2016 Physician Quality Reporting System Data Collection Form: Chronic Obstructive Pulmonary Disease (COPD) (for patients aged 18 and older)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Chronic Obstructive Pulmonary Disease (COPD) (for patients aged 18 and older) IMPORTANT: 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. Patient sample criteria for the COPD Measures Group are patients aged 18 years with a specific diagnosis of COPD accompanied by a specific patient encounter: One of the following diagnosis codes indicating COPD: ICD-10-CM: J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9 Accompanied by: One of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, **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. PLEASE REFER TO THE Chronic Obstructive Pulmonary Disease (COPD) MEASURES GROUP WITHIN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS FOR CLINICAL RECOMMENDATIONS AND FURTHER INFORMATION.

2 Page 2 of 9 Physician Name: Patient Name: Last First MI Date of Birth: / / mm dd yyyy Gender: M F Practice Medical Record Number: Patient Insured - Traditional Medicare*: Medicare Advantage: Other: *Note: A minimum of 11 patients must be Traditional Medicare Part B Appointment Date: / / (1/1/16 12/31/16) mm dd yyyy ICD-10 Diagnosis Code: CPT Encounter Code: CPT Procedure Code: N/A

3 Page 3 of 9 Physician Quality Reporting Measure # 47 : Care Plan Percentage of 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 Documentation that Patient did not Wish or was not able to Name a Surrogate Decision Maker or Provide an Advance Care Plan May also include, as appropriate, the following: That the patient s cultural and/or spiritual beliefs preclude a discussion of advance care planning, as it would be viewed as harmful to the patient's beliefs and thus harmful to the physician-patient relationship. Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record - PM Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan - PM Advance care planning not documented, reason not otherwise specified - PNM Note: The provider does not need to review the Advance Care Plan annually with the patient to meet the numerator criteria; documentation of a previously developed advanced care plan that is still valid in the medical record meets numerator criteria.

4 Page 4 of 9 Physician Quality Reporting Measure # 51 : Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation Percentage of patients aged 18 years and older with a diagnosis of COPD who had spirometry results documented Look for most recent documentation of spirometry results in the medical record; do not limit the search to the reporting period Spirometry results documented and reviewed - PM Spirometry results not documented for - Document reason in medical chart - PE Medical Reason Patient Reason System Reason Spirometry results not documented, reason not otherwise specified - PNM

5 Page 5 of 9 Physician Quality Reporting Measure # 52 : Chronic Obstructive Pulmonary Disease (COPD): Inhaled Bronchodilator Therapy Percentage of patients aged 18 years and older with a diagnosis of COPD and who have an FEV1/FVC less than 60% and have symptoms who were prescribed an inhaled bronchodilator Prescribed Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the reporting period, even if the prescription for that medication was ordered prior to the encounter. Inhaled bronchodilator prescribed AND Spirometry test results demonstrate FEV1/FVC < 60% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) - PM Inhaled bronchodilator not prescribed for AND Spirometry test results demonstrate FEV1/FVC < 60% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) - PE Medical Reason Patient Reason System Reason Spirometry test results demonstrate FEV1/FVC 60% or patient does not have COPD symptoms - PE Spirometry test not performed or documented - PE Inhaled bronchodilator not prescribed, reason not specified AND Spirometry test results demonstrate FEV1/FVC < 60% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) - PNM

6 Page 6 of 9 Physician Quality Reporting Measure #110: Preventive Care and Screening: Influenza Immunization Percentage of 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 of an influenza immunization If reporting this measure between January 1, 2016 and March 31, 2016, choose answer option Influenza immunization administered or previously received when the influenza immunization is ordered or administered to the patient during the months of August, September, October, November, and December of 2015 or January, February, and March of 2016 for the flu season ending March 31, If reporting this measure between October 1, 2016 and December 31, 2016, choose answer option Influenza immunization administered or previously received when the influenza immunization is ordered or administered to the patient during the months of August, September, October, November, and December of 2016 for the flu season ending March 31, Influenza immunizations administered during the month of August or September of a given flu season (either flu season OR flu season) can be reported when a visit occurs during the flu season (October 1 - March 31). In these cases, choose answer option Influenza immunization administered or previously received. Patient visit occurred outside of acceptable date range (i.e., April 1 through September 30, 2016) patient not eligible Influenza immunization administered or previously received - PM Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reason, patient declined or other patient reasons, vaccine not available or other system reasons) Document reason in medical chart - PE Influenza immunization was not administered, reason not given - PNM Previous Receipt - Receipt of the current season s influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st).

7 Page 7 of 9 Physician Quality Reporting Measure #111 : Pneumonia Vaccination Status for Older Adults For patients aged 65 or older. Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine Pneumococcal vaccine administered or previously received - PM Pneumococcal vaccine not administered or previously received, reason not otherwise specified - PNM

8 Page 8 of 9 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

9 Page 9 of 9 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 OR tobacco cessation intervention not performed, reason not otherwise specified. 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 (eg, limited life expectancy, other medical reasons) - PE Tobacco Use includes any type of tobacco. Cessation Counseling Intervention includes brief counseling (3 minutes or less) and/or pharmacotherapy. Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified - PNM