Measure Description
Percentage of patients aged 18 years and older with a diagnosis of hepatitis C with whom a physician or other qualified healthcare professional reviewed the range of treatment options appropriate to their genotype and demonstrated a shared decision making approach with the patient. To meet the measure, there must be documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment.
Instructions
This measure is to be submitted a minimum of once per performance period for all patients with a diagnosis of chronic hepatitis C seen during the performance period. This measure is intended to reflect the quality of services provided for patients with chronic hepatitis C who are undergoing evaluation for antiviral treatment. 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 18 years and older with a diagnosis of chronic hepatitis C
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for chronic hepatitis C (ICD-10-CM): B18.2, B19.20, B19.21
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Numerator
Patients with whom a physician or other qualified healthcare professional reviewed the range of treatment options appropriate to their genotype and demonstrated a shared decision making approach with the patient
Numerator Options:
Performance Met: Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment (G9399)
OR
Denominator Exception: Documentation of medical or patient reason(s) for not discussing treatment options. Medical reasons: Patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons. Patient reasons: Patient unable or unwilling to participate in the discussion or other patient reasons (G9400)
OR
Performance Not Met: No documentation of a discussion in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment (G9401)
Rationale
Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and greater alignment of care with patients' values (Lee, E., & Emanuel, E., 2013). In hepatitis C, the decision about whether to initiate treatment is sensitive to patient preferences about achieving cure and limiting symptoms versus tolerating side effects of medications (Colter, et. al., 2001). It is also intuitive that patients are more likely to be adherent to treatment if they are engaged in the decision to start.
Numerous studies have documented problems with patient-physician communication in this population (Zickmund, et. al., 2004), and patient misperceptions and lack of education have been implicated as barriers to treatment (Zickmund & Bielefeldt, 2007; Richmond, et. al., 2007; McNally’s, et. al., 2006). For these reasons, it is likely that shared decision making would improve decision quality, result in more effective antiviral therapy, and better patient health outcomes.
Clinical Recommendation Statements
The decision to defer treatment for a specific patient should consider the patient’s preferences and priorities, the natural history and risk of progression, the presence of co-morbidities, and the patient’s age. (EASL, 2014).
Treatment decisions should be individualized based on the severity of liver disease, the potential for serious side effects, the likelihood of treatment response, the presence of comorbid conditions, and the patient’s readiness for treatment (Class II a, Level C). (AASLD, 2009)
The Institute of Medicine endorses shared decision-making and the strongly recommends use of decision aids as a way to foster patient-centered care (Committee on Quality of Health Care in American Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001)