Measure 47
Advance Care Plan
DESCRIPTION:
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
| MEASURE ID: | 47 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | No |
| High priority: | Yes |
| Topped out: | Yes for Registry/QCDR and Claims |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR or Claims |
| Maximum points: | 7 for Registry and Claims |
MEASURE PURPOSE:
This measure encourages physicians to discuss advance care planning and choosing a surrogate decision maker with patients who are 65 or older.
Measure 47 FAQs
Q. Is this measure reportable via claims?
A. Yes.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes, encounters coded with GQ, GT, POS 02, or POS 10 modifiers are allowable.
Q. Do I need to report this every time a patient is seen?
A. No, this measure only needs to be reported once per performance period.
Q. Will I receive credit if the patient does not want to name a surrogate care giver or if they do not want to discuss an advanced care plan?
A. Yes, you will receive credit, but you must document that the patient did not want to name a surrogate or discuss a care plan. Also, as appropriate, document that the patient’s cultural and/or spiritual beliefs preclude a discussion of advance care planning, as it would be viewed as harmful to the patient's beliefs and thus harmful to the physician-patient relationship.
Q. What is a care plan and what should be included?
A. An advance care plan designed to respect patient’s autonomy and determine his/her wishes about future life sustaining medical treatment if unable to indicate wishes.
Key interventions and treatment decisions to include in advance directives are: resuscitation procedures, mechanical respiration, chemotherapy, radiation therapy, dialysis, simple diagnostic tests, pain control, blood products, transfusions, and intentional deep sedation are the most common forms and should be thoroughly documented in the medical record for later reference.
Oral Statements:
Conversations with relatives, friends, and clinicians are most common form; should be thoroughly documented in medical record for later reference.
Properly verified oral statements carry same ethical and legal weight as those recorded in writing.
Instructional advance directives (DNR orders, living wills):
Written instructions regarding the initiation, continuation, withholding, or withdrawal of particular forms of life sustaining medical treatment.
May be revoked or altered at any time by the patient.
Clinicians who comply with such directives are provided legal immunity for such actions.
Durable power of attorney for health care or health care proxy:
A written document that enables a capable person to appoint someone else to make future medical treatment choices for him or her in the event of decisional incapacity. (AGS)
Calculation
The numerator: The number of patients who have an advance care plan or surrogate decision maker documented in the medical record, or who have refused to create an advance care plan or name a surrogate decision maker
The denominator: All patients aged 65 years or older.
Exclusions are removed from the denominator: Hospice services received by patient any time during the measurement period: G9692.
Measure calculation example
Dr. Roberts saw 168 patients who are 65 years or older during the reporting period.
Three patients are excluded from the denominator because they received hospice service during the measurement period. The denominator is 168 - 3 = 165.
Of the remaining 165 patients, Dr. Roberts communicated and established an advance care plan — or the patient declined to adopt such a plan — for 162 patients. This is the numerator.
Quality of patient care = 162/165. Dr. Roberts has a score of 98.2% for this measure. This score translated to 5.0 to 5.9 points when reporting by registry.
Important note
Because of how this measure is structured, physicians score 3 points even if they report on only one patient. This is applicable only to small practices with 15 providers or fewer. A score of 100% is required to earn 7 points when reporting by registry.
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.
Benchmarks for registry submissions
The table below shows CMS benchmarks for registry submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | |
|---|---|---|---|---|---|---|---|
Performance rate |
0.34 - 30.26 |
30.27 - 67.77 |
67.78 - 85.87 |
85.88 - 94.95 |
94.96 - 98.75 |
98.76 - 99.84 |
99.85 - 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 |
Benchmarks for claims submissions
The table below shows CMS benchmarks for claims submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | |
|---|---|---|---|---|---|---|---|
Performance rate |
-- |
-- |
-- |
-- |
-- |
-- |
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 |
