cms provided gpro measure workflows - advantmed provided gpro measure workflows . the workflows...

CMS Provided GPRO Measure Workflows The workflows provided by CMS are summarized in this document. They provide a

visual flow diagram for each of the measures by clinical domain. They can help prepare you to understand the questions presented for each measure.

Table of Contents

1. Patient Confirmation Flow – Module Confirmation Flow for CAD Module p. 2-8

2. Patient Confirmation Flow – Measure Confirmation Flow for Care-2 & 3 p. 9-18

3. Patient Confirmation Flow – Module Confirmation Flow for Diabetes Module p. 19-29

4. Patient Confirmation Flow – Module Confirmation Flow for HF Module p. 30-36

5. Patient Confirmation Flow – Module Confirmation Flow for HTN Module p. 37-42

6. Patient Confirmation Flow – Module Confirmation Flow for IVD Module p. 43-48

7. Patient Confirmation Flow – Module Confirmation Flow for MH Module p. 49-55

8. Patient Confirmation Flow – Module Confirmation Flow for PREV-5 through PREV-13 p. 56-98

Please use the link below to access the CMS GPRO Measure Workflows

https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/gpro_web_interface.html

https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/gpro_web_interface.html

Patient Confirmation Flow

For 2016, confirmation of the “Medical Record Found”, or indicating the patient is “Not Qualified for Sample” with a reason of “In Hospice”, “Moved out of Country”, “Deceased”, or “HMO Enrollment”, will only need to be done once

per patient. Refer to the Data Guidance for further instructions.

1. Start Patient Confirmation Flow.

2. Check to determine if Medical Record can be found.

a. If no, Medical Record not found, mark appropriately for completion and stop abstraction. This removes

the patient from the beneficiary sample for all measures/modules. Stop processing.

b. If yes, Medical Record found, continue processing.

3. Check to determine if Patient Qualified for the sample.

a. If no, the patient does not qualify for the sample, select the reason why and enter the date (if date isunknown, enter 12/31/2016) the patient became ineligible for sample. For example; In Hospice, Movedout of Country, Deceased, HMO Enrollment. Mark appropriately for completion and stop abstraction. This

removes the patient from the beneficiary sample for all measures/modules. Stop processing.

b. If yes, the patient does qualify for the sample; continue to the Module Confirmation Flow for CAD Module.

Module Confirmation Flow for CAD Module

For 2016, module or measure specific reasons a patient is “Not Confirmed” or excluded for “Denominator Exclusion” or “Other CMS Approved Reason” will need to be done for each measure/module where the patient appears. Refer to

the Data Guidance for further instructions.

1. Start Module Confirmation Flow for CAD Module. Complete for consecutively ranked patients aged 18 yearsand older at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the CAD module. If this is the case,

the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient has an active diagnosis of CAD or history of cardiac surgery at any time up

through the last day of the measurement period.

a. If no, the patient does not have an active diagnosis of CAD or history of cardiac surgery at any time upthrough the last day of the measurement period, mark appropriately for completion and stop abstraction.

Patient is removed from the performance calculations for this module. Stop processing.

b. If yes, the patient does have an active diagnosis of CAD or history of cardiac surgery at any time up

through the last day of the measurement period, continue processing.

3. Check to determine if the patient qualifies for the module (Other CMS Approved Reason).

a. If no, the patient does not qualify for the module select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. “Other CMS Approved Reason” is requested and approved by

opening a Help Desk T icket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the module, continue to the CAD-7 measure flow.

2016 GPRO CAD-7 (NQF 0066): Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme

(ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular

Systolic Dysfunction (LVEF < 40%)

This flow applies to GPRO Web Interface

The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the CAD Data Guidance and Code Tables

found in the CAD Supporting Document.

1. Start processing 2016 GPRO CAD-7 (NQF 0066) Flow for the patients that qualified for the sample in the

Patient Confirmation Flow and the Module Confirmation Flow for CAD Module.

2. Check to determine if the patient has LVSD (current or prior LVEF less than 40 percent or documented as

moderate or severe) OR has diabetes.

a. If no, the patient did not have LVSD (current or prior LVEF less than 40 percent or documented asmoderate or severe) OR has diabetes, mark appropriately for completion and stop abstraction. Patient is

removed from performance calculations for this measure. Stop processing.

b. If yes, the patient did have LVSD (current or prior LVEF less than 40 percent or documented as moderateor severe) OR has diabetes, the patient will be included in the eligible denominator for performance ratecalculations. Note: Include remainder of patients listed in the Web Interface that were consecutively confirmed and completed for this measure in the denominator. For the sample calculation in the flowthese patients would fall into the ‘d’ category (eligible denominator, i.e. 235 patients). Continue

processing.

3. Check to determine if the patient was prescribed ACE Inhibitor or ARB Therapy at any time during the

measurement period.

a. If no, the patient was not prescribed ACE Inhibitor or ARB Therapy, continue processing.

b. If yes, the patient was prescribed ACE Inhibitor or ARB Therapy, performance is met and the patient willbe included in the numerator. For the sample calculation in the flow these patients would fall into the ‘a’

category (numerator, i.e. 140 patients). Stop processing.

4. Check to determine if the patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator

exception, medical reason(s).

a. If no, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, medical

reason(s), continue processing.

b. If yes, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, medicalreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b¹’ category

(denominator exception, i.e. 45 patients). Stop processing.

5. Check to determine if the patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator

exception, patient reason(s).

a. If no, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, patient

reason(s), continue processing.

b. If yes, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, patientreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b²’ category (denominator exception, i.e. 10 patients). Stop processing.

6. Check to determine if the patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominatorexception, system reason(s).

a. If no, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, systemreason(s), performance is not met and should not be included in the numerator. Stop processing.

b. If yes, patient was Not prescribed ACE Inhibitor or ARB Therapy for a denominator exception, systemreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b³’ category

(denominator exception, i.e. 10 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (140 patients) Eligible Denominator is category ‘d’ in measure flow (235 patients) Denominator Exception is category ‘b¹ plus b² plus b³’ in measure flow (65 Patients) 140 (Performance Met) divided by 170 (Eligible Denominator minus Denominator Exception) equals a performance rate of 82.35 percent Calculation May Change Pending Performance Met


For 2016, confirmation of the “Medical Record Found”, or indicating the patient is “Not Qualified for Sample” with a reason of “In Hospice”, “Moved out of Country”, “Deceased”, or “HMO Enrollment”, will only need to be done once per patient. Refer to the Data Guidance for further instructions.



a. If no, Medical Record not found, mark appropriately for completion and stop abstraction. This removesthe patient from the beneficiary sample for all measures/modules. Stop processing.



a. If no, the patient does not qualify for the sample, select the reason why and enter the date (if date isunknown, enter 12/31/2016) the patient became ineligible for sample. For example; In Hospice, Movedout of Country, Deceased, HMO Enrollment. Mark appropriately for completion and stop abstraction. Thisremoves the patient from the beneficiary sample for all measures/modules. Stop processing.

b. If yes, the patient does qualify for the sample; continue to the Measure Confirmation Flow for CARE-2.

Measure Confirmation Flow for CARE-2

For 2016, module or measure specific reasons a patient is “Not Confirmed” or excluded for “Denominator Exclusion” or “Other CMS Approved Reason” will need to be done for each measure/module where the patient appears. Refer to the Data Guidance for further instructions.

1. Start Measure Confirmation Flow for CARE-2. Complete for consecutively ranked patients aged 65 years andolder at the beginning of the measurement period. Further information regarding patient selection for specificdisease modules and patient care measures can be found in the Web Interface Sampling MethodologyDocument. For patients who have the incorrect date of birth listed, a change of the patient date of birth by theabstractor may result in the patient no longer qualifying for the CARE-2 measure. If this is the case, thesystem will automatically remove the patient from the measure requirements.

2. Check to determine if the patient qualifies for the measure (Other CMS Approved Reason).

a. If no, the patient does not qualify for the module select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this measure. “Other CMS Approved Reason” is requested and approved byopening a Help Desk Ticket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the measure, continue to the CARE-2 measure flow.

2016 GPRO CARE-2 (NQF 0101): Falls: Screening for Future Fall Risk


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the CARE Data Guidance and Code Tables found in the CARE Supporting Document.

1. Start processing 2016 GPRO CARE-2 (NQF 0101) Flow for the patients that qualified for sample in thePatient Confirmation Flow and the Measure Confirmation Flow for Care-2. Note: Include remainder of patientslisted in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 248 patients).

2. Check to determine if the patient was screened for future fall risk at least once during the measurementperiod.

a. If no, the patient was not screened for future fall risk at least once during the measurement period,continue processing.

b. If yes, the patient was screened for future fall risk at least once during the measurement period,performance is met and the patient will be included in the numerator. For the sample calculation in theflow these patients would fall into the ‘a’ category (numerator, i.e. 212 patients). Stop processing.

3. Check to determine if the patient was Not screened for future fall risk due to a denominator exception, medicalreason(s).

a. If no, the patient was Not screened for future fall risk due to a denominator exception, medical reason(s),performance is not met and should not be included in the numerator. Stop processing.

b. If yes, the patient was Not screened for future fall risk due to a denominator exception, medical reason(s),this is a denominator exception and the case should be subtracted from the eligible denominator. For thesample calculation in the flow these patients would fall into the ‘b’ category (denominator exception, i.e. 6patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (212 patients) Eligible Denominator is category ‘d’ in measure flow (248 patients) Denominator Exception is category ‘b’ in measure flow (6 patients) 212 (Performance Met) divided by 242 (Eligible Denominator minus Denominator Exception) equals a performance rate of 87.60 percent Calculation May Change Pending Performance Met

Measure Confirmation Flow for CARE-3


1. Start Measure Confirmation Flow for CARE-3. Complete pre-populated visit information for consecutivelyranked patients aged 18 years and older at the beginning of the measurement period. Further informationregarding patient selection for specific disease modules and patient care measures can be found in the WebInterface Sampling Methodology Document. For patients who have the incorrect date of birth listed, a changeof the patient date of birth by the abstractor may result in the patient no longer qualifying for the CARE-3measure. If this is the case, the system will automatically remove the patient from the measure requirements.


a. If no, the patient does not qualify for the module select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this measure. “Other CMS Approved Reason” is requested and approved byopening a Help Desk Ticket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the measure, continue processing.

3. Check to determine if the patient was seen in the group practice/ACO on this visit date (plus or minus twocalendar days).

a. If no, the patient was not seen in the group practice/ACO on this visit date (plus or minus two calendardays), mark appropriately for completion and stop abstraction. Patient is removed from the performancecalculations for this measure. Stop processing.

b. If yes, the patient was seen in the group practice/ACO on this visit date (plus or minus two calendardays), the patient is included in the eligible denominator for performance rate calculations. Continue tothe CARE-3 measure flow.

2016 GPRO CARE-3 (NQF 0419): Documentation of Current

Medications in the Medical Record

This flow applies to GPRO Web Interface Note: This measure applies to each patient visit

The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the CARE Data Guidance and Code Tables found in the CARE Supporting Document.

1. Start processing 2016 GPRO CARE-3 (NQF 0419) Flow for the patients that qualified for sample in thePatient Confirmation Flow and the Measure Confirmation Flow for Care-3. Note: Include remainder of patientsattributed to the group listed in the Web Interface for patients that were consecutively confirmed andcompleted for this measure in the denominator. For the sample calculation in the flow these patients would fallinto the ‘d’ category (eligible denominator, i.e. 750 visits).

2. Check to determine if the current medications were documented, updated, or reviewed at this visit.

a. If no, the current medications were not documented, updated or reviewed at this visit, continueprocessing.

b. If yes, the current medications were documented, updated, or reviewed at this visit, performance is metand this visit will be included in the numerator. For the sample calculation in the flow these patients wouldfall into the ‘a’ category (numerator, i.e. 609 visits). Stop processing.

3. Check to determine if the current medications documented, updated or reviewed was Not performed due to adenominator exception, medical reason(s).

a. If no, the current medications documented, updated or reviewed was Not performed due to adenominator exception, medical reason(s), performance is not met and should not be included in thenumerator. Stop processing.

b. If yes, the current medications documented, updated or reviewed was Not performed due to adenominator exception, medical reason(s), this is a denominator exception and the visit should besubtracted from the eligible denominator. For the sample calculation in the flow these visits would fall intothe ‘b’ category (denominator exception, i.e. 22 visits). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (609 visits) Eligible Denominator is category ‘d’ in measure flow (750 visits) Denominator Exception is category ‘b’ in measure flow (22 visits) 609 (Performance Met) divided by 728 (Eligible Denominator minus Denominator Exception) equals a performance rate of 83.65 percent Calculation May Change Pending Performance Met









b. If yes, the patient does qualify for the sample; continue to the Module Confirmation Flow for DiabetesModule.

Module Confirmation Flow for Diabetes Module


1. Start Module Confirmation Flow for Diabetes Module. Complete for consecutively ranked patients aged 18through 75 years at the beginning of the measurement period. Further information regarding patient selectionfor specific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the DM module. If this is the case,the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient has a documented history or active diagnosis of diabetes during themeasurement period or year prior to the measurement period.

a. If no, the patient does not have a documented history of diabetes during the measurement period or yearprior to the measurement period, mark appropriately for completion and stop abstraction. Patient isremoved from the performance calculations for this module and composite. Stop processing

b. If yes, the patient does have a documented history of diabetes during the measurement period or yearprior to the measurement period, continue processing.


a. If no, the patient does not qualify for the module select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module and composite. “Other CMS Approved Reason” is requestedand approved by opening a Help Desk Ticket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the module, continue to DM-2 measure flow.

2016 GPRO DM-2 (NQF 0059): Diabetes: Hemoglobin A1c

Poor Control


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the DM Data Guidance and Code Tables found in the DM Supporting Document.

1. Start processing 2016 GPRO DM-2 (NQF 0059) Flow for the patients that qualified for the sample in thePatient Confirmation Flow and the Module Confirmation Flow for Diabetes Module. Note: Include remainder ofpatients listed in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 210 patients).

2. Check to determine if the patient had one or more HbA1c tests performed during the measurement period.

a. If no, patient did not have one or more HbA1c tests performed during the measurement period,performance is met and the patient will be included in the numerator. For the sample calculation in theflow these patients would fall into the ‘a¹’ category (numerator, i.e. 40 patients). Stop processing.

b. If yes, the patient had one or more HbA1c tests performed during the measurement period, record themost recent date the blood was drawn for the HbA1c in MM/DD/YYYY format and the most recent HbA1cvalue OR if test was performed but result is not documented, record “0” (zero) value. Continueprocessing.

3. Check to determine if the patient’s most recent HbA1c value was greater than nine percent or equal to zeropercent.

a. If no, patient’s most recent HbA1c value was not greater than nine percent or equal to zero percent,performance is not met and the patient should not be included in the numerator. Stop processing.

b. If yes, patient’s most recent HbA1c value was greater than nine percent or equal to zero percent,performance is met and the patient will be included in the numerator. For the sample calculation in theflow these patients would fall into the ‘a²’ category (numerator, i.e. 40 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a¹ plus a²’ in the measure flow (80 patients) Eligible Denominator is category ‘d’ in measure flow (210 patients) 80 (Performance Met) divided by 210 (Eligible Denominator) equals a performance rate of 38.10 percent Calculation May Change Pending Performance Met For this Measure, a Lower Rate Indicates Better Performance/Control

2016 GPRO DM-7 (NQF 0055): Diabetes: Eye Exam



1. Start processing 2016 GPRO DM-7 (NQF 0055) Flow for the patients that qualified for the sample in thePatient Confirmation Flow and the Module Confirmation Flow for Diabetes Module. Note: Include remainder ofpatients listed in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 210 patients).

2. Check to determine if the patient was screened for diabetic retinal disease during the measurement periodOR a negative retinal exam was documented in the year prior to the measurement period.

a. If no, the patient was not screened for diabetic retinal disease during the measurement period OR anegative retinal exam was not documented in the year prior to the measurement period, performance isnot met and the patient should not be included in the numerator. Stop processing.

b. If yes, the patient was screened for diabetic retinal disease during the measurement period OR anegative retinal exam was documented in the year prior to the measurement period, performance is metand the patient should be included in the numerator. For the sample calculation in the flow these patientswould fall into the ‘a’ category (numerator, i.e. 180 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (180 patients) Eligible Denominator is category ‘d’ in measure flow (210 patients) 180 (Performance Met) divided by 210 (Eligible Denominator) equals a performance rate of 85.71 percent Calculation May Change Pending Performance Met

2016 GPRO Diabetes Composite Measure



1. Start processing 2016 GPRO Diabetes Composite Measure Flow for the patients that qualified for sample inthe Patient Confirmation Flow and the Module Confirmation Flow for Diabetes Module. Note: Includeremainder of patients listed in the Web Interface that were consecutively confirmed and completed for thecomponents within this denominator for the composite measure. For the sample calculation in the flow thesepatients would fall into the ‘d’ category (eligible denominator, i.e. 210 patients).

2. Check to determine if the patient had one or more HbA1c tests during the measurement period (DM-2).

a. If no, the patient did not have one or more HbA1c tests during the measurement period, the patient failsthe composite measure. Stop processing composite measure.

b. If yes, the patient did have one or more HbA1c tests during the measurement period, record the mostrecent date the blood was drawn for the HbA1c in MM/DD/YYYY format and the most recent HbA1c valueOR if test was performed but result is not documented, record “0” (zero) value. Continue processing.

3. Check to determine if the patient’s most recent HbA1c value was greater than nine percent or equal to zeropercent.

a. If no, the patient’s most recent HbA1c value was not greater than nine percent or equal to zero percent,the patient passes 1 of the 2 components of the Diabetes composite measure. Continue processing forDM-7.

b. If yes, the patient’s most recent HbA1c value was greater than nine percent or equal to zero percent, thepatient fails 1 of the 2 components of the Diabetes composite measure. Stop processing compositemeasure.

4. Check to determine if the patient was screened for diabetic retinal disease during the measurement periodOR a negative retinal exam was documented in the year prior to the measurement period (DM-7).

a. If no, the patient was not screened for diabetic retinal disease during the measurement period OR anegative retinal exam was not documented in the year prior to the measurement period, the patient fails 1of 2 components of the Diabetes composite measure. Stop processing composite measure.

b. If yes, the patient was screened for diabetic retinal disease during the measurement period OR anegative retinal exam was documented in the year prior to the measurement period, the patient passes 1of 2 components of the Diabetes composite measure. Continue processing.

5. Determine if the patient passed DM-2 and DM-7 components of the composite measure. If the patient passedboth components, the patient meets the composite measure. For the sample calculation in the flow thesepatients would fall into the ‘a’ category (numerator, i.e. 190 patients).

190 (Performance Met) divided by 210 (Eligible Denominator) equals a performance rate of 90.48 percent Calculation May Change Pending Performance Met

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (190 patients) Eligible Denominator is category ‘d’ in measure flow (210 patients)







3. Check to determine if the Patient Qualified for the sample.


b. If yes, the patient does qualify for the sample; continue to the Module Confirmation Flow for HF Module.

Module Confirmation Flow for HF Module


1. Start Module Confirmation Flow for HF Module. Complete for consecutively ranked patients aged 18 yearsand older at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the HF module. If this is the case,the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient has an active diagnosis of HF at any time up through the last day of themeasurement period.

a. If no, the patient does not have an active diagnosis of HF at any time up through the last day of themeasurement period, mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. Stop processing.

b. If yes, the patient does have an active diagnosis of HF at any time up through the last day of themeasurement period, continue processing.


a. If no, the patient does not qualify for the module select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. “Other CMS Approved Reason” is requested and approved byopening a Help Desk Ticket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the module, continue to HF-6 measure flow.

2016 GPRO HF-6 (NQF 0083): Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic

Dysfunction (LVSD)


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the HF Data Guidance and Code Tables found in the HF Supporting Document.

1. Start processing 2016 GPRO-HF-6 (NQF 0083) Flow for the patients that qualified for sample in the PatientConfirmation Flow and the Module Confirmation Flow for HF Module.

2. Check to determine if the patient has LVSD (LVEF < 40% or documented as moderate or severe).

a. If no, the patient does not have LVSD (LVEF < 40% or documented as moderate or severe), markappropriately for completion and stop abstraction. Patient is removed from the performance calculationsfor this measure. Stop processing.

b. If yes, the patient does have LVSD (LVEF < 40% or documented as moderate or severe), the patient willbe included in the eligible denominator for performance rate calculations. Note: Include remainder ofpatients listed in the Web Interface that were consecutively confirmed and completed for this measure inthe denominator. For the sample calculation in the flow these patients would fall into the ‘d’ category(eligible denominator, i.e. 215 patients). Continue processing.

3. Check to determine if the patient was prescribed (ordered or currently being taken) Beta-Blocker Therapy atany time during the measurement period.

a. If no, the patient was not prescribed (ordered or currently being taken) Beta-Blocker Therapy at any timeduring the measurement period, continue processing.

b. If yes, the patient was prescribed (ordered or currently being taken) Beta-Blocker Therapy at any timeduring the measurement period, performance is met and the patient will be included in the numerator. Forthe sample calculation in the flow these patients would fall into the ‘a’ category (numerator, i.e. 165patients). Stop processing.

4. Check to determine if the patient was Not prescribed Beta-Blocker Therapy at any time during themeasurement period for a denominator exception, medical reason(s).

a. If no, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, medical reason(s), continue processing.

b. If yes, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, medical reason(s), this is a denominator exception and the case should besubtracted from the eligible denominator. For the sample calculation in the flow these patients would fallinto the ‘b¹’ category (denominator exception, i.e. 20 patients). Stop processing.

5. Check to determine if the patient was Not prescribed Beta-Blocker Therapy at any time during themeasurement period for a denominator exception, patient reason(s).

a. If no, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, patient reason(s), continue processing.

b. If yes, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, patient reason(s), this is a denominator exception and the case should besubtracted from the eligible denominator. For the sample calculation in the flow these patients would fallinto the ‘b²’ category (denominator exception, i.e. 15 patients). Stop processing.

6. Check to determine if the patient was Not prescribed Beta-Blocker Therapy at any time during themeasurement period for a denominator exception, system reason(s).

a. If no, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, system reason(s), performance is not met and should not be included in thenumerator. Stop processing.

b. If yes, the patient was Not prescribed Beta-Blocker Therapy at any time during the measurement periodfor a denominator exception, system reason(s), this is a denominator exception and the case should besubtracted from the eligible denominator. For the sample calculation in the flow these patients would fallinto the ‘b³’ category (denominator exception, i.e. 5 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (165 patients) Eligible Denominator is category ‘d’ in measure flow (215 patients) Denominator Exception is category ‘b¹ plus b² plus b³’ in measure flow (40 patients) 165 (Performance Met) divided by 175 (Eligible Denominator minus Denominator Exception) equals a performance rate of 94.29 percent Calculation May Change Pending Performance Met









b. If yes, the patient does qualify for the sample; continue to the Module Confirmation Flow for HTN Module.

Module Confirmation Flow for HTN Module


1. Start Module Confirmation Flow for HTN Module. Complete for consecutively ranked patients aged 18 through85 years at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the HTN module. If this is the case,the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient has a documented diagnosis of essential HTN within the first six months ofthe measurement period or any time prior to the measurement period but does not end before the start of themeasurement period.

a. If no, the patient does not have a documented diagnosis of essential HTN within the first six months ofthe measurement period or any time prior to the measurement period, mark appropriately for completionand stop abstraction. Patient is removed from the performance calculations for this module. Stopprocessing.

b. If yes, the patient does have a documented diagnosis of essential HTN within the first six months of themeasurement period or any time prior to the measurement period but does not end before the start of themeasurement period, continue processing.

3. Check to determine if the patient qualifies for the module (Denominator Exclusion).

a. If no, the patient does not qualify for the module select: Denominator Exclusion for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. Stop processing.

b. If yes, the patient does qualify for the module, continue processing.



b. If yes, the patient does qualify for the module, continue to HTN-2 measure flow.

2016 GPRO HTN-2 (NQF 0018): Controlling High Blood Pressure


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the HTN Data Guidance and Code Tables found in the HTN Supporting Document.

1. Start processing 2016 GPRO HTN-2 (NQF 0018) Flow for the patients that qualified for sample in the PatientConfirmation Flow and the Module Confirmation Flow for HTN Module. Note: Include remainder of patientslisted in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 240 patients).

2. Check to determine if the patient’s most recent blood pressure was documented during the measurementperiod.

a. If no, the patient’s most recent blood pressure was not documented during the measurement period,performance is not met and the patient should not be included in the numerator. Stop processing.

b. If yes, the patient’s most recent blood pressure was documented during the measurement period, recordthe date of the most recent BP in MM/DD/YYYY format, enter the systolic BP documented in mmHg, andenter the diastolic BP documented in mmHg. Continue processing.

3. Check to determine if the patient’s most recent blood pressure during the measurement period was greaterthan zero but less than 140 over 90 mmHg.

a. If no, the patient’s most recent blood pressure during the measurement period was not greater than zeroor less than 140 over 90 mmHg, performance is not met and the patient should not be included in thenumerator. Stop processing.

b. If yes, the patient’s most recent blood pressure during the measurement period was greater than zero butless than 140 over 90 mmHg, performance is met and the patient will be included in the numerator. Forthe sample calculation in the flow these patients would fall into the ‘a’ category (numerator, i.e. 190patients). Stop processing.



For 2016, confirmation of the “Medical Record Found”, or indicating the patient is “Not Qualified for Sample” with a reason of “In Hospice”, “Moved out of Country”, “Deceased”, or “HMO Enrollment”, will only need to be done once per patient. Please refer to the Data Guidance for further instructions.







b. If yes, the patient does qualify for the sample, continue to the Module Confirmation Flow for IVD Module.

Module Confirmation Flow for IVD Module


1. Start Module Confirmation Flow for IVD Module. Complete for consecutively ranked patients aged 18 yearsand older at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the IVD module. If this is the case,the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient was discharged alive for AMI, CABG, or PCI in the 12 months prior to themeasurement period OR has an active diagnosis of IVD during the measurement period.

a. If no, the patient was not discharged alive for AMI, CABG, or PCI in the 12 months prior to themeasurement OR did not have an active diagnosis of IVD during the measurement period, markappropriately for completion and stop abstraction. Patient is removed from the performance calculationsfor this module. Stop processing.

b. If yes, the patient was discharged alive for AMI, CABG, or PCI in the 12 months prior to the measurementOR does have an active diagnosis of IVD during the measurement period, continue processing.



b. If yes, the patient does qualify for the module, continue to IVD-2 measure flow.

2016 GPRO IVD-2 (NQF 0068): Ischemic Vascular Disease (IVD): Use of Aspirin or Another

Antithrombotic


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the IVD Data Guidance and Code Tables found in the IVD Supporting Document.

1. Start processing 2016 GPRO IVD-2 (NQF 0068) Flow for the patients that qualified for the sample in thePatient Confirmation Flow and the Module Confirmation Flow for IVD Module. Note: Include remainder ofpatients listed in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 110 patients).

2. Check to determine if the patient has documented use of Aspirin or Another Antithrombotic during themeasurement period

a. If no, the patient did not have a documented use of Aspirin or Another Antithrombotic during themeasurement period, performance is not met and should not be included in the numerator. Stopprocessing.

b. If yes, the patient did have a documented use of Aspirin or Another Antithrombotic during themeasurement period, performance is met and the patient will be included in the numerator. For thesample calculation in the flow these patients would fall into the ‘a’ category (numerator, i.e. 96 patients).Stop processing.










b. If yes, the patient does qualify for the sample; continue to the Module Confirmation Flow for MH Module.

Module Confirmation Flow for MH Module


1. Start Module Confirmation Flow for MH Module. Complete for consecutively ranked patients aged 18 yearsand older at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the MH module. If this is the case,the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient has an active diagnosis of major depression including remission ordysthymia during the denominator identification measurement period (12/1/2014 through 11/30/2015). Theactive diagnosis of major depression including remission or dysthymia may correspond to a primary diagnosisat a psychiatric visit or any diagnosis (primary, secondary, etc.) at an office visit.

a. If no, the patient does not have an active diagnosis of major depression including remission or dysthymiaduring the denominator identification measurement period, mark appropriately for completion and stopabstraction. Patient is removed from the performance calculations for this module. Stop processing

b. If yes, the patient does have an active diagnosis of major depression including remission or dysthymiaduring the denominator identification measurement period, continue processing.

3. Check to determine if the patient qualifies for the module (Denominator Exclusion).

a. If no, the patient does not qualify for the module select: Denominator Exclusion for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. Stop processing.





5. Check to determine if the patient had one or more PHQ-9s administered during the denominator identificationmeasurement period between 12/1/2014 and 11/30/2015.

a. If no, the patient did not have one or more PHQ-9s administered during the denominator identificationmeasurement period, mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. Stop processing.

b. If yes, the patient did have one or more PHQ-9s administered during the denominator identificationmeasurement period, continue processing.

6. Check to determine if the patient had any PHQ-9 score greater than 9.

a. If no, the patient did not have any PHQ-9 score greater than 9, mark appropriately for completion andstop abstraction. Patient is removed from the performance calculations for this module. Stop processing.

b. If yes, the patient did have a PHQ-9 score greater than 9, record the date in mm/dd/yyyy format and thescore of the first instance of PHQ-9 greater than 9 that is also associated with an active diagnosis ofmajor depression or dysthymia during the denominator identification measurement period (this isconsidered the index date for performance calculations). Continue to the MH-1 measure flow.

2016 GPRO MH-1 (NQF 0710): Depression Remission

at Twelve Months


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the MH Data Guidance and Code Tables found in the MH Supporting Document.

1. Start processing 2016 GPRO MH-1 (NQF 0710) Flow for the patients that qualified for the sample in thePatient Confirmation Flow and the Module Confirmation Flow for MH Module. Note: Include remainder ofpatients listed in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 60 patients).

2. Check to determine if the patient had one or more PHQ-9s administered during the measurement assessmentperiod (12 months +/- 30 days from the index date).

a. If no, patient did not have one or more PHQ-9s administered during the measurement assessmentperiod, performance is not met and the patient will not be included in the numerator. Stop processing.

b. If yes, the patient did have one or more PHQ-9s administered during the measurement assessmentperiod, continue processing.

3. Check to determine if the patient had any PHQ-9 score less than 5.

a. If no, patient did not have any PHQ-9 score less than 5, performance is not met and the patient shouldnot be included in the numerator. Stop processing.

b. If yes, patient did have a PHQ-9 score less than 5, enter the date in mm/dd/yyyy format and the score ofthe most recent PHQ-9 less than 5 that was administered during the measurement assessment period(within the window of 11 to 13 months from the index date). Performance is met and the patient will beincluded in the numerator. For the sample calculation in the flow these patients would fall into the ‘a’category (numerator, i.e. 40 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a‘ in the measure flow (40 patients) Eligible Denominator is category ‘d’ in measure flow (60 patients) 40 (Performance Met) divided by 60 (Eligible Denominator) equals a performance rate of 66.67 percent Calculation May Change Pending Performance Met

of 43 Version 4.0









b. If yes, the patient does qualify for the sample; continue to the 2016 Measure Confirmation Flow forPREV-5.

Measure Confirmation Flow for PREV-5


1. Start Measure Confirmation Flow for PREV-5. Complete for consecutively ranked patients aged 50 through 74years at the beginning of the measurement period. Further information regarding patient selection for specificdisease modules and patient care measures can be found in the Web Interface Sampling MethodologyDocument. For patients who have the incorrect gender or date of birth listed, a change of the gender orpatient date of birth by the abstractor may result in the patient no longer qualifying for the PREV-5 measure. Ifthis is the case, the system will automatically remove the patient from the measure requirements.

2. Check to determine if the patient qualifies for the measure (Denominator Exclusion).

a. If no, the patient does not qualify for the measure select: Denominator Exclusion for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this measure. Stop processing.



a. If no, the patient does not qualify for the measure select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this measure. “Other CMS Approved Reason” is requested and approved byopening a Help Desk Ticket at [email protected]. Stop processing.

b. If yes, the patient does qualify for the measure, continue to the PREV-5 measure flow.

2016 GPRO PREV-5 (NQF 2372): Breast Cancer Screening


The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used as a substitution for the measure specifications. For Downloadable Resource Mapping, use the Variable Names located on the tabs within the PREV Data Guidance and Code Tables found in the PREV Supporting Document.

1. Start processing 2016 GPRO PREV-5 Flow for the patients that qualified for sample in the PatientConfirmation Flow and the Measure Confirmation Flow for PREV-5. Note: Include remainder of patients listedin Web Interface that were consecutively confirmed and completed for this measure in the denominator. Forthe sample calculation in the flow these patients would fall into the ‘d’ category (eligible denominator, i.e. 230patients).

2. Check to determine if the patient had a mammogram to screen for breast cancer performed during themeasurement period or within the 27 months prior to the measurement period end date.

a. If no, the patient did not have a mammogram performed during the measurement period or within the 27months prior to the measurement period end date, performance is not met and should not be included inthe numerator. Stop processing.

b. If yes, the patient did have a mammogram performed during the measurement period or within the 27months prior to the measurement period end date, performance is met and the patient will be included inthe numerator. For the sample calculation in the flow these patients would fall into the ‘a’ category(numerator, i.e. 188 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (188 patients) Eligible Denominator is category ‘d’ in the measure flow (230 patients) 188 (Performance Met) divided by 230 (Eligible Denominator) equals a performance rate of 81.74 percent Calculation May Change Pending Performance Met



1. Start Measure Confirmation Flow for PREV-6. Complete for consecutively ranked patients aged 50 through 75years at the beginning of the measurement period. Further information regarding patient selection for specificdisease modules and patient care measures can be found in the Web Interface Sampling MethodologyDocument. For patients who have the incorrect date of birth listed, a change of the patient date of birth by theabstractor may result in the patient no longer qualifying for the PREV-6 measure. If this is the case, thesystem will automatically remove the patient from the measure requirements.







2016 GPRO PREV-6 (NQF 0034): Colorectal Cancer Screening



1. Start processing 2016 GPRO PREV-6 (NQF 0034) Flow for the patients that qualified for sample in thePatient Confirmation Flow and the Measure Confirmation Flow for PREV-6. Note: Include remainder ofpatients listed in Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 238 patients).

2. Check to determine if the patient’s colorectal cancer screening is current during the measurement period.

a. If no, the patient’s colorectal cancer screening is not current during the measurement period,performance is not met and should not be included in the numerator. Stop processing.

b. If yes, the patient’s colorectal cancer screening is current during the measurement period, performance ismet and the patient will be included in the numerator. For the sample calculation in the flow thesepatients would fall into the ‘a’ category (numerator, i.e. 210 patients). Stop processing.




1. Start Measure Confirmation Flow for PREV-7. Complete for consecutively ranked patients aged 6 months andolder at the beginning of the measurement period and seen for a visit between October 1, 2015 and March31, 2016. Further information regarding patient selection for specific disease modules and patient caremeasures can be found in the Web Interface Sampling Methodology Document. For patients who have theincorrect date of birth listed, a change of the patient date of birth by the abstractor may result in the patient nolonger qualifying for the PREV-7 measure. If this is the case, the system will automatically remove the patientfrom the measure requirements.




2016 GPRO PREV-7 (NQF 0041): Preventive Care and Screening: Influenza Immunization




2. Check to determine if the patient received an influenza immunization OR reported previous receipt.

a. If no, the patient did not receive an influenza immunization OR did not report previous receipt, continueprocessing.

b. If yes, the patient received an influenza immunization OR reported previous receipt, performance is metand the patient will be included in the numerator. For the sample calculation in the flow these patientswould fall into the ‘a’ category (numerator, i.e. 200 patients). Stop processing.

3. Check to determine if the patient did Not receive an influenza immunization for a denominator exception,medical reason(s).

a. If no, the patient did Not receive an influenza immunization for a denominator exception, medicalreason(s), continue processing.

b. If yes, the patient did Not receive an influenza immunization for a denominator exception, medicalreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b¹’ category(denominator exception, i.e. 10 patients). Stop processing.

4. Check to determine if the patient did Not receive an influenza immunization for a denominator exception,patient reason(s).

a. If no, the patient did Not receive an influenza immunization for a denominator exception, patientreason(s), continue processing.

b. If yes, the patient did Not receive an influenza immunization for a denominator exception, patientreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b²’ category(denominator exception, i.e. 7 patients). Stop processing.

5. Check to determine if the patient did Not receive an influenza immunization for a denominator exception,system reason(s).

a. If no, the patient did Not receive an influenza immunization for a denominator exception, systemreason(s), performance is not met and should not be included in the numerator. Stop processing.

b. If yes, the patient did Not receive an influenza immunization for a denominator exception, systemreason(s), this is a denominator exception and the case should be subtracted from the eligibledenominator. For the sample calculation in the flow these patients would fall into the ‘b³’ category(denominator exception, i.e. 5 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a’ in the measure flow (200 patients) Eligible Denominator is category ‘d’ in the measure flow (238 patients) Denominator Exception is category ‘b¹ plus b² plus b³’ in the measure flow (22 patients) 200 (Performance Met) divided by 216 (Eligible Denominator minus Denominator Exception) equals a performance rate of 92.60 percent Calculation May Change Pending Performance Met



1. Start Measure Confirmation Flow for PREV-8. Complete for consecutively ranked patients aged 65 years andolder at the beginning of the measurement period. Further information regarding patient selection for specificdisease modules and patient care measures can be found in the Web Interface Sampling MethodologyDocument. For patients who have the incorrect date of birth listed, a change of the patient date of birth by theabstractor may result in the patient no longer qualifying for the PREV-8 measure. If this is the case, thesystem will automatically remove the patient from the measure requirements.




2016 GPRO PREV-8 (NQF 0043): Pneumonia Vaccination Status for Older Adults




2. Check to determine if the patient has ever received a pneumococcal vaccination.

a. If no, the patient has not ever received a pneumococcal vaccination, performance is not met and shouldnot be included in the numerator. Stop processing.

b. If yes, patient has ever received a pneumococcal vaccination, performance is met and the patient will beincluded in the numerator. For the sample calculation in the flow these patients would fall into the ‘a’category (numerator, i.e. 175 patients). Stop processing.




1. Start Measure Confirmation Flow for PREV-9. Complete for consecutively ranked patients aged 18 years andolder at the beginning of the measurement period. Further information regarding patient selection for specificdisease modules and patient care measures can be found in the Web Interface Sampling MethodologyDocument. For patients who have the incorrect date of birth listed, a change of the patient date of birth by theabstractor may result in the patient no longer qualifying for the PREV-9 measure. If this is the case, thesystem will automatically remove the patient from the measure requirements.







2016 GPRO PREV-9 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening

and Follow-Up Plan




2. Check to determine if the patient had a BMI calculated during the most recent visit or within the last sixmonths prior to the most recent visit.

a. If no, the patient did not have a BMI calculated during the most recent visit or within the last six monthsprior to the most recent visit,, performance is not met and should not be included in the numerator. Stopprocessing.

b. If yes, the patient had a BMI calculated during the most recent visit or within the last six months prior tothe most recent visit, continue processing.

3. Check to determine if the patient’s most recent BMI is within normal parameters.

a. If no, the patient’s most recent BMI is not within normal parameters, continue processing.

b. If yes, the patient’s most recent BMI is within normal parameters, performance is met and the patient willbe included in the numerator. For the sample calculation in the flow these patients would fall into the ‘a¹’category (numerator, i.e. 95 patients). Stop processing.

4. Check to determine if the patient’s follow-up plan was documented.

a. If no, the patient’s follow-up plan was not documented, performance is not met and should not beincluded in the numerator. Stop processing.

b. If yes, the patient’s follow-up plan was documented, performance is met and the patient will be includedin the numerator. For the sample calculation in the flow these patients would fall into the ‘a²’ category(numerator, i.e. 110 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a¹ plus a²’ in the measure flow (205 patients) Eligible Denominator is category ‘d’ in the measure flow (222 patients) 205 (Performance Met) divided by 222 (Eligible Denominator minus Denominator Exception) equals a performance rate of 92.34 percent Calculation May Change Pending Performance Met



1. Start Measure Confirmation Flow for PREV-10. Complete for consecutively ranked patients aged 18 yearsand older at the beginning of the measurement period. Further information regarding patient selection forspecific disease modules and patient care measures can be found in the Web Interface SamplingMethodology Document. For patients who have the incorrect date of birth listed, a change of the patient dateof birth by the abstractor may result in the patient no longer qualifying for the PREV-10 measure. If this is thecase, the system will automatically remove the patient from the measure requirements.




2016 GPRO PREV-10 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and

Cessation Intervention




2. Check to determine if the patient has been screened for tobacco use at least once within 24 months ANDidentified as a tobacco user.

a. If no, the patient has not been screened for tobacco use at least once within 24 months AND notidentified as a tobacco user, continue processing.

b. If yes, the patient has been screened for tobacco use at least once within 24 months AND identified as atobacco user, continue processing and proceed to step 5.

3. Check to determine if the patient has been screened for tobacco use at least once within 24 months ANDidentified as a tobacco non-user.

a. If no, the patient has not been screened for tobacco use at least once within 24 months AND was notidentified as a tobacco non-user, continue processing.

b. If yes, the patient has been screened for tobacco use at least once within 24 months AND was identifiedas a tobacco non-user, performance is met and the patient will be included in the numerator. For thesample calculation in the flow these patients would fall into the ‘a¹’ category (numerator, i.e. 111 patients).Stop processing.

4. Check to determine if the patient was Not screened for tobacco use for a denominator exception, medicalreason(s).

a. If no, the patient was Not screened for tobacco use for a denominator exception, medical reason(s), orscreening status is unknown, performance is not met and should not be included in the numerator. Stopprocessing.

b. If yes, patient was Not screened for tobacco use for a denominator exception, medical reason(s), this is adenominator exception and the case should be subtracted from the eligible denominator. For the samplecalculation in the flow these patients would fall into the ‘b’ category (denominator exception, i.e. 20patients). Stop processing.

5. Check to determine if tobacco cessation counseling intervention was received if the patient was identified as atobacco user.

a. If no, the patient was identified as a tobacco user and did not receive tobacco cessation counselingintervention, performance is not met and should not be included in the numerator. Stop processing.

b. If yes, patient was identified as a tobacco user and received tobacco cessation counseling intervention,performance is met and the patient will be included in the numerator. For the sample calculation in theflow these patients would fall into the ‘a²’ category (numerator, i.e. 100 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a¹ plus a²’ in the measure flow (211 patients) Eligible Denominator is category ‘d’ in the measure flow (246 patients) Denominator Exception is category ‘b’ in the measure flow (20 patients) 211 (Performance Met) divided by 226 (Eligible Denominator minus Denominator Exception) equals a performance rate of 93.36 percent Calculation May Change Pending Performance Met

2016 GPRO PREV-11: Preventive Care and Screening: Screening for High Blood Pressure and

Follow-Up Documented



1. Start processing 2016 GPRO PREV-11 Flow for the patients that qualified for sample in the PatientConfirmation Flow and the Measure Confirmation Flow for PREV-11. Note: Include remainder of patientslisted in Web Interface that were consecutively confirmed and completed for this measure in the denominator.For the sample calculation in the flow these patients would fall into the ‘d’ category (eligible denominator, i.e.239 patients).

2. Check to determine if the patient was screened for high blood pressure during the measurement period.

a. If no, the patient was not screened for high blood pressure during the measurement period, continueprocessing.

b. If yes, the patient was screened for high blood pressure during the measurement period, continueprocessing and proceed to step 5.

3. Check to determine if the patient was Not screened for high blood pressure for a denominator exception,medical reason(s).

a. If no, the patient was Not screened for high blood pressure for a denominator exception, medicalreason(s), continue processing.

b. If yes, patient was Not screened for high blood pressure for a denominator exception, medical reason(s),this is a denominator exception and the case should be subtracted from the eligible denominator. For thesample calculation in the flow these patients would fall into the ‘b¹’ category (denominator exception, i.e.18 patients). Stop processing.

4. Check to determine if the patient was Not screened for high blood pressure for a denominator exception,patient reason(s).

a. If no, the patient was Not screened for high blood pressure for a denominator exception, patientreason(s), performance is not met and the patient should not be included in the numerator. Stopprocessing.

b. If yes, patient was Not screened for high blood pressure for a denominator exception, patient reason(s),this is a denominator exception and the case should be subtracted from the eligible denominator. For thesample calculation in the flow these patients would fall into the ‘b²’ category (denominator exception, i.e.12 patients). Stop processing.

5. Check to determine if the patient’s most recent blood pressure is within normal parameters [less than 120mmHg (Systolic) and less than 80 mmHg (Diastolic)].

a. If no, the patient’s most recent blood pressure is not within normal parameters, continue processing.

b. If yes, the patient’s most recent blood pressure is within normal parameters, performance is met and thepatient will be included in the numerator. For the sample calculation in the flow these patients would fallinto the ‘a¹’ category (Numerator, i.e. 101 patients). Stop processing.

6. Check to determine if the patient’s follow-up plan was documented.

a. If no, the patient’s follow-up plan was not documented, continue processing.

b. If yes, the patient’s follow-up plan was documented, performance is met and the patient will be includedin the numerator. For the sample calculation in the flow these patients would fall into the ‘a²’ category(numerator, i.e. 75 patients). Stop processing.

7. Check to determine if the patient’s follow-up plan was Not documented for a denominator exception, patientreason(s).

a. If no, the patient’s follow-up plan was Not documented for a denominator exception, patient reason(s),performance is not met and the patient should not be included in the numerator. Stop processing.

b. If yes, the patient’s follow-up plan was Not documented for a denominator exception, patient reason(s),this is a denominator exception and the case should be subtracted from the eligible denominator. For thesample calculation in the flow these patients would fall into the ‘b3’ category (denominator exception, i.e.11 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a¹ plus a²’ in the measure flow (176 patients) Eligible Denominator is category ‘d’ in the measure flow (239 patients) Denominator Exception is category ‘b¹ plus b² plus b3’ in the measure flow (41 patients) 176 (Performance Met) divided by 198 (Eligible Denominator minus Denominator Exception) equals a performance rate of 88.89 percent Calculation May Change Pending Performance Met

2016 GPRO PREV-12 (NQF 0418): Preventive Care and Screening: Screening for Clinical Depression

and Follow-Up Plan




2. Check to determine if the patient was screened for clinical depression using an age appropriate standardizedtool during the measurement period.

a. If no, the patient was not screened for clinical depression using an age appropriate standardized toolduring the measurement period, continue processing and proceed to step 5.

b. If yes, the patient was screened for clinical depression using an age appropriate standardized tool duringthe measurement period, continue processing.

3. Check to determine if the patient had a positive screen for clinical depression during the measurement period.

a. If no, the patient did not have a positive screen for clinical depression during the measurement period,performance is met and the patient will be included in the numerator. For the sample calculation in theflow these patients would fall into the ‘a¹’ category (numerator, i.e. 50 patients). Stop processing.

b. If yes, patient had a positive screen for clinical depression during the measurement period, continueprocessing.

4. Check to determine if the patient had a follow-up plan for clinical depression documented on the date of thepositive screen.

a. If no, the patient did not have a follow-up plan for clinical depression documented on the date of thepositive screen, performance is not met and the patient should not be included in the numerator. Stopprocessing.

b. If yes, the patient had a follow-up plan for clinical depression documented on the date of the positivescreen, performance is met and the patient will be included in the numerator. For the sample calculationin the flow these patients would fall into the ‘a²’ category (numerator, i.e. 116 patients). Stop processing.

5. Check to determine if the patient was Not screened for clinical depression using a standardized tool for adenominator exception, medical reason(s).

a. If no, the patient was Not screened for clinical depression using a standardized tool for a denominatorexception, medical reason(s), continue processing.

b. If yes, the patient was Not screened for clinical depression using a standardized tool for a denominatorexception, medical reason(s), this is a denominator exception and the case should be subtracted from theeligible denominator. For the sample calculation in the flow these patients would fall into the ‘b¹’ category(denominator exception, i.e. 18 patients). Stop processing.

6. Check to determine if the patient was Not screened for clinical depression using a standardized tool for adenominator exception, patient reason(s).

a. If no, the patient Not screened for clinical depression using a standardized tool for a denominatorexception, patient reason(s), performance is not met and the patient should not be included in thenumerator. Stop processing.

b. If yes, the patient was Not screened for clinical depression using a standardized tool for a denominatorexception, patient reason(s), this is a denominator exception and the case should be subtracted from theeligible denominator. For the sample calculation in the flow these patients would fall into the ‘b²’ category(denominator exception, i.e. 23 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a¹ plus a²’ in the measure flow (166 patients) Eligible Denominator is category ‘d’ in the measure flow (227 patients) Denominator Exception is category ‘b¹ plus b²’ in the measure flow (41 patients) 166 (Performance Met) divided by 186 (Eligible Denominator minus Denominator Exception) equals a performance rate of 89.25 percent Calculation May Change Pending Performance Met




2. Check to determine if the patient has a diagnosis of ASCVD (active or history of) at any time up through thelast day of the measurement period.

a. If no, the patient does not have a diagnosis of ASCVD (active or history of) at any time up through thelast day of the measurement period, continue processing.

b. If yes, the patient does have a diagnosis of ASCVD (active or history of) at any time up through the lastday of the measurement period, continue processing and proceed to step 6

3. Check to determine if the patient has ever had a fasting or direct LDL-C greater than or equal to 190 mg/dL.

a. If no, the patient has not ever had a fasting or direct LDL-C greater than or equal to 190 mg/dL, continueprocessing.

b. If yes, the patient has ever had a fasting or direct LDL-C greater than or equal to 190 mg/dL, continueprocessing and proceed to step 6.

4. Check to determine if the patient is aged 40-75 years with a diagnosis of Type 1 or Type 2 diabetes.

a. If no, the patient is not aged 40-75 years or does not have a diagnosis of Type 1 or Type 2 diabetes,mark appropriately for completion and stop abstraction. Patient is removed from the performancecalculations for this measure. Stop processing.

b. If yes, the patient is aged 40-75 years with a diagnosis of Type 1 or Type 2 diabetes, continueprocessing.

5. Check to determine if highest fasting or direct LDL-C is 70-189 mg/dL in the measurement period or two yearsprior to the beginning of the measurement period.

a. If no, the highest fasting or direct LDL-C is not 70-189 mg/dL in the measurement period or two yearsprior to the beginning of the measurement period, mark appropriately for completion and stop abstraction.Patient is removed from the performance calculations for this measure. Stop processing.

b. If yes, the highest fasting or direct LDL-C is 70-189 mg/dL in the measurement period or two years priorto the beginning of the measurement period, continue processing.


a. If no, the patient does not qualify for the measure select: No – Other CMS Approved Reason for patientdisqualification. Mark appropriately for completion and stop abstraction. Patient is removed from theperformance calculations for this module. “Other CMS Approved Reason” is requested and approved byopening a Help Desk Ticket at [email protected]. Stop processing.


2016 GPRO PREV-13: Preventive Care and Screening: Statin Therapy for the Prevention and

Treatment of Cardiovascular Disease



1. Start processing 2016 GPRO PREV-13 Flow for the patients that qualified for the sample in the PatientConfirmation Flow and the Measure Confirmation Flow for PREV-13. Note: Include remainder of patientslisted in the Web Interface that were consecutively confirmed and completed for this measure in thedenominator. For the sample calculation in the flow these patients would fall into the ‘d’ category (eligibledenominator, i.e. 227 patients).

2. Check to determine if the patient is currently a statin user OR received a prescription for a statin during themeasurement period.

a. If no, the patient is not currently a statin user OR did not receive a prescription for a statin during themeasurement period, continue processing.

b. If yes, the patient is currently a statin user OR received a prescription for a statin during the measurementperiod, performance is met and the patient will be included in the numerator. For the sample calculation inthe flow these patients would fall into the ‘a’ category (numerator, i.e. 150 patients). Stop processing.

3. Check to determine if the patient is Not currently a statin user OR did Not receive a prescription for a statinduring the measurement period for a denominator exception, medical reason(s).

a. If no, the patient is Not currently a statin user OR did Not receive a prescription for a statin during themeasurement period for a denominator exception, medical reason(s), performance is not met and thepatient should not be included in the numerator. Stop processing.

b. If yes, the patient is Not currently a statin user OR did Not receive a prescription for a statin during themeasurement period for a denominator exception, medical reason(s), this is a denominator exception andthe case should be subtracted from the eligible denominator. For the sample calculation in the flow thesepatients would fall into the ‘b’ category (denominator exception, i.e. 40 patients). Stop processing.

Sample Calculation Performance Rate Equals Performance Met is category ‘a‘ in the measure flow (150 patients) Eligible Denominator is category ‘d’ in the measure flow (227 patients) Denominator Exception is category ‘b’ in the measure flow (40 patients) 150 (Performance Met) divided by 187 (Eligible Denominator minus Denominator Exception) equals a performance rate of 80.21 percent Calculation May Change Pending Performance Met

cms provided gpro measure workflows - advantmed provided gpro measure workflows . the workflows...

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