must include results of the test. Cancerous colorectal polyps is not acceptable documentation for a colorectal cancer exclusion. More specific documentation by the provider is required. 7

8 Measure 19: Quick Tips (con t) Documentation in the medical record must include both the date of the colorectal screening AND results or findings. Documentation of normal or abnormal in the medical record is acceptable If a specific screening is contraindicated due to a patient s condition, an alternative screening should be used. For example, if a colonoscopy is contraindicated, a FBOT or FIT-DNA during the appropriate time frames should be performed. It is not acceptable to chase screening reports and add them to the medical record after the close of the measurement year even if the exam performed in

9 Measure 19: Skip Vs Performance Met Beneficiary Skip Not Qualified = Hospice, Death, Moved Out of Country, Medicare Not Primary Measure Skip Patients with a diagnosis or past history of total colectomy or colorectal cancer Patients age 65 and older residing in long-term care facilities at any time during Acceptable long-term care facilities are: nursing facilities, custodial care facilities, hospice, intermediate care facilities for individuals with intellectual disabilities or psychiatric residential treatment centers. Performance Met Colorectal cancer screening completed documentation in the medical record of both date and result/finding Performance Not Met Colorectal cancer screening not completed Colorectal cancer screening completed but no documentation of date and/or result/finding 9

10 Measure 19: Numerator & Denominator Inclusion in the Denominator: Beneficiary is qualified for the sample Medical record is available Age qualifications met (see page 3) Beneficiary is qualified for the measure (see page 4) Inclusion in the Numerator: Current screening documentation or notation is in the medical record (see page 5) 10

11 Disclaimer: This presentation was current at the time it was published. The CMS Programs are subject to policy changes. Links to the resource documents have been provided in the following page(s) within this document for your reference. Review the link(s) for specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 11

12 Resources: CMS Quality Payment Program website: Payment-Program.html Educational Resources: Quality Payment Resource Library: Library/2018-Resources.html Quality Measure Specification Supporting Documents (with codes): Library/2018-Web-Interface-Measures-and-supporting-documents.zip 12