2021 MIPS Measure #288: Dementia: Education and Support of Caregivers for Patients with Dementia

Measure Description

Percentage of patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of dementia seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

All patients with dementia

Denominator Criteria (Eligible Cases):

All patients regardless of age

AND

Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F05, F10.27, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94

AND

Patient encounter during the performance period (CPT): 90791, 90792, 90832, 90834, 90837, 96116, 96130, 96132, 96136, 96138, 96146, 96156, 96158, 96164, 96167, 96170, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99487, 99490, 99497

Numerator

Patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months

Definitions:

Caregiver – Is broadly defined and the Work Group adopted the definition utilized by the National Quality Forum and Feinberg.(1) Caregiver refers to any relative, partner, friend, or neighbor who has a significant relationship with, and who provides a broad range of assistance for, an older adult or an adult with chronic or disabling conditions.(1)

Education – Requires learning and processing information about disease management and health behavior changes. This should also include advising the caregiver that, as a caregiver, he or she is at “increased risk of serious illness (including circulatory and heart conditions and respiratory disease and hypertension), increased physician visits and use of prescription medications, emotional strain, anxiety, and depression.”(2) Providers are encouraged to review state specific guidelines to ensure education is being provided as required.

Additional Resources – Are defined as situation-specific, tailored programs to assist the caregiver; these included national organizations such as the Alzheimer’s Association, but also include local resources, such as community, senior center and religion-based support groups.

Numerator Instructions:There are a number of assessment tools available for the caregiver. These should be considered as an integral component of comprehensive caregiver education and support. The American Medical Association has developed a Caregiver Health Self-assessment Questionnaire to help caregivers analyze their own behavior and health risks and, with their physician’s help, make decisions that will benefit both the caregiver and the patient. This questionnaire is available on the AMA website.

NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met:

Caregiver provided with education and referred to additional resources for support (4322F)

OR

Denominator Exception:

Patient does not have a caregiver (G2184)ORDenominator Exception:

Documentation caregiver is trained and certified in dementia care (G2185)

ORDenominator Exception:

Patient/caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed (G2186)

OR

Performance Not Met:

Caregiver not provided with education and not referred to additional resources for support, reason not otherwise specified (4322F with 8P)