2023 # AQI72 Perioperative Anemia Management

Measure Title: Perioperative Anemia Management

Description: Percentage of patients, aged 18 years and older, undergoing elective total joint arthroplasty who were screened for anemia preoperatively AND, if positive, have documentation that one or more of the following management strategies were used prior to PACU discharge.

Management strategies include one or more of the following:

• Cell salvage techniques employed intraoperatively
• Intraoperative antifibrinolytic therapy or tourniquet, if not contraindicated
• Preoperative iron supplementation, epoetin alpha
• Use of evidence-based preoperative anemia management algorithm supplemented with laboratory testing and/or multidisciplinary consult

Denominator: 

Patients, aged 18 years and older, undergoing elective total joint arthroplasty.

Denominator Note: For the purpose of this measure, total joint arthroplasty includes arthroplasty of the knee, hip, and shoulder.

Denominator Criteria (Eligible Cases):

All patients, aged 18 years and older

AND

Elective Surgery: G9643

AND

Patient encounter during the reporting period (CPT): 01214, 01215, 01402, 01638

Numerator: 

Patients who were screened for anemia preoperatively AND, if positive, have documentation that one or more of the following management strategies were used prior to PACU discharge.

Management strategies include one or more of the following:

·         Cell salvage techniques employed intraoperatively

·         Intraoperative antifibrinolytic therapy or tourniquet, if not contraindicated

·         Preoperative iron supplementation, epoetin alpha

·         Use of evidence-based preoperative anemia management algorithm supplemented with laboratory testing and/or multidisciplinary consult

Numerator definition: For the purpose of this measure, a positive preoperative anemia screening result is defined as a Hgb value <13 gm/dL all adults, regardless of gender

Numerator note: Preoperative screening for anemia could include any of the following tests: complete blood count (CBC), arterial blood gas (ABG), venous blood gas (VBG), or other point of care hemoglobin/hematocrit test within 90 days and until one day prior to the surgical procedure.

Denominator Exclusions: Surgeon or other non-anesthesia professional clinician completed one or more of the management strategies without direction or assistance from the anesthesia professional: 11A80

Denominator Exceptions: 

Negative preoperative anemia screening result [11A68]

OR

Documentation of medical or patient reason(s) for not screening for anemia and/or using selected management strategies (e.g., patient refusal, contraindication, etc) [11A69]

 National Quality Forum (NQF) number, if applicable
N/A

Care setting(s) 
Hospital

Telehealth, if applicable
No

Number of performance rates required for measures
1

Traditional vs. inverse measure
Traditional

Proportional, continuous variable, and/or ratio measure indicator
Proportional

Risk adjustment, if applicable
No

Submission pathway 
Traditional MIPS