Measure Title:
Provision of Feedback Following a Cognitive or Mental Status Assessment with Documentation of Understanding of Test Results and Subsequent Healthcare Plan
Measure Description:
Percentage of patients, regardless of age, who received a standardized cognitive or mental status assessment followed by provision of feedback regarding test results and associated recommendations, who acknowledged understanding of test results and associated recommendations and healthcare plan.
Denominator
All patients, regardless of age, where there is documentation of concerns regarding cognitive changes. Reported concerns may come from: the patient, a treating provider, or a caregiver of the patient.
AND
Patient encounter during the performance period (CPT):
90791; 96156; 96116; 96121; 96132; 96133; 96146; 96105; 96125; 96110
AND NOT
DEATH
Numerator
Patients that underwent a standardized cognitive or mental status assessment for whom feedback of test results and associated treatment recommendations was provided to the receiver or their caregiver, with documentation of understanding of test results and associated treatment recommendations/healthcare plan. Test results may include any of the following types of information:
Explanation of test results and their implication to everyday function
Explanation of how test results contribute to determination of diagnosis
Discussion of factors contributing to identified cognitive difficult
Discussion of expected prognosis and the impact of treatment recommendations on cognitive, behavioral, and emotional functioning
Discussion of warning signs for cognitive decline
Discussion of protective factors against cognitive decline and/or factors that promote healthy cognitive development
Treatment recommendations provided clearly and in a way that is easily understood. This may include:
Treatment options.
Compensatory strategies.
Referral recommendations for allied and other medical specialties.
Community resources.
Safety concerns.
Caregiver support.
Lifestyle modifications beneficial for healthy brain aging.
Receiver acknowledged understanding of the results, recommendations and subsequent treatment plan during the feedback session.
Receiver was provided the opportunity to ask questions during the feedback session.
NUMERATOR NOTE: If interview and cognitive assessment are part of the same encounter though completed on separate dates, the feedback acknowledgment occurs after the testing CPT code.
Numerator Options:
Performance Met:
Patients underwent a cognitive or mental status assessment*
*See definitions below for details
AND
Understanding of test results and associated treatment recommendations/healthcare plan was acknowledged* by the patient OR receiver and documented within the medical record.
Note that, for providers working in interdisciplinary settings, performance is met for this measure when interactive feedback of cognitive test results was provided directly to a physician or treatment team member for the purpose of integration with other medical information to be provided directly to the patient or caregiver. For example, a statement in the report/feedback note/chart note documenting this occurred such as: “The [patient OR receiver] was receptive to the results and acknowledged receipt and understanding of test results and associated treatment recommendations/healthcare plan. The opportunity to ask questions was provided, and they were provided contact information should there be further questions or need for additional assistance,” would meet this performance.
*See definitions below for details
OR
Denominator Exception:
Patient presents an acute condition or crisis who are not administered a standardized assessment
OR
Denominator Exception:
Patient refuses to participate in feedback session
OR
Denominator Exception:
Patient is unable to communicate AND does not have a caregiver available to provide information.
OR
Denominator Exception:
Feedback AND/OR report was not provided to patient and/or caregivers under the CURES act Preventing Harm Exception, which states: “It will not be information blocking for an actor to engage in practices that are reasonable and necessary to prevent harm to a patient or another person, provided certain conditions are met.”
OR
Denominator Exception:
Contexts where results reporting to patients is limited or prohibited by organizational policy or law.
OR
Performance Not Met:
Test results and subsequent healthcare actions were not directly provided to the patient or receiver (as described above) AND/OR there was no acknowledgment from whom the information was provided.
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 question, and patient characteristics, cognitive assessment may entail targeted assessment of a particular cognitive domain or a comprehensive assessment battery encompassing multiple domains. 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 [14].
The following list is illustrative of types of tests or 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).
Neuropsychological Assessment Battery (NAB)
Boston Diagnostic Aphasia Examination (BDAE)
California Verbal Learning Test-Third Edition (CVLT3)
Wechsler Memory Scale-Fourth Edition (WMS-IV)
Mental status examination – refers to an assessment of behavioral and cognitive functioning that includes descriptions of the following: level of consciousness, appearance, behavior, speech and motor activity, mood and affect, thought and perception, and attitude, insight and judgement. Mental status examinations also include assessment of higher cognitive abilities of alertness, language, memory, constructional ability and praxis, and abstract reasoning [15]. Examples are below:
Montreal Cognitive Assessment (MoCA)
Mini-Mental Status Examination (MMSE)
Acknowledgment: A verbal or non-verbal expression that expresses recognition or acceptance.
Receiver: The individual that is provided test results and subsequent healthcare actions. This may include the patient OR a caregiver OR the referring provider OR a treatment team member OR a treating physician.
NQF Number
N/A
NQS Domain
Person and Caregiver-Centered Experience and Outcomes
High Priority
Yes
High Priority Type
Patient experience
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