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