2018 CMS Web Interface

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1 CMS Web Interface MH-1 (NQF 0710): Depressin Remissin at Twelve Mnths Measure Steward: MNCM CMS Web Interface V2.0 Page 1 f 27 11/13/2017

2 Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION... 5 BENEFICIARY SAMPLING... 5 NARRATIVE MEASURE SPECIFICATION... 6 DESCRIPTION:... 6 IMPROVEMENT NOTATION:... 6 INITIAL POPULATION:... 6 DENOMINATOR:... 6 DENOMINATOR EXCLUSIONS:... 6 DENOMINATOR EXCEPTIONS:... 6 NUMERATOR:... 6 NUMERATOR EXCLUSIONS:... 6 DEFINITIONS:... 6 GUIDANCE:... 7 SUBMISSION GUIDANCE... 8 PATIENT CONFIRMATION... 8 SUBMISSION GUIDANCE... 9 DENOMINATOR CONFIRMATION... 9 SUBMISSION GUIDANCE DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE NUMERATOR REPORTING SUBMISSION GUIDANCE NUMERATOR REPORTING DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS CMS Web Interface V2.0 Page 2 f 27 11/13/2017

3 COPYRIGHT CMS Web Interface V2.0 Page 3 f 27 11/13/2017

4 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The measure dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each measure dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. CMS Web Interface V2.0 Page 4 f 27 11/13/2017

5 CMS WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the CMS Web Interface Sampling Dcument, which will be made available during the perfrmance year at CMS.gv. CMS Web Interface V2.0 Page 5 f 27 11/13/2017

6 NARRATIVE MEASURE SPECIFICATION DESCRIPTION: The percentage f patients 18 years f age r lder with majr depressin r dysthymia wh reached remissin 12 mnths (+/- 30 days) after an index visit. IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: Patients age 18 and lder with a diagnsis f majr depressin r dysthymia and an initial PHQ-9 scre greater than nine during the index visit. DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Patients with a diagnsis f biplar disrder Patients with a diagnsis f persnality disrder Patients wh were permanent nursing hme residents DENOMINATOR EXCEPTIONS: Nne NUMERATOR: Patients wh achieved remissin at twelve mnths as demnstrated by a twelve mnth (+/- 30 days) PHQ-9 scre f less than five NUMERATOR EXCLUSIONS: Nt Applicable DEFINITION: Denminatr Identificatin Perid - The perid in which eligible patients can have an index event. The denminatr identificatin perid ccurs prir t the measure assessment perid and is defined as 13 mnths t ne mnth prir t the start f the measurement assessment perid. The denminatr identificatin perid is frm 12/1/2016 t 11/30/2017. Fr patients with an index event, there needs t be enugh time fllwing index fr the patients t have the pprtunity t reach remissin twelve mnths +/- 30 days after the index date. Index Date - The date in which the first instance f elevated PHQ-9 greater than nine AND diagnsis f depressin r dysthymia ccurs during the denminatr identificatin measurement perid (12/1/2016 t 11/30/2017). Measure Assessment Perid - The index date marks the start f the measurement assessment perid fr each patient which is 13 mnths (12 mnths +/- 30 days) in length t allw fr a fllw-up PHQ-9 between 11 and 13 mnths fllwing the index date. This assessment perid is fixed and des nt start ver with a higher PHQ-9 that may ccur after the index date. Remissin - Is defined as a PHQ-9 scre f less than five. Twelve Mnths - Is defined as the pint in time frm the index date extending ut twelve mnths and then allwing a grace perid f thirty days prir t and thirty days after this date. The mst recent PHQ-9 scre less than five btained during this tw mnth perid is deemed as remissin at twelve mnths, values btained prir t r after this perid are nt cunted as numeratr cmpliant (remissin). CMS Web Interface V2.0 Page 6 f 27 11/13/2017

7 GUIDANCE: Nne CMS Web Interface V2.0 Page 7 f 27 11/13/2017

8 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr submitting requires the fllwing: Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample Guidance Patient Cnfirmatin If the patient is deceased, in hspice, mved ut f the cuntry r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be submitted in their place, if available. The CMS Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have been sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) CMS Web Interface V2.0 Page 8 f 27 11/13/2017

9 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient has an active diagnsis f majr depressin r dysthymia during the denminatr identificatin perid (12/1/2016 t 11/30/2017) OR OR OR If the patient has a dcumented diagnsis f majr depressin r dysthymia in the medical recrd select Yes If yu are unable t cnfirm the diagnsis f majr depressin r dysthymia fr the patient select Nt Cnfirmed - Diagnsis If there is a denminatr exclusin fr patient disqualificatin frm the measure select Denminatr Exclusin If there is an "ther" CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr and Denminatr Exclusin cdes can be fund in the CMS Web Interface MH Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Nt Cnfirmed Diagnsis r Denminatr Exclusin r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be submitted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all CMS Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure, and reasn fr request in a Quality Payment Prgram Service Desk inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm a CMS Apprved Reasn is selected will be skipped and anther patient must be submitted in their place, if available. NOTE: - Active Diagnsis is defined as a diagnsis that is either n the patient s prblem list, a diagnsis cde listed n the encunter, r is dcumented in a prgress nte indicating that the patient is being treated r managed fr the disease r cnditin during the measurement perid - Encunters in a Psychiatric, Behaviral, r Mental Health Setting require the diagnsis f depressin r dysthymia t be a primary diagnsis - Patient must be age 18 years r lder at the time f the index event (cnfirming diagnsis and PHQ-9 greater than 9) - Index Date is defined as the date n which the first instance f elevated PHQ-9 greater than 9 AND diagnsis f depressin r dysthymia ccurs during the denminatr identificatin perid (12/1/2016 t 11/30/2017) - Denminatr Exclusins - active diagnsis f biplar disrder r persnality disrder anytime prir t the end f the perfrmance perid. Patients wh were a permanent nursing hme resident any time during the denminatr identificatin perid r the measure assessment perid. - Permanent Nursing Hme Resident is defined as a patient wh is residing in a lng term residential facility any time during the denminatr identificatin perid r befre the end f the measurement CMS Web Interface V2.0 Page 9 f 27 11/13/2017

10 assessment perid. It des nt include patients wh are receiving shrt term rehabilitative services fllwing a hspital stay, nr des it include patients residing in assisted living r grup hme settings CMS Web Interface V2.0 Page 10 f 27 11/13/2017

11 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient had ne r mre PHQ-9s administered during the denminatr identificatin perid between 12/1/2016 and 11/30/2017 OR If the patient did nt have a PHQ-9 administered during the denminatr identificatin perid select N If the patient did have a PHQ-9 administered during the denminatr identificatin perid select Yes Denminatr cdes can be fund in the CMS Web Interface MH Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If N is selected, the patient is nt cnsidered denminatr eligible. The patient will be skipped and anther patient must be submitted in their place, if available. NOTE: - PHQ-9 administratin des nt require a face-t-face visit; multiple mdes f administratin are acceptable (telephne, mail, e-visit, , patient prtal, ipad/tablet, r patient kisk) - Index date marks the start f the measurement assessment perid fr each patient which is 13 mnths (12 mnths +/- 30 days) in length t allw fr a fllw-up PHQ-9 between 11 and 13 mnths fllwing the index date. This assessment perid is fixed and des nt start ver with a higher PHQ-9 that may ccur after the index date CMS Web Interface V2.0 Page 11 f 27 11/13/2017

12 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient had a PHQ-9 scre greater than 9 between 12/1/2016 and 11/30/2017 OR If the patient did nt have a PHQ-9 greater than 9 during the denminatr identificatin perid select N If the patient did have a PHQ-9 greater than 9 during the denminatr identificatin perid select Yes IF YES Recrd the date f the index PHQ-9 scre greater than 9 in MM/DD/YYYY frmat. This is the patient s index date. AND Enter the scre f the PHQ-9 assciated with the Index Date Denminatr cdes can be fund in the CMS Web Interface MH Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If N is selected, the patient is nt cnsidered denminatr eligible. The patient will be skipped and anther patient must be submitted in their place, if available. NOTE: - Enter the first instance f PHQ-9 greater than 9 that is als assciated with a diagnsis f majr depressin r dysthymia during the time perid f 12/1/2016 and 11/30/2017. This is the Index Event Date fr this patient and marks the start f the 13 mnth assessment perid (12 mnths +/- 30 days) - All nine questins must be answered t have a valid summary scre. If a patient chses mre than ne respnse fr a single questin, select the wrse respnse (higher number) t calculate the summary scre CMS Web Interface V2.0 Page 12 f 27 11/13/2017

13 NUMERATOR SUBMISSION SUBMISSION GUIDANCE Determine if the patient had ne r mre PHQ-9s administered during the Measurement Assessment Perid (12 mnths +/- 30 days frm the Index Event/ Date) OR If the patient did nt have ne r mre PHQ-9s administered during the Measurement Assessment Perid, select N If the patient did have ne r mre PHQ-9s administered during the Measurement Assessment Perid, select Yes Numeratr cdes can be fund in the CMS Web Interface MH Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr NOTE: - The nly tl apprpriate fr indicating remissin is a cmpleted PHQ-9 CMS Web Interface V2.0 Page 13 f 27 11/13/2017

14 NUMERATOR SUBMISSION SUBMISSION GUIDANCE Determine if the patient achieved remissin with a fllw-up PHQ-9 perfrmed and a scre less than 5 at 12 mnths (+/- 30 days) f the initial (index date) PHQ-9 scre greater than 9 OR IF YES If the patient did nt have a PHQ-9 less than 5 select N If the patient did have a PHQ-9 less than 5 select Yes Recrd the date f the PHQ-9 scre less than 5 in MM/DD/YYYY frmat. This is the patient s Remissin Date. AND Enter the scre f the PHQ-9 assciated with the Remissin Date Numeratr cdes can be fund in the CMS Web Interface MH Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr NOTE: - If mre than ne PHQ-9 scre was btained between the 11 and 13 mnth windw, select the mst recent PHQ-9 date and scre within that windw - Scres btained prir t r after this perid are nt cunted as numeratr cmpliant (remissin) - Patient remissin, a fllw-up PHQ-9 result less than 5, may be determined during a telehealth encunter - PHQ-9 administratin des nt require a face-t-face visit; multiple mdes f administratin are acceptable (telephne, mail, e-visit, , patient prtal, ipad/tablet, r patient kisk) CMS Web Interface V2.0 Page 14 f 27 11/13/2017

15 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin submitted in the CMS Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Claims data cannt be used t cnfirm a diagnsis (DM, IVD, HTN etc.,) used fr sampling purpses as claims are the riginal surce f the diagnsis sampling. Claims data can be used t prepare the CMS Web Interface Excel, but supprting medical recrd dcumentatin will be required t substantiate what is submitted in the event f an audit. CMS Web Interface V2.0 Page 15 f 27 11/13/2017

16 Appendix I: Perfrmance Calculatin Flw Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f "In Hspice", "Mved ut f Cuntry", "Deceased", r "HMO Enrllment", will nly need t be dne nce per patient. Start* Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures The patient will be skipped and replaced. N Medical Recrd Fund Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Patient Qualified fr the Sample. IF NOT, Select the Reasn & Enter Date** Patient Became Ineligible fr Sample (In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment) Yes Cntinue t Measure Cnf *See the Measure Submissin Dcument fr further instructins n hw t submit this measure **If date is unknwn, enter 12/31/ CMS Web Interface V2.0 Page 16 f 27 11/13/2017

17 Measure Cnfirmatin Flw fr MH-1 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Start* Cmplete fr cnsecutively ranked patients aged 18 years and lder during the denminatr identificatin measurement perid** N Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Patient has an Active Diagnsis f Majr Depressin Including Remissin r Dysthymia During Denminatr Identificatin Measurement Perid (12/1/2016 thrugh 11/30/2017)*** Yes Yes One r Mre PHQ-9s Administered During the Denminatr Identificatin Measurement Perid between 12/1/2016 and 11/30/2017 Yes PHQ-9 Scre > 9* During the Denminatr Identificatin Measurement Perid N Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. N N Patient Qualified fr the Measure. IF NOT, Select: Denminatr Exclusin fr Patient Disqualificatin Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Yes Recrd the date in mm/dd/yyyy frmat and the scre f the first instance f PHQ-9 > 9 that is als assciated with an active diagnsis f majr depressin r dysthymia during the Denminatr Identificatin Measurement Perid (this is cnsidered the Index Date fr perfrmance calculatins) N Patient Qualified fr the Measure. IF NOT, Select: N Other CMS Apprved Reasn fr Patient Disqualificatin**** Cntinue t Measure Flw *See the Measure Submissin Dcument fr further instructins n hw t submit this measure **Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the MH-1 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. ***The active diagnsis f Majr Depressin r Dysthymia must crrespnd with a primary diagnsis at a psychiatric visit r any diagnsis (primary, secndary, etc.) at an ffice visit **** Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv CMS Web Interface V2.0 Page 17 f 27 11/13/2017

18 Measure Flw fr MH-1 Start* Include Remainder f Patients Listed in CMS Web Interface that were Cnsecutively Cnfirmed and Cmpleted fr this Measure in the Denminatr (i.e., 60 Patients) d The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatin. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the MH Cding Dcument. One r Mre PHQ-9s Administered During the Measurement Assessment Perid (12 mnths +/- 30 days frm the Index Date) N Perfrmance Nt Met: D Nt Include in Numeratr Yes Mst recent PHQ-9 Scre During the Measurement Assessment Perid (12 mnths +/- 30 days frm the Index Date) is < 5 N Perfrmance Nt Met: D Nt Include in Numeratr Yes Recrd the date in mm/dd/yyyy frmat and the scre f the mst recent PHQ-9 < 5 that was administered during the measurement assessment perid (within the windw f 11 t 13 mnths frm the index date) Perfrmance Met: Include in Numeratr (i.e., 40 Patients) a Perfrmance Rate= Perfrmance Met (a=40 Patients) 40 Patients = 66.67% Denminatr (d=60 Patients) = 60 Patients CALCULATION MAY CHANGE PENDING PERFORMANCE MET ABOVE SAMPLE CALCULATION: *See the Measure Submissin Dcument fr further instructins n hw t submit this measure CMS Web Interface V2.0 Page 18 f 27 11/13/2017

19 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr MH-1. CMS Web Interface V2.0 Page 19 f 27 11/13/2017

20 Measure Cnfirmatin Flw fr MH-1 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr MH-1. Cmplete fr cnsecutively ranked patients aged 18 years and lder during the denminatr identificatin perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the MH-1 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient has an active diagnsis f majr depressin r dysthymia during the denminatr identificatin perid (12/1/2016 thrugh 11/30/2017). The active diagnsis f majr depressin r dysthymia must crrespnd t a primary diagnsis at a psychiatric visit r any diagnsis (primary, secndary, etc.) at an ffice visit. a. If n, the patient des nt have an active diagnsis f majr depressin r dysthymia during the denminatr identificatin perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing b. If yes, the patient des have an active diagnsis f majr depressin r dysthymia during the denminatr identificatin perid, cntinue prcessing. 3. Check t determine if the patient qualifies fr the measure (Denminatr Exclusin). a. If n, the patient des nt qualify fr the measure select: Denminatr Exclusin fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 4. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested CMS Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 5. Check t determine if the patient had ne r mre PHQ-9s administered during the denminatr identificatin perid between 12/1/2016 and 11/30/2017. a. If n, the patient did nt have ne r mre PHQ-9s administered during the denminatr identificatin perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient did have ne r mre PHQ-9s administered during the denminatr identificatin perid, cntinue prcessing. 6. Check t determine if the patient had any PHQ-9 scre greater than 9 during the denminatr identificatin perid. CMS Web Interface V2.0 Page 20 f 27 11/13/2017

21 a. If n, the patient des nt have a PHQ-9 scre greater than 9 during the denminatr identificatin perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des have a PHQ-9 scre greater than 9 during the denminatr identificatin perid, recrd the date in mm/dd/yyyy frmat and the scre f the first instance f PHQ-9 greater than 9 that is als assciated with an active diagnsis f majr depressin r dysthymia during the denminatr identificatin perid (this is cnsidered the index date fr perfrmance calculatins). Cntinue t the MH-1 measure flw. CMS Web Interface V2.0 Page 21 f 27 11/13/2017

22 Measure Flw fr MH-1 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the MH Cding Dcument. 1. Start prcessing MH-1 (NQF 0710) Flw fr the patients that qualified fr the sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr MH-1. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 60 patients). 2. Check t determine if the patient had ne r mre PHQ-9s administered during the measurement assessment perid (12 mnths +/- 30 days frm the index date). a. If n, patient did nt have ne r mre PHQ-9s administered during the measurement assessment perid, perfrmance is nt met and the patient will nt be included in the numeratr. Stp prcessing. b. If yes, the patient did have ne r mre PHQ-9s administered during the measurement assessment perid, cntinue prcessing. 3. Check t determine if the patient s mst recent PHQ-9 scre during the measurement assessment perid (12 mnths +/- 30 days frm the index date) is less than 5. a. If n, patient s mst recent PHQ-9 scre during the measurement assessment perid (12 mnths +/- 30 days frm the index date) is nt less than 5, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, patient s mst recent PHQ-9 scre during the measurement assessment perid (12 mnths +/- 30 days frm the index date) is less than 5, enter the date in mm/dd/yyyy frmat and the scre f the mst recent PHQ-9 less than 5 that was administered during the measurement assessment perid (within the windw f 11 t 13 mnths frm the index date). Perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a categry (numeratr, i.e. 40 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (40 patients) Denminatr is categry d in measure flw (60 patients) 40 (Perfrmance Met) divided by 60 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.0 Page 22 f 27 11/13/2017

23 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the CMS Web Interface MH Cding Dcument. *MH-1: Depressin Remissin at Twelve Mnths Measure Cmpnent/Excel Tab Data Element Variable Name Cding System(s) Denminatr/Denminatr Cdes Depressin r Dysthymia Diagnsis DEPRESSION_CODE I10 SNM DYSTHYMIA_CODE I10 SNM Index PHQ-9 PHQ9_TOOL_CODE LN PHQ-9 Greater Than 9 PHQ9_TOOL_CODE LN WITH a scre Denminatr Exclusin/Denminatr Exclusin Cdes Exclusins BIPOLAR_DX_CODE NH_RES_CODE PERSONALITY_DIS_CODE greater than 9 I9 I10 SNM C4 I9 I10 SNM Numeratr/Numeratr Cdes Assessment PHQ-9 PHQ9_TOOL_CODE LN PHQ-9 Less Than 5 PHQ9_TOOL_CODE LN WITH a scre less than 5 *Fr EHR mapping, the cding within MH-1 is cnsidered t be all-inclusive CMS Web Interface V2.0 Page 23 f 27 11/13/2017

24 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: Depressin is a cmmn and treatable mental disrder. The Centers fr Disease Cntrl and Preventin states that an estimated 6.6% f the U.S. adult ppulatin (14.8 millin peple) experiences a majr depressive disrder during any given 12-mnth perid. Additinally, dysthymia accunts fr an additinal 3.3 millin Americans. In 2006 and 2008, an estimated 9.1% f U.S. adults reprted symptms fr current depressin. [(Centers fr Disease Cntrl and Preventin, 2010). Current Depressin Amng Adults United States, 2006 and MMWR 2010;59(38); ] Persns with a current diagnsis f depressin and a lifetime diagnsis f depressin r anxiety were significantly mre likely than persns withut these cnditins t have cardivascular disease, diabetes, asthma and besity and t be a current smker, t be physically inactive and t drink heavily. [Strine TW et al. Depressin and anxiety in the United States: findings frm the 2006 Behaviral Risk Factr Surveillance System. Psychiatr Serv 2008;59: ] Peple wh suffer frm depressin have lwer incmes, lwer educatinal attainment and fewer days wrking days each year, leading t seven fewer weeks f wrk per year, a lss f 20% in ptential incme and a lifetime lss fr each family wh has a depressed family member f $300,000. [Smith, 2010) J. P., & Smith, G. C. (2010). Lng-term ecnmic csts f psychlgical prblems during childhd. Scial Science & Medicine, 71, ] The cst f depressin (lst prductivity and increased medical expense) in the United States is $83 billin each year. [Greenberg, 2003). The ecnmic burden f depressin in the United States: Hw did it change between 1990 and 2000? Jurnal f Clinical Psychiatry, 64, ] CLINICAL RECOMMENDATION STATEMENTS: Surce: Institute fr Clinical Systems Imprvement (ICSI) Majr Depressin in Adults in Primary Care (Trangle, 2016) Recmmendatins Majr Depressin in Adults in Primary Care Majr depressin is a treatable cause f pain, suffering, disability and death, yet primary care clinicians detect majr depressin in nly ne-third t ne-half f their patients with majr depressin (Williams Jr, 2002; Schnfeld, 1997). Usual care fr depressin in the primary care setting has resulted in nly abut half f depressed adults getting treated (Kessler, 2005) and nly 20-40% shwing substantial imprvement ver 12 mnths (Unützer, 2002; Katn, 1999). Recmmendatins and algrithm ntatins supprting depressin utcmes and duratin f treatment accrding t ICSI s Health Care Guideline: Recmmendatin: Clinicians shuld establish and maintain fllw-up with patients. Apprpriate, reliable fllw-up is highly crrelated with imprved respnse and remissin scres. It is als crrelated with the imprved safety and efficacy f medicatins and helps prevent relapse. [Recmmendatin 7a page 50] Practive fllw-up cntacts (in persn, telephne) based n the cllabrative care mdel have been shwn t significantly lwer depressin severity (Unützer, 2002). In the available clinical effectiveness trials cnducted in real clinical practice settings, even the additin f a care manager leads t mdest remissin rates (Trivedi, 2006b; Unützer, 2002). Interventins are critical t educating the patient regarding the imprtance f preventing relapse, safety and efficacy f medicatins, and management f ptential side effects. Establish and maintain initial fllw-up cntact intervals (ffice, phne, ther) (Hunkeler, 2000; Simn, 2000). PHQ-9 as mnitr and management tl. The PHQ-9 is an effective management tl, as well, and shuld be used rutinely fr subsequent visits t mnitr treatment utcmes and severity. It can als help the clinician decide if/hw t mdify the treatment plan (Duffy, 2008; Löwe, 2004). Using a measurement-based apprach t depressin care, PHQ-9 results and side effect evaluatin shuld be cmbined with treatment algrithms t drive patients tward CMS Web Interface V2.0 Page 24 f 27 11/13/2017

25 remissin. A five-pint drp in PHQ-9 scre is cnsidered the minimal clinically significant difference (Trivedi, 2009). Every time that the PHQ-9 is assessed, suicidality is assessed, as well. If the suicidality was indeed f high risk, urgent referral t crisis specialty health care is advised. In case f lw suicide risk, the patient can prceed with treatment in the primary care practice (Huijbregts, 2013). Care Algrithm: Has the patient reached remissin? [Algrithm anntatin 7b page 51] The gals f treatment shuld be t achieve remissin, reduce relapse and recurrence, and return t previus level f ccupatinal and psychscial functin. Full remissin is defined as a tw-mnth perid devid f majr depressive signs and symptms (American Psychiatric Assciatin, 2013: Diagnstic and Statistical Manual f Mental Disrders, 5th Editin). If using a PHQ-9 tl, remissin translates t PHQ-9 scre f less than 5 (Krenke, 2001). Results frm the STAR*D study shwed that remissin rates lwered with mre treatment steps, but the verall cumulative rate was 67% (Rush, 2006). Respnse is defined as a 50% r greater reductin in symptms (as measured n a standardized rating scale). Partial respnse is defined as a 25-50% reductin in symptms. This definitin is based n hw the depressin literature defines respnse. Respnse and remissin take time. In the STAR*D study, lnger times than expected were needed t reach respnse r remissin. In fact, ne-third f thse wh ultimately respnded did s after six weeks. Of thse wh achieved remissin by Quick Inventry f Depressive Symptmatlgy (QIDS), 50% did s nly at r after six weeks f treatment (Trivedi, 2006b). If the primary care clinician is seeing sme imprvement, cntinue wrking with that patient t augment r increase dsage t reach remissin. This can take up t three mnths. A reasnable criterin fr extending the initial treatment: assess whether the patient is experiencing a 25% r greater reductin in baseline symptm severity at six weeks f therapeutic dse. If the patient's symptms are reduced by 25% r mre, but the patient is nt yet at remissin, and if medicatin has been well tlerated, cntinue t prescribe. Raising the dse is recmmended (Trivedi, 2006b). Imprvement with psychtherapy is ften a bit slwer than with pharmactherapy. A decisin regarding prgress with psychtherapy and the need t change r augment this type f treatment may require 8 t 10 weeks befre evaluatin (Schulberg, 1998). Care Algrithm: Cntinuatin and Maintenance Treatment Duratin Based n Episde [Algrithm anntatin 7c page 51] Acute therapy is the treatment phase fcused n treating the patient t remissin. Acute therapy typically lasts 6-12 weeks but technically lasts until remissin is reached (American Psychiatric Assciatin, 2010). Full remissin is defined as a tw-mnth perid devid f majr depressive signs and symptms (American Psychiatric Assciatin, 2013; Diagnstic and Statistical Manual f Mental Disrders, 5th Editin). Cntinuatin therapy is the fur-t-nine mnth perid beynd the acute treatment phase during which the patient is treated with antidepressants, psychtherapy, ECT r ther smatic therapies t prevent relapse (American Psychiatric Assciatin, 2010). Relapse is cmmn within the first six mnths fllwing remissin frm an acute depressive episde; as many as 20-85% f patients may relapse (American Psychiatric Assciatin, 2010). This measure assesses achievement f remissin, which is a desired utcme f effective depressin treatment and mnitring. Adult Depressin in Primary Care- Guideline Aims CMS Web Interface V2.0 Page 25 f 27 11/13/2017

26 Increase the percentage f patients with majr depressin r persistent depressive disrder wh have imprvement in utcmes frm treatment fr majr depressin r persistent depressive disrder Increase the percentage f patients with majr depressin r persistent depressive disrder wh have a fllw-up t assess f respnse t treatment. Imprve cmmunicatin between the primary care physician and the mental health care clinician (if patient is cmanaged). CMS Web Interface V2.0 Page 26 f 27 11/13/2017

27 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT MN Cmmunity Measurement, All rights reserved. CMS Web Interface V2.0 Page 27 f 27 11/13/2017

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