eCQM: Dementia: Cognitive Assessment (CMS 149v5)

eCQM:

Dementia: Cognitive Assessment

CMS ID:

CMS 149v5

Measure Type:

Process

MIPS High Priority Measure:

No

Quality ID:

281

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance Benchmark for MIPS:

100%

Description:

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
  • Denominator
  • Numerator
  • Exception

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.

  1. 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).

  2. 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:

    1. Status: Performed

  3. 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

Measure Criteria

Data Elements

Denominator eligible visits (two or more required during the measurement period)

  • Office Visit
  • Nurse Visit
  • Nursing Home Visit
  • Home Visit
  • Email Encounter
  • Telephone Encounter
  • Letter
  • Telemedicine Visit

Examples of measure-appropriate diagnoses for dementia and mental degenerations

ICD-10

  • A52.17 (General paresis)
  • F01.50 (Vascular dementia without behavioral disturbance)
  • F01.51 (vascular dementia with behavioral disturbance)
  • G30.0 (Alzheimer’s disease with early onset)
  • G30.1 (Alzheimer’s disease with late onset)
  • G30.9 (Alzheimer’s disease, unspecified)

ICD-9

  • 331.0 (Alzheimer’s disease)
  • 294.21 (Dementia, unspecified, with behavioral disturbance)
  • 290.0 (Senile dementia, uncomplicated)

Examples of measure-appropriate data elements for cognitive assessments

  • Total score BOMC (LOINC 72173-8)
  • Total score MoCA (LOINC 72172-0)
  • Total score MMSE (LOINC 72106-8)
  • Total score AD8 (LOINC 71722-3)
  • Total score IQCODE (LOINC 71493-1)
  • Total score SLUMS (LOINC 71492-3)
  • Prior assessment brief interview for mental status (BIMS) summary score MDSv3 (LOINC 58151-2)

Table 2. Practice Fusion Suggested Workflows for Denominator Exceptions

Exception Criteria

Practice Fusion Suggested Workflows

Medical reason(s) for not assessing cognition - Receiving palliative care

  1. In the Screenings/Interventions/Assessments section of a chart note, search for and record one of the following data elements:

    1. Palliative care (regime/therapy) (SNOMED CT 103735009)

    2. Hospice care (regime/therapy) (SNOMED CT 385763009)

  2. Record the status as “Performed”

Documentation of patient reason(s) for not assessing cognition

  1. In the Screenings/Interventions/Assessments section of a chart note, search for a cognitive assessment (found in Table 1) and select.

  2. Record the status as “Not Performed”

  3. Record the reason from the options listed below:

    1. Refusal of treatment by patient

    2. Medical contraindication

    3. Procedure contraindicated

    4. Treatment not tolerated

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

    • Mini-Cog

  • Use of a standardized tool or instrument to assess cognition other than those listed will also meet numerator performance.

More Information

eCQMs

  1. How does the eCQM Dashboard work?
  2. How​ ​do​ ​I​ ​create​ ​a​ ​group​ ​in​ ​the​ ​eCQM​ ​Dashboard?
  3. eCQM Depression Remission at Twelve Months (CMS159v5)
  4. eCQM: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (CMS137v5)
  5. eCQM: Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS 2v6)
  6. eCQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v5)
  7. eCQM: Closing the Referral Loop: Receipt of Specialist Report (CMS 50v5)
  8. eCQM: Documentation of Current Medications in the Medical Record (CMS 68v6)
  9. eCQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan (CMS 69v5)
  10. eCQM: Functional Status Assessments for Congestive Heart Failure (CMS 90v6)
  11. eCQM: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) (CMS 122v5)
  12. eCQM: Diabetes: Foot Exam (CMS 123v5)
  13. eCQM: Cervical Cancer Screening (CMS 124v5)
  14. eCQM: Breast Cancer Screening (CMS 125v5)
  15. eCQM: Pneumococcal Vaccination Status for Older Adults (CMS 127v5)
  16. eCQM: Colorectal Cancer Screening (CMS 130v5)
  17. eCQM: Diabetes: Eye Exam (CMS 131v5)
  18. eCQM: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CMS 138v5)
  19. eCQM: Falls: Screening for Future Fall Risk (CMS 139v5)
  20. eCQM: Preventive Care and Screening: Influenza Immunization (CMS 147v6)
  21. eCQM: Dementia: Cognitive Assessment (CMS 149v5)
  22. eCQM: Chlamydia Screening for Women (CMS 153v5)
  23. eCQM: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (CMS 155v5)
  24. eCQM: Use of High-Risk Medications in the Elderly (CMS 156v5)
  25. eCQM: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet (CMS 164v5)
  26. eCQM: Controlling High Blood Pressure (CMS 165v5)
  27. eCQM: Use of Imaging Studies for Low Back Pain (CMS 166v6)

Feedback and Knowledge Base