2016 Physician Quality Reporting System Data Collection Form: Parkinson s Disease (for patients aged 18 and older)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Parkinson s Disease (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 (), 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 Parkinson s Disease Measures Group are: patients aged 18 years and older, with a specific diagnosis of Parkinson s Disease accompanied by a specific patient encounter: The following diagnosis code indicating Parkinson s disease: ICD-10-CM: G20 AND one of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Measure #47 need only be reported on patients 65 years and older. **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. REFER TO THE PARKINSON S DISEASE MEASURES GROUP WITHIN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR CLINICAL RECOMMENDATIONS AND FURTHER INFORMATION.

2 Page 2 of 5 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 (visit) Code: CPT Procedure Code: N/A

3 Page 3 of 5 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 - 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 - Advance care planning not documented, reason not otherwise Physician Quality Reporting Measure # 289 : Parkinson s Disease: Annual Parkinson s Disease Diagnosis Review had an annual assessment including a review of current medications (e.g., medications that can produce Parkinson-like signs or symptoms) and a review for the presence of atypical features (e.g., falls at presentation and early in the disease course, poor response to levodopa, symmetry at onset, rapid progression [to Hoehn and Yahr stage 3 in 3 years], lack of tremor or dysautonomia) at least annually Parkinson s disease diagnosis reviewed - Parkinson s disease diagnosis was not reviewed, reason not otherwise specified - PNM

4 Page 4 of 5 Physician Quality Reporting Measure # 290 : Parkinson s Disease: Psychiatric Disorders or Disturbances Assessment were assessed for psychiatric disorders or disturbances (e.g., psychosis, depression, anxiety disorder, apathy, or impulse control disorder) at least annually Psychiatric disorders or disturbances assessed - Psychiatric disorders or disturbances not assessed, reason not otherwise Physician Quality Reporting Measure # 291 : Parkinson s Disease: Cognitive Impairment or Dysfunction Assessment were assessed for cognitive impairment or dysfunction at least annually Cognitive impairment or dysfunction assessed - Cognitive impairment or dysfunction was not assessed, reason not otherwise Physician Quality Reporting Measure # 292 : Parkinson s Disease: Querying about Sleep Disturbances All patients with a diagnosis of Parkinson s disease (or caregivers, as appropriate) who were queried about sleep disturbances at least annually Patient (or caregiver) queried about sleep disturbances - Patient (or caregiver) not queried about sleep disturbances, medical reason(s) - PE Patient (or caregiver) not queried about sleep disturbances, reason not otherwise

5 Page 5 of 5 Physician Quality Reporting Measure # 293 : Parkinson s Disease: Rehabilitative Therapy Options All patients with a diagnosis of Parkinson s Disease (or caregiver(s), as appropriate) who had rehabilitative therapy options (e.g., physical, occupational, or speech therapy) discussed at least annually Rehabilitative therapy options discussed with patient (or caregiver) - Rehabilitative therapy options not discussed with patient (or caregiver), medical reason(s)- PE Rehabilitative therapy options not discussed with patient (or caregiver), reason not otherwise Physician Quality Reporting Measure # 294 : Parkinson s Disease: Parkinson s Disease Medical and Surgical Treatment Options Reviewed All patients with a diagnosis of Parkinson s disease (or caregiver(s), as appropriate) who had the Parkinson s disease treatment options (e.g., non-pharmacological treatment, pharmacological treatment, or surgical treatment) reviewed at least once annually reviewed with patient (or caregiver) - not reviewed with patient (or caregiver), medical reasons (eg, patient is unable to respond and no informant is available) - PE not reviewed with patient (or caregiver), reason not otherwise