CMS122v11 – Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

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

– DENOMINATOR EXCLUSIONS:

• Exclude patients who are in hospice care for any part of the measurement period.
• Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of during the measurement period.
• Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:

– Advanced illness with two outpatient encounters during the measurement period or the year prior

– OR advanced illness with one inpatient encounter during the measurement period or the year prior

– OR taking dementia medications during the measurement period or the year prior

• Exclude patients receiving palliative care during the measurement period.

– NUMERATOR

Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period

For Denominator:

Patients fulfilling the following criteria are included in the denominator of this measure:

• Patients aged 18-75 at the end of measurement period with a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

• Patients with a diagnosis of diabetes where diabetes prevalence period overlaps the measurement period. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses and click ‘Add’. Search for the diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

For Numerator:

Include patients satisfying any of the conditions:

• Patient has most recent HbA1c without result. To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs and click ‘+ Add Order’ button.

Here, select a laboratory and search for the ‘HbA1c’ test. Once done, click on the ‘Save’ or ‘Sign’ button.

Next, click on the ‘Mark As Received’ button.

On the ‘Edit Lab Result’ screen, add the observations and click on the ‘Save’ button. There should be no result entered in the ‘Result’ field.

Note:

Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’. 

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

• Patient has most recent elevated HbA1c. To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs and click ‘+ Add Order’ button. Then select a laboratory and search for the ‘HbA1c’ test. Once done, click on the ‘Save’ or ‘Sign’ button.

Next, click on the ‘Mark As Received’ button. On the ‘Edit Lab Result’ screen, add the observations and click on the ‘Save’ button. Enter a result greater than 9% in the ‘Result’ field.

• Patient has no record of HbA1c. There should be no record of HbA1c laboratory test performed during the measurement period.

For Denominator Exclusions:

Patients satisfying any of the following conditions are excluded from the denominator:

1. Patients who were in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
   • 385763009: Hospice Care (Regime/Therapy)
   • 385765002: Hospice Care Management (Procedure)

1. •  To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

• Patients with hospice care assessment performed during the measurement period. To document the assessment, follow the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an evaluation. Then select ‘Performed’ from the ‘Status’ dropdown and enter ‘Yes’ in the ‘Result’ field.
• Patients with hospice encounter during the measurement period. To document the hospice encounter, follow the workflow Patient > Clinical > Evaluations.

2. Patients aged 66 years of age or older at the end of measurement period and lived in a nursing home for long term on or before the end of measurement period. For documentation, navigate to Patient > Clinical > Evaluations.

3. Patients 66 years of age or older with two or more outpatient encounters with advanced illness and fulfilling frailty criteria. Outpatient encounters should occur one year prior to or during the measurement period. To document an outpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
   • Frailty device ordered or used during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

4. Patients 66 years of age or older having an inpatient encounter with advanced illness and fulfilling frailty criteria. Inpatient encounters should occur one year prior to or during the measurement period. To document an inpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
   • Frailty device ordered or used during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

5. Patients 65 years of age or older taking dementia medication one year prior to or during the measurement period and fulfilling frailty criteria. Record the medication via the workflow Patient > Clinical > Prescription. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’. Workflows for recording frailty criteria:
   • Frailty device ordered or used during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill
6. Patients receiving palliative care during the measurement period.
   • To record the ‘Palliative Care Encounter’ performed, use the workflow Patient > Provider Note > eSuperbill.
   • To document the ‘Encounter for palliative care’ diagnosis, use the workflow Patient > Provider Note > Diagnoses.
   • To record the ‘Palliative Care Intervention’ performed, use the workflow Patient > Clinical > Evaluations.
   • To record the ‘Functional Assessment of Chronic Illness Therapy’ assessment performed, navigate to Patient > Clinical > Evaluations.