Measure Description
Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months
Instructions
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure is appropriate for use in all non-acute settings (with the exception of emergency departments and acute care hospitals). 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.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients aged 65 years and older who have a history of falls (history of falls is defined as 2 or more falls in the past year or any fall with injury in the past year). Documentation of patient reported history of falls is sufficient
Denominator Criteria (Eligible Cases):
Patients aged ≥ 65 years on date of encounter
AND
Patient encounter during the performance period (CPT or HCPCS): 92540, 92541, 92542, 92548, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439
AND
Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year: 1100F
AND NOT DENOMINATOR EXCLUSIONS:
Hospice services for patient provided any time during the measurement period: G9718
Numerator
Patients who had a risk assessment for falls completed within 12 months
Definitions:
Fall – A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force.
Risk Assessment – Comprised of balance/gait AND one or more of the following: postural blood pressure, vision, home fall hazards, and documentation on whether medications are a contributing factor or not to falls within the past 12 months.
Balance/gait Assessment - Medical record must include documentation of observed transfer and walking or use of a standardized scale (e.g., Get Up & Go, Berg, Tinetti) or documentation of referral for assessment of balance/gait.
Postural blood pressure - Documentation of blood pressure values in supine and then standing positions.
Vision Assessment - Medical record must include documentation that patient is functioning well with vision or not functioning well with vision based on discussion with the patient or use of a standardized scale or assessment tool (e.g., Snellen) or documentation of referral for assessment of vision.
Home fall hazards Assessment - Medical record must include documentation of counseling on home falls hazards or documentation of inquiry of home fall hazards or referral for evaluation of home fall hazards.
Medications Assessment - Medical record must include documentation of whether the patient’s current medications may or may not contribute to falls.
Numerator Instruction:
All components do not need to be completed during one patient visit, but should be documented in the medical record as having been performed within the past 12 months.
Numerator Options:
Performance Met: Falls risk assessment documented (3288F)
OR
Denominator Exception: Documentation of medical reason(s) for not completing a risk assessment for falls (i.e., patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair) (3288F with 1P)
OR
Performance Not Met: Falls risk assessment not completed, reason not otherwise specified (3288F with 8P)
Rationale
Screening for specific medical conditions may direct the therapy. Although the clinical guidelines and supporting evidence calls for an evaluation of many factors, it was felt that for the purposes of measuring performance and facilitating implementation this initial measure must be limited in scope. For this reason, the work group defined an evaluation of balance and gait as a core component that must be completed on all patients with a history of falls as well as four additional evaluations – at least one of which must be completed within the 12 month period. Data elements required for the measure can be captured and the measure is actionable by the physician.
Clinical Recommendation Statements
Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment. This assessment should be performed by a health care professional with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualized, multifactorial intervention.
(NICE) (Grade C)
Multifactorial assessment may include the following:
• Identification of falls history
• Assessment of gait, balance and mobility, and muscle weakness
• Assessment of osteoporosis risk
• Assessment of the older person’s perceived functional ability and fear relating tofalling
• Assessment of visual impairment
• Assessment of cognitive impairment and neurological examination
• Assessment of urinary incontinence
• Assessment of home hazards
• Cardiovascular examination and medication review (nice) (grade c)
A falls risk assessment should be performed for older persons who present for medical attention because of a fall, report recurrent falls in the past year, report difficulties in walking or balance or fear of falling, or demonstrate unsteadiness or difficulty performing a gait and balance test.
The falls risk evaluation should be performed by a clinician with appropriate skills and experience. [C] A falls risk assessment is a clinical evaluation that should include the following, but are not limited to:
• A history of fall circumstances
• Review of all medications and doses
• Evaluation of gait and balance, mobility levels and lower extremity joint function
• Examination of vision
• Examination of neurological function, muscle strength, proprioception, reflexes, and tests of cortical, extrapyramidal, and cerebellar function
• Cognitive evaluation
• Screening for depression
• Assessment of postural blood pressure
• Assessment of heart rate and rhythm
• Assessment of heart rate and rhythm, and blood pressure responses to carotid sinus stimulation if appropriate
• Assessment of home environment
The falls risks assessment should be followed by direct intervention on the identified risk. [A] (AGS)