Measure Description
Percentage of patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%) and who have an FEV1 less than 60% predicted and have symptoms who were prescribed a long-acting inhaled bronchodilator.
Instructions
This measure is to be submitted a minimum of once per performance period for all COPD patients seen during the performance period. 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 COPD (FEV1/FVC < 70%), who have an FEV1 < 60% predicted and have symptoms (e.g., dyspnea, cough/sputum, wheezing)
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9
AND
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99424, 99426
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
AND
Spirometry test results demonstrate FEV1/FVC < 70%, FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): G8924
Numerator
Patients who were prescribed a long-acting inhaled bronchodilator
Definition:
Prescribed – Includes patients who were “prescribed“medication at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter
Numerator Options:
Performance Met: Long-acting inhaled bronchodilator prescribed (G9695)
OR
Denominator Exception: Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (G9696)
OR
Denominator Exception: Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (G9697)
OR
Denominator Exception: Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (G9698)
OR
Performance Not Met: Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (G9699)
Rationale
Despite major efforts to broadly disseminate the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and use of COPD performance measures across different specialty societies, management of COPD, and specifically prescription for long-acting inhaled bronchodilators, remains suboptimal. Studies show a wide range of deficiencies in adherence to guidelines regarding long-acting inhaled bronchodilator use across different settings (Asche et al., 2012; CDC, 2012; Fitch, et al., 2011; Nantsupawat et al., 2012; Perez et al., 2011; Sharif, et al., 2013). Underuse of bronchodilators were found related to hospital readmissions and to increased total costs of services when compared to patient care adhering to GOLD guidelines (Asche et al., 2012; Nantsupawat et al.,2012)
Suboptimal COPD management has implications for severity of illness, disease progression, patient quality of life and health status, exacerbations (and associated costs) and mortality. Improved adherence to COPD management guidelines, specifically appropriate use of long-acting inhaled bronchodilators, has the potential to improve clinical outcomes and cost of care related to COPD. As a result, we believe this measure will continue to increase appropriate long-acting inhaled bronchodilator use, improving patient management and total costs ofCOPD.
Clinical Recommendation Statements
Recommendation 3: For stable COPD patients with respiratory symptoms and FEV1 < 60% predicted, ACP, ACCP, ATS, and ERS recommend treatment with inhaled bronchodilators (Grade: strong recommendation, moderate-quality evidence). Recommendation 4: ACP, ACCP, ATS, and ERS recommend that clinicians prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled ß-agonists for symptomatic patients with COPD and FEV1 <60% predicted. (Grade: strong recommendation, moderate-quality evidence). Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile. Monotherapy with a longacting inhaled agent (long-acting anticholinergic, long-acting ß-agonist, or corticosteroid) was superior to placebo or short-acting anticholinergic therapy in reducing exacerbations (Qaseem et al, 2011)
Bronchodilator medications are given on either an as-needed basis or a regular basis to reduce or prevent symptoms (Evidence A). Bronchodilator medications are central to symptom management in COPD. Inhaled therapy is preferred. Long-acting inhaled bronchodilators are convenient and more effective at producing maintained symptom relief than short-acting bronchodilators. Based on efficacy and side effects, inhaled bronchodilators are preferred over oral bronchodilators. (Evidence A) (GOLD, 2015)