2023 # MBHR15 Consideration of Cultural-Linguistic and Demographic Factors in Cognitive Assessment

Measure Title: Consideration of Cultural-Linguistic and Demographic Factors in Cognitive Assessment

Description: Percentage of patients, regardless of age, referred for evaluation due to concerns for cognitive changes or difficulties for whom 1) a standardized valid assessment of cognition was performed and 2) interpretation of results included consideration of appropriate and relevant cultural-linguistic and demographic factors.

Denominator: 

All patients, regardless of age, where there is documentation of concerns regarding cognitive changes or difficulties. Reported concerns may come from: the patient, a treating provider, or a caregiver of the patient.

AND

Patient encounter during the performance period (CPT): 

96156; 96116; 96121; 96132; 96133; 96146; 96105; 96125; 96110

Numerator: 

Patients for whom a standardized valid assessment of cognition* was performed and reporting of results included documentation of provider’s consideration of relevant cultural-linguistic and demographic factors that may have affected assessment and resulting assessment results. OR Provider has determined they are unable to provide an assessment to a patient due to inability to appropriately account for relevant cultural-linguistic and demographic factors that would result in inaccurate assessment results .

*See definitions below for details

*Note that reporting can be satisfied through a formal report of cognitive testing results; written statement within medical documentation; or via formal feedback session notes. For example, a statement may include: “The patient’s cultural, linguistic, disability, and other demographic and socioeconomic factors were taken into account when interpreting the results of the current evaluation,” would meet this performance. Additionally, performance of this measure would be met if the clinician has determined they are unable to provide an assessment to a patient due to an inability to appropriately account for relevant cultural-linguistic and demographic factors that would ultimately result in inaccurate assessment results.

Definitions:  

Standardized cognitive assessment – refers to the administration of reliable and research-validated assessment methods or tests that cover one or a combination of the following cognitive domains: memory, language, visual-spatial, executive functioning, academic skills, developmental level, intellectual functioning, attention, and processing speed. Depending on medical needs, referral questions, and patient characteristics, cognitive assessment may entail targeted assessment of a particular cognitive domain or a comprehensive assessment battery encompassing multiple domains. Assessment of functional abilities and activities of daily living may also be included in these evaluations. Psychological functioning may also be formally assessed to identify whether emotional or social factors are influencing cognitive functioning. Meeting performance for this measure is not limited to a specific cognitive test as long as it meets the above criteria and is commonly accepted within the medical community. Examples of well validated and commonly accepted cognitive tests can be found in Strauss, Sherman, & Spreen, A Compendium of Neuropsychological Tests [8].

The following list is illustrative of types of tests and test batteries that would meet this criterion and are not meant to be equal or interchangeable. Clinical judgment, commiserate with education and training, is needed in selecting and interpreting the chosen test(s).

• Montreal Cognitive Assessment (MoCA)
• Mini-Mental Status Examination (MMSE)
• Neuropsychological Assessment Battery (NAB)
• Boston Diagnostic Aphasia Examination (BDAE)
• California Verbal Learning Test-Third Edition (CVLT3)
• Wechsler Memory Scale-Fourth Edition (WMS-IV)
• Katz Index of Independence in Activities of Daily Living
• Lawton Instrumental Activities of Daily Living Scale (IADL) 

Cultural, linguistic and demographic factors include, but are not limited to:

• Distinctive cultural or socio-demographic groups
• Language of origin or preference and language proficiency
• Physical, mental or emotional disability.
• Socioeconomic factors.
• Educational level and background
• Individuals from groups for whom there are insufficient or limited test adaptations, normative data, or validity studies.

Denominator Exclusions: Death

Denominator Exceptions: Patients present with an acute condition or crisis who are not administered a standardized cognitive assessment

OR

Patient refuses to participate or is unable to complete the assessment

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

Care setting(s) 
Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Home Care; Hospital; Hospital Inpatient; Hospital Outpatient; Long Term Care; Nursing Home; Outpatient Services; Rehabilitation Facility; Rehabilitation Facility: Inpatient

Telehealth, if applicable
Yes

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