hedis hybrid measure abstraction: w34 · 7. w34. medical history. past medical history last...

HEDIS® Hybrid Measure Abstraction: W34Prepared for: 9th Annual HEDIS® Training WebinarDecember 10, 2019

1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

W34

Well-Child Visit: 3, 4, 5, 6 years old

HEDIS® 2020 Tech Specs Changes/Updates

Section: Utilization

Page 441

Summary of changes from 2019:

Added instructions to not count services provided via telehealth when reporting this measure.

Added a note to clarify that handouts given during a visit without evidence of a discussion does not meet criteria for health education/anticipatory guidance.

Added a note to clarify that “well-developed” does not count for mental development.

Added the Rules for Allowable Adjustments of HEDIS® section.

© 2019 Confidential. All rights reserved. 2

W34


Measure Description:

The percentage of members 3–6 years of age who had one or more well-child visits with a PCP during the measurement year (2019).

The well-child visit can be found anytime during the measurement year for this measure. The child only needs to be age 3, 4, 5, or 6 as of December 31, 2019.

Numerator:

At least one well-child visit with a PCP during the measurement year.

The PCP does not have to be the practitioner assigned to the child.


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pgs. 441-442


Instructions for Medical Record Review

Documentation in the medical record must include a note indicating a visit to a PCP, the date when the well-care visit occurred, and evidence of all the following:

– Health history

– Physical development

– Mental development

– Physical exam

– Anticipatory guidance/health education

Do not include services rendered during an inpatient or ED visit

The components may be from different dates of service


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pg. 442


Health HistoryA health history is an assessment of the member’s history of disease or illness. Health history can include, but is not limited to, past illness or lack of illness, surgeries/hospitalizations or lack of surgeries/hospitalizations, and family history.

Relevant aspects of history include: Documentation of the child's health over the past weeks/months/years meets the criteria for

health history (may also be stated as interval history)

Notation of allergies, medications, and immunization status (all three must be in the same DOS to meet criteria)

“Health History reviewed” is also valid evidence

Family health history


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pg. 442 Interval hx is the same as the health hx over the last week/month/day. Documentation may be found such as “Interval history- None”, “Interval history- N/A”


Health History

Do NOT count birth historyPCS #200767 8/13/2018

Question: We would like to verify documentation of a member’s birth history to see if it meets criteria for the health history component of a well-child visit. If so, is this only acceptable for W15, or would it also be acceptable for W34 and/or AWC? Thank you for your time.

Answer: Newborn exam would have a limited health history. Therefore, documentation of birth history meets criteria for the health history component of the W15 measure. Birth history does not meet health history criteria for the W34 and AWC measures.


W34


Can we capture health history from this encounter?

Yes – See Health Hx.

Assume DOS is during measurement year.


W34

Medical HistoryPast Medical History last reviewed on 5/1/19Family History last reviewed on 5/1/19Social History last reviewed 5/1/19

Presenter

Presentation Notes

Statements of “reviewed” have been approved by auditors in prior seasons if the reviewed date is the same as DOS



W34Health History

Valid Examples Invalid Examples

1. Health history outside measurement year.

2. Health history during an acute inpatient stay or an ED visit.

3. Alone medication history, allergy history, or immunization history will not count. (All three components should be present on the same day of service).

1. Must have addressed a health history in measurement year.

2. Any illness that occurs in previous weeks/months/years (may be in HPI).

3. Negative statements, such as “no change in history”/ “no chronic illnesses,” are acceptable.

4. Combination of all three (i.e., medication Hx, allergy Hx, and immunization) in the same DOS.

5. Past illness (or lack of illness), surgery or hospitalization (or lack of surgery or hospitalization), and family health history.

See Bright Future current PDF for more details.


Health HistoryEach sub-measure will now have two additional drop downs:

Visit Type

(this will ensure that the reviewers are not abstracting from the incorrect visit type)

Well-child visit

Sick visit/follow-up visit

Urgent care visit

Evidence

PMH/SH/FHx or PFSH

Allergies Hx, medication Hx, and immunization Hx

Problem list

HPI/interval Hx (with chronic condition)

Hx of condition

Other (if this option has been selected, a free text box should open below)


W34

Presenter

Presentation Notes

Cannot remove HPI/INTERVAL HX (WITH CHRONIC CONDITION) – this is part of our software AND ALLOWS FOR TARGET AUDITS. CANNOT BE REMOVED. Sick visits are still acceptable however goal is to remind reviewer to be aware of what type of visit and if it is related to the acute/chronic condition. Evidence: Others: If the medical record states, Chief complaint: “follow up” with no condition but under assessment and plan it states the condition for which they are following up on with status of said condition. Free text box: History of illness in assessment/plan section only.


STEP 1: DOS: Enter the visit DOS

STEP 2: Visit type:Select appropriate visit type

STEP 3:Provider type:Select appropriate provider type

STEP 4:Evidence:Select appropriate evidence

Will be the same for all other properties in this measure


W34

Presenter

Presentation Notes

This is our abstraction steps and will be the same for each property


Physical DevelopmentA physical developmental history assesses specific age-appropriate physical developmental milestones, which are physical skills seen in children as they grow and develop.

Documentation of Physical Developmental Milestones Appropriate for Age (not all inclusive)

Rides bike

Can throw ball

Developing appropriately for age, normal growth and development

Runs and plays on playground at school

Teeth brushing

Potty training

NOTE: Documentation of tanner stage/scale does not count towards physical development.


W34

Presenter

Presentation Notes


Visit Type (this will ensure that the reviewers are not abstracting from the incorrect visit type)

Well-child visit


Urgent care visit

Evidence

Notation of growth and development

Skipping/hopping on one foot

Runs/jumps/climbs

Copies shapes

Gross motor/fine motor

Riding bikes

Standing on one foot for three to five seconds

Other (if this option has been selected, a free text box should open underneath)


Physical DevelopmentEach sub-measure will now have two additional drop downs:

Well-Child Visit: 3, 4, 5, 6 years oldW34

Presenter

Presentation Notes

Sick visits are still acceptable however goal is to remind reviewer to be aware of what type of visit and if it is related to the acute/chronic condition. Other examples: These would include examples that are not in the dropdown as it is not all inclusive (i.e. pedals a tricycle, ties a knot, draws a person with 6 body parts)



W34Physical Development


1. Notation of Tanner stage/scale

2. Notation of “appropriate for age” without specific mention of development

3. Notation of “well-developed/nourished/ appearing”

4. Evidence from telehealth/inpatient/ED visit

1. Developing appropriately for age (key word: “developing”)

2. Crawls, walks, rolls over

3. Hops on one foot

4. Runs/climbs well

5. Stands on one foot for three to five seconds



Test Your Knowledge

NCQA Case #236711 5/30/2019

Question: For the physical development history portion, would notation on a completed Staying Healthy Assessment form of "Does your child brush and floss her/his teeth daily?” that answered “Yes” and the form is signed by the provider be considered compliant?

Rationale is that Bright Futures notes feeding, dressing, and brushing own teeth would all be indications of physical development.


W34


Test Your Knowledge

NCQA Case #236711 5/30/2019

Answer: Yes. The documentation above meets criteria for the physical developmental history component. Forms and tools completed by a patient (or parent/caregiver) are eligible for use when the following criteria are met:

1. Documentation must indicate the appropriate topic was addressed (e.g., physical developmental milestones).

2. For forms/tools completed by the member/parent there must be evidence of discussion between provider and member. This can include a provider signing/initialing the form on the date of the office visit when the discussion occurred; or if aprovider documents in the visit note that he/she discussed the form/tool with the member this meets criteria.

3. The form/tool must be in the member's medical record and documented within the required time frame for the measure.

That said, documentation that the member is brushing their teeth is an appropriate topic for the W34 physical developmental history component and meets criteria.


W34


Mental DevelopmentA mental developmental history assesses specific age-appropriate mental developmental milestones, which are behaviors seen in children as they grow and develop.

Documentation of Mental Developmental Milestones Appropriate for Age (not all inclusive)

Developing appropriately for age, normal mental development

School performance

Verbalizes well and understands instructions

Competent with fork and spoon; ability to use silverware and or documentation of feeding problems (i.e., feeding self finger foods)

Responds appropriately to commands

Potty training


W34

Presenter

Presentation Notes

PCS# 2447711 7/24/2019 HEDIS® 2020 Tech Specs pg. 442 Trainer: Note that potty training is counted for both physical and mental development, but you can not double count.


Mental DevelopmentAdditional documentation of mental developmental milestones appropriate for age (not all inclusive):

Behaves appropriately for age

Behavior appropriate for age

No school behavior problems

Notation of “behavior appropriate”

Judgement and insight good

Cognitive function intact

Normal speech pattern

Normal cognitive ability for age

Depression screening – for 5- and 6-year-old ONLY

Neurological: Appropriate for age


W34

Presenter

Presentation Notes

PCS #247503- Depression screening specifically for 5-6 yo. PCS#253694- Normal Cognitive ability for age PCS#253363- Normal speech Pattern


Mental DevelopmentDocumentation that does NOT count:

Mental Status – Normal: Considered a status at the time of visit and not a developmental milestone

Documentation of “motor function normal, no focal deficit”


W34

Presenter

Presentation Notes

PCS# 212101 (11/6/18)- motor function normal, no focal deficit If the provider documents motor function normal, no focal deficit; is this acceptable to abstract as mental development? Answer- This documentation is more indicative of a neurological exam which is part of the physical exam. PCS# 252605 (9/16/19)- mental status We are finding documentation of member being "happy" or "content", as these are considered social and emotional milestones for members in this age range. Answer- Documentation of "happy" or "content" alone appears to be an assessment of the member's mood or behavior at the time of the visit (e.g., mental status) versus evidence that an assessment was made about the patient's mental development.

Visit Type (this will ensure that the reviewers are not abstracting from the incorrect visit type)

Well-child visit


Urgent care visit

Evidence

Notation of growth and development

School performance

Understanding and responding to commands

Competent with fork and spoon

Social interaction

Cognitive assessment

Other (if this option has been selected, a free text box should open underneath)


Mental DevelopmentEach sub-measure will now have two additional drop downs:

Well-Child Visit: 3, 4, 5, 6 years oldW34

Presenter

Presentation Notes

Sick visits are still acceptable however, goal is to remind reviewer to be aware of what type of visit and if it is related to the acute/chronic condition. Others: These would include examples that are not in the dropdown as it is not all inclusive (i.e. statements of delayed development, documentation of depression in 5 and 6-year olds, behavior appropriate for age)



W34Mental Development


1. Notation of “appropriately responsive for age”

2. Notation of “neurological exam”


1. School performance

2. Understands and responds to commands

3. Learning alphabet and numbers

4. Competent with fork and spoon

5. Imaginative play


Lessons Learned

Test Your Knowledge

NCQA Case #247500 7/24/2019

Question: For the AWC, W15, and W34 measures, can we use documentation of the Denver questionnaire for mental development without a copy of test and/or test results?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247500 7/24/2019

Answer: Documentation of "Denver questionnaire" alone does not meet criteria for the mental and physical developmental history components. That said, NCQA does not review and approve forms/tools but forms/tools are eligible for use when the following criteria are met:

1. Documentation must indicate the appropriate topic was addressed (e.g., physical developmental milestones or mental developmental milestones).

2. For forms/tools completed by the member/parent, there must be evidence of discussion between provider and member. This can include a provider signing/initialing the form on the date of the office visit when the discussion occurred; or if a provider documents in the visit note that they discussed the form/tool with the member, this would meet criteria. (Continued)


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247500 7/24/2019

Answer – Continued:3. The form/tool must be in the member's medical record and documented within the required time frame for

the measure. Documentation about the same topic abstracted from a form/tool cannot be double counted for the same member (e.g., if documentation of smoking history from one questionnaire is counted as anticipatory guidance it cannot also be counted as evidence of health history).

The documentation can be abstracted directly from the tool, as long as the tool meets the three criteria listed above.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #228943 5/30/2019

Question: A pre-printed office form labeled by American Academy of Pediatrics used by provider for a WC exam under ROS says "School": Behavior NL, Attention NL, Homework NL, Parent/Teacher concerns: NL next heading is "Home:" Oppositional behavior NL, Parent concerns NL.1. Would this meet criteria for mental development? 2. Would notation of “behaves appropriately for age,” “no school behavior problems,” notations or notation of depressed mood be considered compliant for mental development?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #228943 5/30/2019

Answer: Documentation of "behaves appropriately for age” and “behavior appropriate for age” meets criteria for mental developmental history for all three well-child measures (W15, W34, and AWC). This documentation indicates an assessment of the child's mental development. Documentation of “no school behavior problems” meets criteria towards the mental developmental history indicator for the W34 and AWC measures.

Documentation of "depressed mood" appears to be an assessment of the member's mood or behavior at the time of the visit (e.g., mental status) versus evidence that an assessment was made about the patient's mental development. Therefore, this example does not meet criteria for the mental developmental history component of the W34 measure. This documentation still meets criteria for mental developmental history if it is noted under physical exam.(Follow up question next slide)


W34

Lessons Learned

Test Your Knowledge

NCQA Case #228943 5/30/2019

Follow-up Question: Can the notation of behavior appropriate without notation of appropriate for age or appropriately for age still be considered compliant? Also would documentation of the above stated notations in the physical exam section of the progress note be considered compliant?

Response to the Follow-up Question You Submitted Via a Comment: Documentation of "notation of behavior appropriate" without the notation of "appropriate for age" or "appropriately for age" meets criteria for mental developmental history for all three well-child measures (W15, W34, and AWC). This documentation still meets criteria for mental developmental history if it is noted under physical exam.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247711 7/24/2019

Question: In Bright Futures, potty training/urinating independently is listed under social language and self-help and not specifically under gross or fine motor, therefore only being able to meet criteria for mental development. Our question is when a PCP assesses and documents that child is potty trained, using toilet independently, or working on potty training, could that also meet criteria for physical development, because they would have to use their hand to turn knobs and lids, climb on/off potty seat, and/or undress self, which uses gross and fine motor skills?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247711 7/24/2019

Answer: For the W34 measure, documentation of toilet training/urinating independently meet compliance for both the mental and physical developmental history indicators. However, documentation about the same topic cannot be double counted for the same member (e.g., if documentation of "potty trained" is counted as physical developmental history, then it cannot also be counted as evidence of mental developmental history for the same member). Certain items under the header "Social Language and Self-help" are considered evidence of both mental and physical developmental history and mental developmental history alone. For example, documentation of toilet training meets criteria for both physical and mental developmental history and documentation that the child engages in imaginative play meets criteria for mental developmental history (but not physical).


W34

Lessons Learned

Test Your Knowledge

NCQA Case #217870 12/26/2018

Question: In regard to the W34 physical and mental development components, can an assessment of the feeding problems (e.g., feeds self finger foods) be counted for mental and physical development?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #217870 12/26/2018

Answer: Documentation of an assessment of self-feeding problems meet criteria for the physical and mental developmental history component of the W34 measure. However, documentation about the same topic cannot be double counted for the same member (e.g., if documentation of "feeds self finger foods" is counted as physical developmental history, it cannot also be counted as evidence of mental developmental history). Please note, if these notations are limited to body systems associated with the acute or chronic condition then it would not meet criteria. The Bright Futures Guidelines and Pocket Guide should be used to provide additional information and examples that may be helpful when evaluating medical record documentation for the well-child measures.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #234973 5/30/2019Question: At a sick visit for fever, vomiting, and cough, under Physical Exam/PSYCH note reads "alert, oriented, cognitive function intact, cooperative with exam, good eye contact, judgement and insight good, mood/affect full range, no auditory or visual hallucinations, speech clear" would either or both verbiage "judgement and insight good" or "cognitive function intact" meet compliance for the Mental Development component?

Question asked: For mental development, we are seeing statements such as judgment and insight intact or judgment and insight good or cognitive function intact or no speech difficulties in the progress notes, would these statements be considered compliant to mental development?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #234973 5/30/2019

Answer: Yes. The documentation in your example meets criteria for mental developmental history. Keep in mind that services that are specific to the assessment or treatment of an acute or chronic condition do not count toward the measure.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247503 7/26/2019

Question: For the W34 measure, we have seen depression screening as early as 6 years old. What is the earliest age a depression screen can be counted for assessment of mental development?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #247503 7/26/2019

Answer: Documentation of a depression screening meets criteria for the mental developmental history of the W34 measure. In Bright Futures, the 5- and 6-year old visits assess for diagnoses such as psychiatric and learning disorders.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #253363 9/13/2019

Question: When reviewing documentation for W15, W34, and AWC we consider documentation in the medical record of a "normal speech pattern" or "normal speech" to mean that the provider is assessing milestones the patient is achieving for MD. Without mention of development, would you also consider this an appropriate assessment for MD?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #253363 9/13/2019

Answer: Documentation related to speech, such as "normal speech pattern" or "normal speech", meets criteria for mental developmental history for the W15 and W34 measured. For the AWC measure documentation related to speech does not meet criteria for the mental developmental history. For this measure, evidence that the provider assessed whether the adolescent is developing skills to become a healthy adult meets mental developmental history criteria. This includes assessing whether the adolescent is choosing behaviors that optimize wellness and contribute to a healthy lifestyle. The Bright Futures Guidelines andPocket Guide (https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/Pages/default.aspx) contains additional information that may be helpful when evaluating medical record documentation for the well-child measures. The guide lists examples of well-child visits by age, and the appendices include examples of what meets criteria for different ages. Documentation for the mental developmental history components do not have to specify indicate "development" or specific milestones/behaviors/skills, but there must be enough evidence that the provider assessed whether the member is developing mentally appropriately for their age.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #253694 9/27/2019

Question: For mental development, we are seeing statements such "normal cognitive ability for age" and "cognitive function intact." Would these statements be considered compliant for mental development?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #253694 9/27/2019

Answer: Yes. Documentation of "normal cognitive ability for age" and "cognitive function intact" also meets criteria for the mental developmental history component of the W15 and W34 measures.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #251156 8/27/2019

Question: Under the neurological exam section, we are finding documentation that states, “Neurological: Appropriate for Age" or uses the language “Normal neuro exam for age”. We are planning to accept this as appropriate documentation for mental development. Do you agree?


W34

Lessons Learned

Test Your Knowledge

NCQA Case #251156 8/27/2019

Answer: Notations of neurological exams do not meet criteria for the mental developmental history component. This notation is often used as documentation of a physical exam, not of the patient's mental developmental history. Therefore, documentation of "Neurological: Appropriate for Age" and “Normal neuro exam for age” alone does not meet criteria for the mental developmental history component for any of the well-child measures (W15, W34, AWC).


W34

Lessons Learned

Test Your Knowledge

NCQA Case #263359 11/26/2019Can we consider documentation of Child's ability to identify own sex or knowing own gender, as an evidence of Mental Development for W34 Measure? because we feel that child with age of 3 years can have sense of their gender identity.


W34

Lessons Learned

Test Your Knowledge

NCQA Case #263359 11/26/2019

Answer: Yes, the example above meets criteria for mental developmental history for the W34 measure.


W34


Example for mental and physical development: States “G and D” for “growth and development.”

Assume that documentation and dates are within the valid time frame.


W34

Presenter

Presentation Notes

Growth and Development assessments encompass the aspects of mental and physical milestones.


A Physical Exam

Height, weight, blood pressure, along with a hands-on physical exam

A completed physical examination form (the physical exam must show an actual hands-on assessment)

Progress note that includes a physical exam

Any “hands-on” physical exams

NOTE: Vital signs alone do NOT count as a physical exam.


W34

Presenter

Presentation Notes


Well-Child Visit: 3, 4, 5, 6 years oldHealth Education/Anticipatory Guidance Sample

Physical and oral health, healthy eating, physical activity

Safety belt/car seat/booster seat

Wears bicycle helmet

Nutrition

Discussed and handouts given

Anticipatory guidance discussed

Parents counseled on anticipatory guidance

Counseling/education factors reviewed

Pet safety (only if the member is stated to have pets)

NOTE: For example, if member is being seen for fever only, anticipatory guidance related to smoking or exposure will count as it is not directly related to the fever.


W34

For general statements of “anticipatory guidance discussed,”

please note: If the member is seen for sick conditions, details of the

anticipatory guidance are required to confirm that it is not related to an

acute condition.

Presenter

Presentation Notes

Bright Futures pg. 51 HEDIS® 2020 Tech Specs pg. 442


This is a good example of anticipatory guidance.



W34

SOCIAL SITUATION: Edmond’s primary caregiver(s) are his mother and father. He does not attend preschool. There have been no changes in the family. A regular schedule is maintained in the household.

Presenter

Presentation Notes

Bright Futures pgs. 68-81


An Example of Anticipatory Guidance



W34

Celine Dion

Celine DionCeline Dion

Celine Dion

Presenter

Presentation Notes

Bright Futures pgs. 68-81 - car seat, bike safety, etc. is considered anticipatory guidance.


Is it valid to capture anticipatory guidance from this page?

No. This is not acceptable due to being condition related. (See ROS)

Note: This documentation is not acceptable if it is not related to the chief complaint (i.e., ear drainage, ear pain, sore throat, cough-any respiratory issues (URI) or ENT issues).



W34

Presenter

Presentation Notes

PCS# 232723 4/2/2019



W34

PHYSICAL EXAM PHYSICAL HEALTH DEVELOPMENT MENTAL HEALTH DEVELOPMENT ANTICIPATORY GUIDANCE

Weight Developing appropriately for age. Normal growth and development

Making good grades in school Safety (car seats, swimming lessons, seat belts, helmets, knee and elbow pads, strangers, etc.)

Height Can skip Understands and responds to commands

Nutrition (vitamins, frequency of eating, snacks, ideal weight)

Chest Hops on one foot School performance Discussions on fitness and the importance of exercise

Heart Runs and climbs well Competent with fork and spoon Oral health (Dental visits, eating habits, need for orthodontics, etc.)

Lungs Rides a tricycle Very imaginative play Mental health (confidence, self-esteem, etc.)

Stands on one foot for 3-5 seconds Developing appropriately for age Normal growth and development

Preparing for school

Presenter

Presentation Notes

Bright Futures pgs. 68-81


Helpful Hints

Preventive services may be rendered on visits other than well-child visits.

Well-child preventive services count toward the measure, regardless of the primary intent of the visit. Services that are specific to an acute or chronic condition do not count toward the measure.

Urgent care visits count towards the measure if done by PCP provider type.


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pg. 442 PCS#179748 (2/28/2018)


Helpful Hints

Visits to school-based clinics with practitioners whom the organization would consider PCPs may be counted if documentation that a well-care exam occurred is available in the medical record or administrative system in the time frame specified by the measure. The PCP does not have to be assigned to the member.

Components may be abstracted from different dates of service within the measurement year.


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pg. 442 PCS# 179748 (2/28/2018)



W34Anticipatory Guidance


1. Information regarding medications or immunizations or their side effects


3. Statement of “anticipatory guidance” documented during a sick visit/follow up without specific mention as to what type of AG was discussed or given.

1. Safety

2. Exercise/fitness

3. Counsel weight

4. Oral health (dental visits)

5. Counsel parent (car seat, swimming, safety gear, etc.)

6. Nutrition counselling (vitamins, ideal weight)

7. Preparing for school

8. Obesity-related anticipatory guidance



Helpful Hints

All five elements must be present for the visit to be compliant.

– However, if less than five elements are documented, we still abstract the elements that are present.

– Example: A well-child visit during the measurement year only contains a physical exam. Abstract the physical exam and enter it into the tool.

If you are using a well-child form, make sure that the form is completed, not just present in the chart.


W34

Presenter

Presentation Notes

Advantmed abstraction policies.


Do NOT use the following:

Do not include services rendered during an inpatient or ED visit.

“Well-child check” written in the progress note does NOT count. All components MUST be present.

Just because a form for a “well visit” is used does NOT mean it meets the criteria. There MUST be notation that the form was completed. Check marks and slashes count, but a totally blank section does NOT count.


W34

Presenter

Presentation Notes

HEDIS® 2020 Tech Specs pg. 442 Advantmed abstraction policies.


The following documentation does NOT count as numerator compliant:


W34

HEDIS® 2020 Tech Specs, Volume 2, Page 443

Presenter

Presentation Notes


Which components can we capture from this note?

Health History

Physical Exam

Physical Development

Mental Development

Anticipatory Guidance


W34DOS: 5/1/19


Which components can we capture from this note (DOS is 5/1/19)?


Mental Development

Physical Exam

Health History


57

W34

Presenter

Presentation Notes

Health History- PMH Mental Development- Under developmental milestones section Physical Development- Under developmental milestones section Physical Exam- Under the Physical Exam section Anticipatory guidance- at the top of the note- discussions around parental concerns, diet/proper servings, toilet training concerns


Which components of the W34 can be captured in this example?

Mental Development



W34DOS: 5/1/2019

Presenter

Presentation Notes

Mental Development- Grade in school, has friends Anticipatory guidance- Dietary behaviors, Exercise, screen time Trainer Note: Physical development/Anticipatory Guidance: “Brushes teeth twice a day. Flosses”. In this record the member is 6 yrs of age and therefore “brushes teeth” would only count towards the AG. For members age 3 and 4 we CAN USE IF EVIDENCE THAT THE CHILD IS DOING THE BRUSHING TEETH.




Mental Development

Physical Exam


Health History


W34DOS: 5/1/2019

Presenter

Presentation Notes

PCS# 212676 11/15/2018 Health History- Interval History Mental Development- Under assessment- Normal Growth and Development Physical Development- Under assessment- Normal Growth and Development Physical Exam- Under the Physical Exam section Anticipatory guidance- Family support discussion, parental health

DOS: 5/1/19




Health History


W34

Presenter

Presentation Notes

Bright Futures pgs. 68-81 Health History- History, N=no, NI= Needs information, Y= yes Anticipatory guidance- AG section




Health History

Mental Development


Physical Exam



W34

Presenter

Presentation Notes

Health History- Interval History Mental Development- Under growth and development section Physical Development- Under growth and development section Physical Exam- Under the Physical Exam section Anticipatory guidance- AG section

PCS Review

Test Your Knowledge

NCQA PCS #172419 (1/3/2018)

Questions: Scenario 1: If smoking status is “never smoker” or “smoking: none” is documented under the social Hx, does this qualify for anticipatory guidance for the W34 measure?

Scenario 2: If documentation states no passive smoke exposure under the social Hx, does this qualify for anticipatory guidance for the W34 measure?


W34

PCS Review

Test Your Knowledge

NCQA PCS #172419 (1/3/2018)

Answer: Yes. The documentation above indicates a discussion related to anticipatory guidance occurred and would meet criteria. The Bright Futures Pocket Guide lists "keeping a home/vehicle smoke-free; use of smoke detectors; don’t use tobacco/e-cigarettes/alcohol/drugs" as examples of documentation that meets criteria for health education/anticipatory guidance. Thus, for the W15, W34, and AWC measures, documentation of "smoking status: never smoker, smoking: none, and smoking exposure" may count as anticipatory guidance if it is not related to an acute or chronic condition. For all of the well-child measures (W15, W34, and AWC), a checklist with AG/HE topics selected by the provider is an indication that the provider asked about the topics. (Continued)


W34

PCS Review

Test Your Knowledge

NCQA PCS #172419 (1/3/2018) - CONTINUED

Answer: It is expected that if a provider receives a concerning response, the provider would then provide AG/HE regarding the topic. This is because checklists are often used as a method to prompt an AG and HE discussion. Documentation of a list of topics (or topics marked off on a checklist) is considered evidence of a discussion related to those topics and meets criteria for AG/HE. In addition, the Bright Futures Pocket Guide (https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/Pages/default.aspx) contains additional information that may be helpful when evaluating medical record documentation for the well-child measures. The guide lists examples of health education/anticipatory guidance by age, and the appendices includes examples of what meets criteria for different ages.


W34

PCS Review

Test Your Knowledge

NCQA PCS #179748 (2/28/2018)

Question: Can we use a visit from urgent care?


W34

PCS Review

Test Your Knowledge

NCQA PCS #179748 (2/28/2018)

Question: Yes. Services that occurred in an urgent care setting can count towards the well-child measures. Preventative services may be rendered on visits other than well-child visits. Well-child preventative services count toward the measures regardless of the primary intent of the visit, but services that are specific to an acute or chronic condition do not count toward the measures. If the visit to urgent care was rendered by a PCP (as defined in Appendix 3) and the service was not specific to an acute or chronic condition, it can be used towards the measure.


W34

PCS Review

Optional Exclusions

There are no optional exclusions for W34 in hybrid review.


W34

PCS Review

Secondary Pursuit Notes:

Alternate Provider Identified

Other (e.g., clues in the documentation that there may be another provider)


W34

Questions?

69

70

Thank you.

hedis hybrid measure abstraction: w34 · 7. w34. medical history. past medical history last...

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