2017 Eligible Measure Applicability (EMA) for Claims Data Submission of Individual Quality Measures

Transcription

1 2017 Eligible Measure Applicability (EMA) for Claims Data Submission of Individual Quality Measures

2 QPP Clinically Related Measures Analysis Used in EMA Step 1: Clinical Relation including an Outcome/High Test of the 2017 Claims Data Submission of Individual Quality Measures 1 Urinary Incontinence Care 48 N/A Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older 50 High Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older 2 Diabetic Care 1 Intermediate Outcome Diabetes: Hemoglobin A1c Poor Control 117 N/A Diabetes: Eye Exam 128 N/A Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan Note: When submitting #117, it is not subject to EMA for theses clinically related measures. It is expected to submit #1 and #128, if #117 is submitted. 3 Lung Care 51 N/A Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation 52 N/A Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy 130 High Documentation of Current Medications in the Medical 4 Emergency Care 254 N/A Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain 5 Ear, Nose, & Throat Care 255 N/A Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure 91 High Acute Otitis Externa (AOE): Topical Therapy 93 High Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy Avoidance of Inappropriate Use 6 Pathology 99 N/A Breast Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade 100 N/A Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade 249 N/A Barrett s Esophagus 250 N/A Radical Prostatectomy Pathology Reporting 251 N/A Quantitative Immunohistochemical (IHC) Evaluation of Human Epidermal Growth Factor Receptor 2 Testing (HER2) for Breast Cancer Patients 7 Diagnostic Imaging 145 High Radiology: Exposure Dose or Time Reported for Procedures Using Fluoroscopy

3 8 Appropriate Follow- Up Imaging 146 High Radiology: Inappropriate Use of Probably Benign Assessment Category in Mammography Screening 147 High Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy 195 N/A Radiology: Stenosis Measurement in Carotid Imaging Reports 225 High Radiology: Reminder System for Screening Mammograms 436 N/A Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques 405 High Appropriate Follow-Up Imaging for Incidental Abdominal Lesions 406 High Appropriate Follow-Up Imaging for Incidental Thyroid Nodules in Patients 9 Eye Care 12 N/A Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 14 N/A Age-Related Macular Degeneration (AMD): Dilated Macular Examination 19 High Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 117 N/A Diabetes: Eye Exam 140 N/A Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement 141 Outcome Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care 10 Surgical Care 21 High Perioperative Care: Selection of Prophylactic Antibiotic First OR Second Generation Cephalosporin 23 High Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) 47 High Care Plan 11 Chiropractic Care 131 High Pain Assessment and Follow-Up 182 High Functional Outcome Assessment 12 Pathology Lung Cancer 395 Outcome Lung Cancer Reporting (Biopsy/ Cytology Specimens) 396 Outcome Lung Cancer Reporting (Resection Specimens)

4 13 Gynecological Care 422 High Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury 432 Outcome Proportion of Patients Sustaining a Bladder Injury at the Time of any Pelvic Organ Prolapse Repair 433 Outcome Proportion of Patients Sustaining a Bowel Injury at the time of any Pelvic Organ Prolapse Repair 434 Outcome Proportion of Patients Sustaining a Ureter Injury at the Time of any Pelvic Organ Prolapse Repair 14 Headache Care 419 High Overuse of Neuroimaging for Patients with Primary Headache And a Normal Neurological Examination 435 Outcome Quality of Life Assessment for Patients with Primary Headache Disorders 15 Immunization Care 110 N/A Preventive Care and Screening: Influenza Immunization 111 N/A Pneumococcal Vaccination Status for Older Adults 16 General Care 130 High Documentation of Current Medications in the Medical 226 N/A Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 134 N/A Preventive Care and Screening: Screening for Depression and Follow-Up Plan 317 N/A Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Note: When submitting #130 and/or #226, they are not subject to EMA for these clinically related measures. It is expected to submit #130, #226, if quality measures if #134 and/or #317 is submitted. 17 Preventive Care 112 N/A Breast Cancer Screening 113 N/A Colorectal Cancer Screening 130 High Documentation of Current Medications in the Medical 317 N/A Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Note: When submitting #130 or #317, they are not subject to EMA for these clinically related measures. It is expected to submit #130 and #317, if #112 and/or #113 are submitted. There is no requirement for both #112 and #113 to be submitted.

5 18 19 Colonoscopy Care Endoscopy and Polyp Surveillance High N/A Documentation of Current Medications in the Medical Photodocumentation of Cecal Intubation Note: When submitting #130, it is not subject to EMA for these clinically related measures. If quality measure #425 is submitted, it is expected to submit # High Colonoscopy Interval for Patients with a History of Adenomatous Polyps Avoidance of Inappropriate Use 320 High Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients