Measure 431
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
DESCRIPTION:
The percentage of adult patients who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months and received brief counseling if identified as an unhealthy alcohol user.
| MEASURE ID: | 431 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | No |
| High priority: | No |
| Topped out: | No |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
This measure encourages physicians to screen patients for alcohol dependence and document a treatment plan when the patient’s alcohol consumption is unhealthful.
Measure 431 FAQs
Q. Is this measure reportable via claims?
A. No.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes, encounters coded with GQ, GT, 95, or POS 02 modifiers are allowable.
Q. The measure says to report once per performance period. Is the performance period a year?
A. Yes, you can report once per year.
Q. The measure states that two patient encounters are required. What does this mean?
A. The denominator criteria (or the eligible patient population) is all patients 18 and older who had one preventive encounter OR two patient encounters during the measurement period.
At least two patient encounters during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90845, 92517, 92518, 92519, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92548, 92549, 92550, 92552, 92553, 92555, 92556, 92557, 92567, 92570,92584, 92587, 92588, 92650, 92651, 92652, 92653, 92620, 92622, 92625, 92626 96156, 96158, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0270, G0271
OR at least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439
AND NOT DENOMINATOR EXCLUSIONS:
Patients with dementia in the patient’s history through the end of the measurement period: M1164
OR
Patients who use hospice services any time during the measurement period: M1165
* Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS).
Q. Do I have to screen the patient every visit?
A. No, if a patient came in within the last 12 months and was screened, the patient does not need to be screened again.
Q. What is the "completed audit screening" mean?
A. Completed audit screening means that the patient was assessed using one of the screening tools in the measure. One is called the “AUDIT Screening Instrument” and the other is “AUDIT-C Screening Instrument”.
Q. Is any counseling required if the patient does not drink or drinks at an acceptable level?
A. No, counseling is only required if the screening tool detects unhealthy alcohol use.
Q. If we screen the patient and they respond they do not drink and therefore we do not provide any cessation information, will that be accepted for this measure?
A. Yes, if the patient was not identified as an unhealthy alcohol user when screened, no cessation information needs to be provided and performance is met.
Q. Where are the assessment tools located for this measure?
A. There are 3 tools available for the measure.
Single Question Screening: How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 years) or more drinks in a day? (response ≥ 2)
Calculation
Physicians must report on three distinct sets of numerators and denominators to satisfy reporting requirements for this measure.
Criteria 1
The numerator: Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months.
The denominator: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period.
Criteria 2
The numerator: Patients who received brief counseling.
The denominator: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period who were screened for unhealthy alcohol use and identified as an unhealthy alcohol user.
Criteria 3
The numerator: Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within 12 months AND who received brief counseling if identified as an unhealthy alcohol user.
The denominator: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period.
Measure calculation example
Dr. Strauss saw 138 adult patients on at least two visits or one preventative visit during the reporting period. None of these patient encounters can be excluded, so the denominator for Criteria 1 is 138.
Dr. Strauss screened 122 of these patients using a systematic screening method to identify unhealthy alcohol use. This is the numerator for Criteria 1. Quality of patient care = 122/138. Dr. Laurent has a score of 88.4% for Criteria 1.
Of the 122 patients Dr. Strauss screened for unhealthy alcohol use, 34 indicated unhealthy use of alcohol. Of these patients, 31 received brief counseling. This is the numerator for Criteria 2. Quality of patient care = 31/34. Dr. Strauss has a score of 91.2% for Criteria 2.
For Criteria 3, the denominator is 138. The numerator is 31. Quality of patient care = 31/138. Dr. Strauss has a score of 22.5% for Criteria 3.
Overall performance rate is determined using a specific performance rate. For Measure 431, it is the second performance rate. Dr. Strauss has a score of 91.2% for this measure. This translates to 5 to 5.9 points.
Important note
Clinicians can score 3 points even if they report only one patient. This is applicable only to small practices with 15 providers or fewer. Points achieved for the Quality category will account for 30% of the overall MIPS score.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
| Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
1.29 - 11.21 |
11.22 - 33.66 |
33.67 - 59.99 |
60.00 - 78.74 |
78.75 - 93.89 |
93.90 - 99.52 |
99.53 - 99.99 |
-- |
-- |
100 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
6.0 - 6.9 |
7.0 - 7.9 |
-- |
-- |
10 |
