MBHR11 Cognitive Assessment with Counseling on Safety and Potential Risk

Measure Title

Cognitive Assessment with Counseling on Safety and Potential Risk

 

Measure Description

Percentage of patients, regardless of age, referred for evaluation due to concerns for cognitive impairment for whom 1) a standardized valid assessment of cognition was performed and 2) reporting of results included counseling on safety and potential risks.

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 counseling on safety and potential risks**. (PRO2011.4M)

*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 question, 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 in Strauss, Sherman, & Spreen, A Compendium of Neuropsychological Tests [30].

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)

Weschler Memory Scale-Fourth Edition (WMS-IV)

Katz Index of Independence in Activities of Daily Living

Lawton Instrumental Activities of Daily Living Scale (IADL) 

**Safety Concerns and Potential Risk – include, but are not limited to, the following areas of concern and potential safety risks identified based on the results of cognitive assessment in one or more of the following areas:

Fall risk/balance problems

Medication management

Financial management

Home safety risks (e.g., cooking, smoking, etc.)

Inability to respond rapidly to crisis/household emergencies

Need for increased supervision due to memory problems, poor judgment, or decreased safety awareness

Physical aggression posing threat to self, family caregiver, or others

Possibility of getting lost/Wandering

Community navigation/driving

Access to firearms or other weapons

Access to potentially dangerous materials

Operation of hazardous equipment

Vulnerability to undue influence of others who may have mal-intent

Suicidality

Abuse or neglect 

Warning signs of disease progression and avoidance of risk for exacerbation of cognitive impairment

Medical decision-making

Comprehension of medical plan, treatment recommendations, and prognosis

Presence of cognitive, psychosocial, or emotional barriers affecting adherence to medical recommendations

 

Denominator Exclusions

Death

 

Denominator Exceptions

Patients present with an acute condition or crisis who are not administered a standardized cognitive assessment  (PRO2011.4Ex1)

OR

Patient refuses to participate or is unable to complete the assessment  (PRO2011.4Ex2)

NQF Number    

N/A

 

NQS Domain

Effective Clinical Care

 

High Priority

No

 

High Priority Type

N/A

 

Measure Type

Process

 

Meaningful Measure Area

Prevention, Treatment, and Management of Mental Health

 

 Inverse Measure

No

 

Proportional Measure

Yes

 

Continuous Variable Measure

No

               

Ratio Measure

No

 

Number of performance rates to be submitted

1

 

 Measure Risk-Adjusted?[

No

               

Care Setting

Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Hospital, Home Care, Hospital, Hospital Inpatient, Hospital Outpatient, Long Term Care, Nursing Home, Outpatient Services, Rehabilitation Facility  

 

Includes Telehealth?    

Yes