Multiple Chronic Conditions Measures

Multiple Chronic Conditions Measures

·  20 patients needed. At least 11 patients must have Fee for Service Medicare.
·  Patient must be aged 66 years and older on date of visit.
·  An answer of "Not Done" on all patients on one measure will result in a performance rate of 0% and the provider will get a PQRS penalty.
·  Some measures may be performed or ordered by a provider different than the one reporting PQRS.
·  Each provider needs to sign a PQRS consent at http://mdinteractive.com/webpen

Provider Last Name:______Provider First Name:______

NPI:______TIN: ______Provider Phone:______

Last Name:______First Name :______MI:______

DOB:______GENDER: F__ M __ Medicare: Yes___ No___ Visit Date:______

Care Plan (47)

□  Advance Care Plan or Surrogate Decision-Maker Documented
□  Patient did not wish or not able to name a surrogate decision-maker or provide an advance care plan
□  Not Done

Influenza Immunization (110)

□  Administered or Previously Received
□  Not Administered for Documented Reasons
□  Not Administered

Body Mass Index (BMI) Screening and Follow Up(128)

□  BMI Within Normal Parameters
□  BMI Above the Upper Parameter AND Plan Documented
□  BMI Below the Lower Parameter AND Plan Documented
□  Not Eligible for BMI Calculation or Follow Up Plan
□  BMI Not Documented
□  BMI Above The Upper Parameter or Below the Lower Parameter and NO Plan Documented

Current Medications with Dosages (130)

□  Documented
□  Patient is not Eligible
□  Not Documented

Pain Assessment and Follow-Up (131)

□  Assessed, Pain Present AND Follow Up Plan Documented
□  Assessed, No Pain, No Follow-up Plan Required
□  Not Assessed for Documented Reasons
□  Assessed, Pain Present, but No Follow-Up Plan for Documented Reasons
□  Not Assessed
□  Assessed, Pain Present, but No Follow-up Plan

Screening for Clinical Depression and Follow-Up Plan (134)

□  Positive Screen, Follow-Up Plan Documented
□  Negative Screen
□  Positive Screen, Follow-up Plan Not Done, Patient Not Eligible
□  Not Done – Documented Reason
□  Positive Screen, Follow-Up Plan Not Done
□  Not Done

Falls: Risk Assessment (154)

□  Done
□  No Falls or Only One Fall Without Injury in the Past Year
□  Falls Status Not Documented
□  Not Done for Medical Reasons
□  Not Done

Falls: Plan of Care (155)

□  Done
□  No Falls or Only One Fall Without Injury in the Past Year
□  Falls Status Not Documented
□  Not Done for Medical
□  Not Done

Use of High-Risk Medications in the Elderly (238)

□  One High-Risk Medication Ordered
□  Not Done

For questions call 800-634-4731 or email

http://www.mdinteractive.com