TBD Low Back Pain: Use of Imaging Studies 0052 NCQA

Transcription

1 CMS-1524-P 354 Low Back Pain: Use of maging Studies 0052 NCQA 202 & 203 schemic Vascular Disease (VD): Complete Lipid 0075 NCQA Panel and LDL Control Diabetes: Hemoglobin A 1 c Control (<8.0%) 0575 NCQA OTHER PHYSCAN QUALTY REPORTNG SYSTEM EHR MEASURES 39 Screening or Therapy for Osteoporosis for Women 0046 /NCQA Aged 65 Years and Older 47 Advance Care Plan 0326 /NCQA 48 Urinary ncontinence: Assessment of Presence or 0098 /NCQA Absence of Urinary ncontinence in Women Aged 65 Years and Older 124 Health nformation Technology (HT): Adoption/Use 0488 CMS/QP of Electronic Health Records (EHR) 173 Preventive Care and Screening: Unhealthy Alcohol Use Screening Adopted 238 Drugs to be Avoided in the Elderly 0022 NCQA * For the purpose of reporting this measure under the, the reporting of this measure will count if at least one of the two parameters does not contain a 0 percent performance rate. ** For the purpose of reporting this measure under the, the reporting of this measure will count if at least one of the two pairs does not contain a 0 percent performance rate. (4) 2012 s Groups We propose to retain the following measures groups for the 2012 : (1) Diabetes Mellitus; (2) CKD; (3) Preventive Care; (4) CABG; (5) Rheumatoid Arthritis; (6) Perioperative Care; (7) Back Pain; (8) CAD; (9) Heart Failure; (10) VD; (11) Hepatitis C; (12) HV/ADS; (13) CAP, and (14) Asthma. For 2012, we propose that the CABG, CAD, Heart Failure, and HV/ADS measures groups would continue to be reportable through the registry-based reporting mechanism only, while the remaining Diabetes Mellitus, CKD, Preventive Care, Rheumatoid Arthritis, Perioperative Care, Back Pain, VD, Hepatitis C, CAP, and Asthma measures groups would continue to be reportable through either claims-based reporting or registry-based reporting for the We are retaining these measures groups for the 2012 particularly because we believe the measures groups

2 CMS-1524-P 355 reflect the services furnished to beneficiaries by a particular specialty. We also believe that retaining these measures groups will provide consistency from program year to program year. n addition to the 14 measures groups previously, we propose the following 10 new measures groups for 2012 to provide eligible professionals with more measures groups on which to report: Chronic Obstructive Pulmonary Disease (COPD). nflammatory Bowel Disease. Sleep Apnea. Epilepsy. Dementia. Parkinson's. Elevated Blood Pressure. Radiology. Cardiovascular Prevention, which contains individual measures from the proposed core measure set previously discussed. Cataracts. These are the measures groups that were presented to us for inclusion for reporting under the Section 1848(k)(2)(C)(ii) of the Act provides an exception to the requirement that measures be endorsed by the. We may exercise this exception authority in a specified area or medical topic for which a feasible and practical measure has not been endorsed by, so long as due consideration is given to measures that have been endorsed by the. For the

3 CMS-1524-P 356 measures contained within these measures groups that are not currently -endorsed, we are proposing to exercise this authority due to our interest in all of the proposed 10 measures group's topics. We believe that each of the proposed additional measures groups address gaps in the measures groups and will also allow for greater reporting options for individual eligible professionals, thereby increasing participation in the. Finally, as in previous program years, for 2012, we propose that the measures included in any proposed 2012 measures group be reportable either as individual measures or as part of a measures group, except for the Back Pain measures group, which would continue to be reportable only as part of a measures group and not as individual measures in As with measures group reporting in prior program years, we propose that each eligible professional electing to report a group of measures for 2012 must report all measures in the group that are applicable to each patient or encounter to which the measures group applies at least up to the minimum number of patients required by the applicable reporting criteria. The measures proposed for inclusion in each of the 2012 measures groups are identified in Tables 32 through 55 of this proposed rule. Some measures proposed for inclusion in the 2012 measures groups are also 2011 individual measures. The title of each such measure is preceded with its in Tables 32 through 55. As stated previously, the is a unique identifier assigned by us to all measures in the

4 CMS-1524-P 357 measure set. Once a is assigned to a measure, it will not be used again, even if the measure is subsequently retired from the measure set. s that are not preceded by a number (in other words, those preceded by "") in Tables 32 through 55 were never part of a measure set prior to A number will be assigned to such measures for TABLE 32: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 DABETES MELLTUS MEASURES GROUP Title 1 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus 2 Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus 3 Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus 117 Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient 119 Diabetes Mellitus: Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients 0059 NCQA 0064 NCQA 0061 NCQA 0055 NCQA 0062 NCQA 163 Diabetes Mellitus: Foot Exam 0056 NCQA

5 CMS-1524-P 358 TABLE 33: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CKD MEASURES GROUP Title 121 Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus, ntact Parathyroid Hormone (ipth) and Lipid Profile) 122 Chronic Kidney Disease (CKD): Blood Pressure Management 123 Chronic Kidney Disease (CKD): Plan of Care Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA) 153 Chronic Kidney Disease (CKD): Referral for Arteriovenous (AV) Fistula Not applicabl e AMA-PC P AMA-PC P AMA-PC P AMA-PC P TABLE 34: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 PREVENTATVE CARE MEASURES GROUP Title 39 Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older 48 Urinary ncontinence: Assessment of Presence or Absence of Urinary ncontinence in Women Aged 65 Years and Older 110 Preventive Care and Screening: nfluenza mmunization for Patients 50 Years Old 111 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older 112 Preventive Care and Screening: Screening Mammography 113 Preventive Care and Screening: Colorectal Cancer Screening 128 Preventive Care and Screening: Body Mass ndex (BM) Screening and Follow-Up 173 Preventive Care and Screening: Unhealthy Alcohol Use Screening 0046 AMA-PC P 0098 AMA-PC P 0041 AMA-PC P 0043 NCQA 0031 NCQA 0034 NCQA 0421 CMS/QP AMA-PC P

6 CMS-1524-P 359 Title 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation ntervention 0028 AMA-PC P TABLE 35: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CABG MEASURES GROUP* Title 43 Coronary Artery Bypass Graft (CABG): Use of nternal Mammary Artery (MA) in Patients with solated CABG Surgery 44 Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with solated CABG Surgery 164 Coronary Artery Bypass Graft (CABG): Prolonged ntubation (Ventilation) 165 Coronary Artery Bypass Graft (CABG): Deep Sternal Wound nfection Rate 166 Coronary Artery Bypass Graft (CABG): Stroke/Cerebrovascular Accident (CVA) 167 Coronary Artery Bypass Graft (CABG): Postoperative Renal nsufficiency 168 Coronary Artery Bypass Graft (CABG): Surgical Re-exploration 169 Coronary Artery Bypass Graft (CABG): Antiplatelet Medications at Discharge 170 Coronary Artery Bypass Graft (CABG): Beta-Blockers Administered at Discharge 171 Coronary Artery Bypass Graft (CABG): Lipid Management and Counseling * This measures group is reportable through registry-based reporting only STS 0235 STS 0129 STS 0130 STS 0131 STS 0114 STS 0115 STS 0237 STS 0238 STS 0118 STS

7 CMS-1524-P 360 TABLE 36: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 RHEUMATOD ARTHRTS MEASURES GROUP Title 108 Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy 176 Rheumatoid Arthritis (RA): Tuberculosis Screening 177 Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity 178 Rheumatoid Arthritis (RA): Functional Status Assessment 179 Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis 180 Rheumatoid Arthritis (RA): Glucocorticoid Management 0054 NCQA AMA-PCP AMA-PCP AMA-PCP AMA-PCP AMA-PCP TABLE 37: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 PEROPERATVE CARE MEASURES GROUP Title 20 Perioperative Care: Timing of Antibiotic Prophylaxis Ordering 21 Perioperative Care: Selection of Prophylactic Antibiotic First OR Second Generation Cephalosporin 22 Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) 23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When ndicated in ALL Patients) 0270 /NCQA 0268 /NCQA 0271 /NCQA 0239 /NCQA

8 CMS-1524-P 361 TABLE 38: PROPOSED MEASURES NCLUDED N THE 2012 PROPOSED BACK PAN MEASURES GROUP Title 148 Back Pain: nitial Visit 0322 NCQA 149 Back Pain: Physical Exam 0319 NCQA 150 Back Pain: Advice for Normal Activities 0315 NCQA 151 Back Pain: Advice Against Bed Rest 0313 NCQA TABLE 39: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CAD MEASURES GROUP* Title 6 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 196 Coronary Artery Disease (CAD): Symptom and Activity Assessment Coronary Artery Disease (CAD): Lipid Control Preventive Care and Screening: Tobacco Use: Screening and Cessation ntervention 0028 * This measures group is reportable through registry-based reporting only. TABLE 40: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 HEART FALURE MEASURES GROUP* Title 5 Heart Failure: Angiotensin-Converting Enzyme (ACE) nhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 8 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 198 Heart Failure: Left Ventricular Function (LVF) Assessment 199 Heart Failure: Patient Education Preventive Care and Screening: Tobacco Use: 0028

9 CMS-1524-P 362 Title Screening and Cessation ntervention * This measures group is reportable through registry-based reporting only. TABLE 41: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 VD MEASURES GROUP Title 201 schemic Vascular Disease (VD): Blood Pressure Management Control 202 schemic Vascular Disease (VD): Complete Lipid Profile 203 schemic Vascular Disease (VD): Low Density Lipoprotein (LDL-C) Control 204 schemic Vascular Disease (VD): Use of Aspirin or Another Antithrombotic 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation ntervention 0073 NCQA 0075 NCQA 0075 NCQA 0068 NCQA 0028 TABLE42: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 HEPATTS C MEASURES GROUP Title 84 Hepatitis C: Ribonucleic Acid (RNA) Testing Before nitiating Treatment 85 Hepatitis C: HCV Genotype Testing Prior to Treatment 0395 AMA-PCP 0396 AMA-PCP 86 Hepatitis C: Antiviral Treatment Prescribed 0397 AMA-PCP 87 Hepatitis C: HCV Ribonucleic Acid (RNA) 0398 AMA-PCP Testing at Week 12 of Treatment 89 Hepatitis C: Counseling Regarding Risk of 0401 AMA-PCP Alcohol Consumption 90 Hepatitis C: Counseling Regarding Use of 0394 AMA-PCP Contraception Prior to Antiviral Therapy 183 Hepatitis C: Hepatitis A Vaccination in Patients 0399 AMA-PCP

10 CMS-1524-P 363 Title with HCV 184 Hepatitis C: Hepatitis B Vaccination in Patients with HCV 0400 AMA-PCP TABLE 43: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 HV/ADS MEASURES GROUP* Title 159 HV/ADS: CD4+ Cell Count or CD4+ Percentage 0404 AMA-PCP 160 HV/ADS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis 0405 AMA-PCP 161 HV/ADS: Adolescent and Adult Patients with HV/ADS Who Are Prescribed Potent Antiretroviral Therapy 0406 AMA-PCP 162 HV/ADS: HV RNA Control After Six Months of Potent Antiretroviral Therapy 0407 AMA-PCP 205 HV/ADS: Sexually Transmitted Disease Screening for Chlamydia and Gonorrhea 0409 AMA-PCP 206 HV/ADS: Screening for High Risk Sexual Behaviors 0413 AMA-PCP 207 HV/ADS: Screening for njection Drug Use 0415 AMA-PCP 208 HV/ADS: Sexually Transmitted Disease Screening for Syphilis 0410 AMA-PCP * This measures group is selected to be reportable through registry-based reporting only. TABLE 44: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CAP MEASURES GROUP Title 56 Community-Acquired Pneumonia (CAP): Vital Signs 57 Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation 0232 /NCQA 0094 /NCQA 58 Community-Acquired Pneumonia (CAP): 0234 /NCQA

11 CMS-1524-P 364 Title Assessment of Mental Status 59 Community-Acquired Pneumonia (CAP): Empiric Antibiotic 0096 /NCQA TABLE 45: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 ASTHMA MEASURES GROUP Title 53 Asthma: Pharmacologic Therapy Asthma: Asthma Assessment Asthma: Tobacco Use: Screening Ambulatory Setting 232 Asthma: Tobacco Use: ntervention Ambulatory Screening TABLE 46: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 COPD MEASURES GROUP Title 110 Preventive Care and Screening: nfluenza mmunization for Patients 50 Years Old 111 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older 51 Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation 52 Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation ntervention

12 CMS-1524-P 365 TABLE 47: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 BD MEASURES GROUP* Title nflammatory Bowel Disease (BD): Assessment of nflammatory Bowel Disease Activity and Severity nflammatory Bowel Disease (BD): Preventive Care: Steroid Sparing Therapy nflammatory Bowel Disease (BD): Preventive Care: Steroid Related atrogenic njury Bone Loss Assessment nflammatory Bowel Disease (BD): Preventive Care: nfluenza mmunization nflammatory Bowel Disease (BD): Preventive Care: Pneumococcal mmunization nflammatory Bowel Disease (BD): Screening for Latent TB Before nitiating Anti-TNF Therapy nflammatory Bowel Disease (BD): Hepatitis B Assessment Before nitiating Anti-TNF Therapy 226 Preventative Care and Screening: Tobacco Use; Screening and Cessation ntervention * This measures group is reportable thought registry-based reporting only AGA/AM A-PCP AGA/AM A-PCP AGA/AM A-PCP AGA/AM A-PCP AGA/AM A-PCP AGA/AM A-PCP AGA/AM A-PCP AMA-PCP TABLE 48: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 SLEEP APNEA MEASURES GROUP* Title Measur e Numbe r Assessment of Sleep Symptoms AMA/PCP/AASM Severity Assessment at nitial Diagnosis AMA/PCP/AASM Positive Airway Pressure Therapy Prescribed AMA/PCP/AASM Assessment of Adherence to Positive Airway Pressure Therapy AMA/PCP/AASM * This measures group is reportable thought registry-based reporting only.

13 CMS-1524-P 366 TABLE 49: PROPOSED MEASURES N THE PROPOSED 2012 EPLEPSY MEASURES GROUP Title Seizure Type(s) and Current Seizure Frequency(ies) A Documentation of Etiology of Epilepsy or Epilepsy Syndrome A Querying and Counseling about Anti-Epileptic Drug (AED) Side-Effects A Counseling about Epilepsy Specific Safety ssues A Counseling for Women of Childbearing Potential with Epilepsy A TABLE 50: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 DEMENTA MEASURES GROUP* Title Dementia: Staging of Dementia Dementia: Cognitive Assessment Dementia: Functional Status Assessment Dementia: Neuropsychiatric Symptom Assessment Dementia: Management of Neuropsychiatric Symptoms Dementia: Screening for Depressive Symptoms Dementia: Counseling Regarding Safety Concerns Dementia: Counseling Regarding Risks of Driving Dementia: Caregiver Education and Support AAGS/ AMDA/APA/ AAGS/AMD A/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/ AAGS/ AMDA/APA/

14 CMS-1524-P 367 Title * This measures group is reportable thought registry-based reporting only. TABLE 51: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 PARKNSON'S MEASURES GROUP* Title Annual Parkinson's Disease Diagnosis Review AAN Psychiatric Disorders or Disturbances Assessment AAN Cognitive mpairment or Dysfunction Assessment AAN Querying about Sleep Disturbances AAN Parkinson's Disease Rehabilitative Therapy Options AAN Parkinson's Disease Related Safety ssues Counseling AAN Parkinson's Disease Medical and Surgical Treatment Options Reviewed AAN * This measures group is reportable thought registry-based reporting only. TABLE 52: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 ELEVATED BLOOD PREASSURE MEASURES GROUP* Title Aspirin or Other Anti-Platelet or Anti-Coagulant Therapy ABM Complete Lipid Profile ABM Urine Protein Test ABM Annual Serum Creatinine Test ABM Diabetes Documentation or Screen Test ABM Counseling for Diet and Physical Activity ABM Blood Pressure Control ABM LDL Control ABM Overall Hypertension Care Satisfaction ABM Patient Self-care Support ABM * This measures group is reportable thought registry-based reporting only.

15 CMS-1524-P 368 TABLE 53: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 RADOLOGY MEASURES GROUP* Title to a Radiation Dose ndex Registry Cumulative Count of Potential High Dose Radiation maging Studies: CT Scans and Cardiac Nuclear Medicine Scans Utilization of a Standardized Nomenclature for CT maging Description ABR Appropriateness: Follow-up CT maging for ncidental Pulmonary Nodules According to Recommended Guidelines ABR Overuse: Abdomen, Pelvis or Combined Abdomen/Pelvies CT Studies ABR Equipment Evaluatoin for Pediatric CT maging Protocols ABR Utilization of Pediatric CT maging Protocols ABR Search for Prior maging Studies through a Secure, Authorized Media-Free Shared Archive ABR mages Available for Patient Follow-up and Comparison Purposes ABR Exposure Time Reported for Procedures Using Fluoroscopy * This measures group is reportable thought registry-based reporting only. ABMS/AB R/ACR/PCP PCP/ACR/ NCQA TABLE 54: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CARDOVASCULAR PREVENTON MEASURES GROUP Title 204 schemic Vascular Disease (VD): Use of Aspirin or another Antithrombotic 0068 NCQA 236 Controlling High Blood Pressure 0018 NCQA 2 Diabetes Mellitus: Low Density Lipoprotein 0064 NCQA (LDL-C) Control in Diabetes Mellitus 226 pair: a. Tobacco Use Assessment, b Tobacco Cessation ntervention schemic Vascular Disease (VD): Complete 0075 NCQA Lipid Profile and LDL Control < 100 Proportion of adults 18 years and older who have had their BP measured within the preceding 2 years CMS

16 CMS-1524-P 369 TABLE 55: PROPOSED MEASURES NCLUDED N THE PROPOSED 2012 CATARACTS MEASURES GROUP* Title Cataracts: mprovement in Patient's Visual Function within 90 Days Following Cataract Surgery AAO Cataracts: mprovement in Patient's Visual Function within 90 Days Following Cataract Surgery AAO 191 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery 0565 /NCQA 192 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures 0564 /NCQA * This measures group is reportable thought registry-based reporting only. As with measures group reporting in the 2008, 2009, 2010, and 2011, we propose that each eligible professional electing to report a group of measures for 2012 must report all measures in the group that are applicable to each patient or encounter to which the measures group applies at least up to the minimum number of patients required by the applicable reporting criteria. We proposed that the measures proposed for the 2012 Back Pain s Group would continue to be reportable only as part of a measures group and not as individual measures for the s selected for inclusion in all other 2012 measures groups would be reportable either as individual measures or as part of a measures group. We note that the specifications for measures groups do not necessarily contain all the specification elements of each individual measure making up the measures group. This is based on the need for a common set of denominator specifications for all the measures making up a measures group in order to define the applicability of the measures

17 CMS-1524-P 370 group. Therefore, the specifications and instructions for measures groups would be provided separately from the specifications and instructions for the individual 2012 measures. We will post the detailed specifications and specific instructions for reporting measures groups on the section of the CMS Web site at by no later than December 31, Additionally, the detailed measure specifications and instructions for submitting data on those 2012 measures groups that were also included as 2011 measures groups may be updated or modified by the measure developer prior to Therefore, the 2012 measure specifications for any given measures group could be different from specifications and submission instructions for the same measures group used for For example, the measure developer may change the codes contained in the measure's denominator. These measure specification changes do not materially impact the intended meaning of the measures or the strength of the measures. We invite public comment on our proposed retention of all 2011 measures groups, as well as our newly proposed measures groups for the (5) Proposed 2012 s for Group Practices Selected to Participate in the GPRO (GPRO) For 2012, we propose that group practices selected to participate in the 2012 GPRO would be required to report on 40 proposed measures listed in Table 55. Specifically, for the 2012