CARE FOR OLDER ADULTS (COA)

Transcription

1 CARE FOR OLDER ADULTS (COA) APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE HEDIS (Hybrid) To assess the percentage of adults ages 66 years and older who had each of the following during the measurement year: Advance care planning Medication review Functional status assessment Pain assessment Members 66 years of age and older as of December 31 st of the measurement year. Members in Hospice are excluded. Advance care planning is a discussion about preferences for resuscitation, life sustaining treatment, and end of life care. These conversations ensure the member s wishes are fulfilled should the need to make those types of decisions arise. A complete medication list should be present in the medical record, and a medication review should be conducted at least once annually by a prescribing practitioner or clinical pharmacist. Functional status assessment, including activities of daily living (ADL) or instrumental activities of daily living (IADL), should be completed at least annually. The assessment must be comprehensive, not relating to an acute or single condition, event or body system. A pain assessment should be completed at least annually.

2 NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? Please see code table. Advanced Care Planning: The presence of an advanced care plan in the medical record. Documentation of an advance care planning discussion with the provider and the date it was discussed. Documentation of the discussion must occur during the measurement year. Note; member reporting to provider that they do not have an advance care plan is not considered discussion or initiation of discussion. Notation that the member previously executed an advance care plan. Examples of advance care plans - Advance directive - Actionable medical orders - Living will - Surrogate decision maker Medication Review: Presence of a complete medication list in the medical record and evidence of a medication review by a prescribing practitioner or clinical pharmacist and the date the review was performed. Notation that the member is not taking any medication and the date when it was noted. A review of side effects for a single medication at the time of the prescription is not sufficient. Functional Status Assessment: Notation that ADLs were assessed. Notation of assessment of at least five of the following: - Bathing - Dressing - Eating - Transferring

3 - Using toilet - Walking Notation that IADLs were assessed. Notation of assessment of at least four of the following: - Shopping for groceries - Driving or using public transportation - Using the telephone - Meal preparation - Housework - Home repair - Laundry - Taking medications - Handling finances Result of a standardized functional status assessment tool. Notation that at least three of the following four components were assessed: - Cognitive status - Ambulation status - Sensory ability (hearing, vision, and speech) - Other functional independence (e.g., exercise, ability to perform job) A functional status assessment limited to an acute or single condition, event or body system does not meet criteria for a comprehensive functional status assessment. The components of a functional status assessment may occur over multiple visits during the measurement year. Pain Assessment: Documentation in the medical record that the patient was assessed for pain, (which may include positive or negative findings for pain). Result of a standardized pain assessment tool.

4 REFERENCES Notation of a pain management or pain treatment plan alone does not meet criteria. Notation of a screening for chest pain alone or documentation of chest pain alone does not meet criteria. For more information, please refer to Passport Health Plan s Adult Preventive Health Clinical Practice Guideline. Available on our website. The criteria above are based on standards established under NCQA s HEDIS 2018 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

5 CARE FOR OLDER ADULTS Meet Screening Criteria Advance Care Planning CPT CPT-CAT-II 1123F ACP DISCUSS/DSCN MKR DOCD CPT-CAT-II 1124F ACP DISCUSS-NO DSCNMKR DOCD CPT 1157F ADVNC CARE PLAN IN RCRD CPT 1158F ADVNC CARE PLAN TLK DOCD HCPCS S0257 Counseling and discussion regarding advance directives or end of life care planning and decisions, with patient and/or surrogate (list separately in addition to code for appropriate evaluation and management service) (S0257) Medication Review CPT CPT CPT CPT 1160F RVW MEDS BY RX/DR IN RCRD Medication List CPT 1159F MED LIST DOCD IN RCRD HCPCS G8427 Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications (G8427) Transitional Care Management Services CPT TCM 14 Day CPT TCM 7 Day Functional Status Assessment CPT 1170F FXNL STATUS ASSESSED Pain Assessment CPT 1125F AMNT PAIN NOTED PAIN PRSNT CPT 1126F AMNT PAIN NOTED NONE PRSNT