MEASURE DESCRIPTION:
Percentage of patients aged 70 years or older, who undergo an inpatient procedure requiring anesthesia services and have a positive frailty screening result who receive a multidisciplinary consult or care during the hospital encounter.
NQS DOMAIN:
Communication and Care Coordination
MEASURE TYPE:
Process
HIGH PRIORITY STATUS:
Yes
INVERSE MEASURE:
No
INSTRUCTIONS:
This measure is to be reported each time a frail patient undergoes an inpatient procedure during the reporting period. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.
Measure Reporting via the Qualified Clinical Data Registry
Patient demographics, Place of Service codes, CPT codes and Registry codes are used to identify patients who are included in the measure denominator. Registry codes are used to report the numerator.
DENOMINATOR:
All patients aged 70 years or older, who undergo an inpatient procedure requiring anesthesia services and have a positive frailty screening result.
Denominator Definition: Frailty can be screened using an established tool including but not limited to following tools:
Fried Frailty Phenotype Criteria
Modified Frailty Index
The Vulnerable Elders Survey-
Denominator Criteria (Eligible Cases):
All patients aged 70 years and older
AND
Place of Service Code: 21
AND
Patient encounter during the reporting period (CPT):
00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00562, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00754, 00756, 00770, 00790, 00792,00794, 00796, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01922, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01937, 01938, 01939, 01940, 01941, 01942, 01951, 01952, 01991, 01992, 20526, 20550, 20551, 20552, 20553, 20600, 20604, 20605, 20606, 20610, 20611, 27096, 36555, 36556, 36570, 36571 36578, 36580, 36581, 36582, 36583, 36584, 36585, 62263, 62264, 62270, 62272, 62273, 62280, 62281, 62282, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62328, 62329, 62350, 62355, 62360, 62361, 62362, 62365, 62370, 63650, 63661, 63662, 63663, 63664, 63685, 63688, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64454, 64461, 64463, 64479, 64483, 64486, 64487, 64488, 64489, 64490, 64493, 64505, 64510, 64517, 64520, 64530, 64600, 64605, 64610, 64620, 64624, 64625, 64630, 64633, 64635, 64640, 64680, 64681, 93503, 95990, 95991
AND
Positive Frailty Screening Result: 11A14
-
Denominator Exclusions:
Emergent cases
NUMERATOR:
Patients who receive a multidisciplinary consult and/or multidisciplinary care during the hospital encounter
Numerator Definition: A multidisciplinary consult should include documentation of a discussion of the frailty screening result and can include consultation initiated by the anesthesiologist or other qualified anesthesia provider with surgery, geriatrics, hospital medicine, palliative care, or other appropriate specialty to help manage the perioperative care of a frail patient.
-
Numerator Options:
Performance Met: Patient received multidisciplinary consult and/or multidisciplinary care (11A15)
OR
Performance Not Met: Patient did not receive multidisciplinary consult or multidisciplinary care (11A16)
RELEVANT FIELDS:
-
Date of Service
-
Date of Birth
-
ASA CPT Code
-
Frailty Screening Result
-
Multidisciplinary Care
RATIONALE:
Frailty is a health state that makes a patient particularly vulnerable to stressors, such as surgery. Among elderly surgical patients, frailty has been well-associated with post-operative complications and mortality. While evidence is still evolving regarding appropriate interventions to best manage frailty in the perioperative setting and to optimize patient outcomes, there is agreement that preoperative assessment and identification of frailty is an important first step to ensure coordinated and patient-centric care for the frail patient throughout their perioperative course. Preoperative identification of frailty and appropriate multi-disciplinary consultation allows for the care team to provide appropriate counseling regarding the anticipated outcomes of surgery, better anticipate post-operative complications, and better prepare patients and families for their postoperative course. Multi-disciplinary consultation for frail patients can also allow for the implementation of appropriate team-based care pathways to manage complications such as postoperative delirium, as well as help patients and families define their care goals and expectations.
REPORTING CODES: