QPP APM Entity (APP)

Measure Specifications

The APP only requires ACO's to report on 3 measures, however measures are reported in the MIPS CQM (Clinical  Quality Measure)

Quality ID #1 (DM-2)

Diabetes: Hemoglobin A1c (HbA1c)

Poor Control (>9%)

Measure Description

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c >9.0% during the measurement period. 

Denominator

Patients 18-75 years of age with diabetes with a visit during the measurement period. 

Numerator

Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%.

Numerator Instructions: A lower calculated performance rate for this measure indicates better clinical care or control. The "Performance Not Met" numerator for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all the denominator eligible patients did not receive the appropriate care or were not in proper control.

Patient is numerator compliant if the most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. Ranges and thresholds do not meet criteria for this indicator. A distinct numeric result is required for numerator compliance. Do not include HbA1c levels reported by the patient.

Instructions

This measure is to be submitted a minimum of once per performance period for patients with diabetes seen during the performance period. The most recent quality-data code submitted will be sued for performance calculation. 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.

Note: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

 

Quality ID #236 (HTN-2)

Controlling High Blood Pressure

Measure Description

Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period or the year prior to the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period. 

Denominator

Patients 18-85 years of age who had a visit and a diagnosis of essential hypertension overlapping the measurement period or the year prior to the measurement period. 

Denominator Note: The diagnosis of essential hypertension must be present some time between year prior to the measurement period and before the end of the measurement period (January 1, 2020 - December 31, 2021).

Numerator

Patients whose most recent blood pressure is adequately controlled (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) during the measurement period. 

Numerator Instruction: To describe both systolic and diastolic blood pressure values, each must be submitted separately. If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure. 

Numerator Note: In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. 

Do not include BP readings: Taken during an acute patient stay or ED visit, Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure, with the exception of fasting blood tests, reported by or taken by the patient (with the exception of BP values taken by a remote monitoring device, which are then reported to the provider)

If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled."

If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

Instructions

This measure is to be submitted a minimum of once per performance period for patients with hypertension seen during the performance period. The performance period for this measure is 12 months. The most recent quality code submitted will be used for performance calculation. 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.

 

Quality ID #134 (Prev-12)

Preventive Care and Screening for Depression and Follow-Up Plan

Measure Description

The percentage of adolescent patients 12 and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter.

Denominator

All patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period. 

Denominator Note: The intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure.

Numerator

Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the eligible encounter.

Definitions: 

Screening: Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms. 

Standardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized.

Follow-Up Plan

Documented follow-up for a positive depression screening must include one or more of the following: 

  • Referral to a practitioner who is qualified to diagnose and treat depression

  • Pharmacological interventions

  • Other interventions or follow-up for the diagnosis or treatment of depression

Examples of a follow-up plan include but are not limited to:​

  • Referral to a practitioner or program for further evaluation for depression, for example referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression

  • Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, phamacological interventions, or additional treatment options

Instructions 

This measure is to be submitted a minimum of once per measurement period for patients seen during the measurement period. The most recent screening submitted will be used for performance calculation. 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. The follow-up plan must be related to a positive depression screening, example: "Patient referred for psychiatric evaluation due to positive depression screening."

Note: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95 or POS 02 modifiers) are allowable.