Dementia: Cognitive Assessment
MIPS High Priority Measure:
Eligible for Quality Programs:
Performance Benchmark for MIPS:
Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period.
Numerator: Patients for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period.
Denominator: All patients, regardless of age, with an active diagnosis of dementia and two eligible visits (found in Table 1) during the measurement period.
Denominator Exclusions: None
Denominator Exceptions: Documentation of medical reason(s) for not assessing cognition (e.g., patient with very advanced stage dementia, receiving palliative care, other medical reason) OR documentation of patient reason(s) for not assessing cognition. Suggested workflows for recording denominator exceptions can be found in Table 2.
eCQM Patient Reports
eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.
The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.
The measure cohorts included in the eCQM Patient Report for CMS 149v5 Dementia: Cognitive Assessment are:
- Initial patient population
Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.
Conduct a cognitive assessment for all of your patients with an active diagnosis of dementia or mental degeneration (example diagnoses found in Table 1) at least once a year during a face-to-face encounter (Office Visit, Nurse Visit, Nursing Home, or Home Visit).
During the encounter in which the cognitive assessment is completed, record that the assessment was completed in the Screenings/Interventions/Assessments section. The search terms that will meet the numerator criteria for this measure are listed in Table 1. Make sure that you record the following data for the assessment:
The cognitive assessment should be conducted and recorded during the first encounter that occurs within the performance period and reviewed during the second encounter that occurs within the performance period. Patients will be added to the denominator of this measure after their second encounter.
Table 1. Measure Criteria for CMS 149v5
Denominator eligible visits (two or more required during the measurement period)
Examples of measure-appropriate diagnoses for dementia and mental degenerations
Examples of measure-appropriate data elements for cognitive assessments
Table 2. Practice Fusion Suggested Workflows for Denominator Exceptions
Practice Fusion Suggested Workflows
Medical reason(s) for not assessing cognition - Receiving palliative care
Documentation of patient reason(s) for not assessing cognition
Additional Measure Information
This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:
The denominator exceptions have been updated to include “receiving palliative care” to align with the measure logic.
Added Mini-Cog as an allowable standardized logic tool to assess cognition.
To access a complete list of the dementia diagnosis codes that will place a patient in the denominator, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.
Cognition can be assessed by the clinician during the patient's encounter. Cognition can also be assessed by direct examination of the patient using one of a number of instruments, including several originally developed and validated for screening purposes. Examples include, but are not limited to:
Blessed Orientation-Memory-Concentration Test (BOMC)
Montreal Cognitive Assessment (MoCA)
St. Louis University Mental Status Examination (SLUMS)
Mini-Mental State Examination (MMSE)
Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
Ascertain Dementia 8 (AD8) Questionnaire
Minimum Data Set (MDS) Brief Interview of Mental Status (BIMS) [Note: Validated for use with nursing home patients only]
Formal neuropsychological evaluation
Use of a standardized tool or instrument to assess cognition other than those listed will also meet numerator performance.
- For the CMS specifications for this measure, please click here.
- To learn more about the MIPS quality category reporting requirements for 2017, please click here.
- For additional information about quality measures, you may also visit the CMS Quality Payment Programs website and Practice Fusion’s Quality Payment Program Center.