Ambulatory Palliative Care Patients’ Experience of Feeling Heard and

Measure Specification

Seriously ill persons often report feeling silenced, ignored, and misunderstood in medical institutions (Institute of Medicine (IOM), 2015). Systematically monitoring, reporting, and responding to how well patients feel heard and understood are crucial to creating and sustaining a health care environment that excels in caring for those who are seriously ill.

The quality of provider communication in serious illness is built on at least four mutually reinforcing processes: information gathering, information sharing, responding to emotion, and fostering relationships. These elements directly shape patient experience and, when done well, help patients feel known, informed, in control, and satisfied, thus improving well- being and quality of life.

The purpose of the Feeling Heard and Understood measure is to facilitate and improve effective patient-provider communication in palliative care that engenders trust, acknowledgement, and a whole-person orientation to care. The importance of this measure is predicated on existing guidelines and conceptual models of the quality of palliative care, including the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (2018), the National Quality Forum Preferred Practices of Palliative and Hospice Care (2006) (i.

e., Preferred Practices 7, 9, and 24), a consensus building process from the National Coalition for Hospice and Palliative Care, and input from qualitative inquiry of patients and providers. REFERENCES Frosch DL, May SG, Rendle KAS, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making.

Health Aff. 2012;31(5):1030–1038. Gramling R, Stanek S, Ladwig S, et al. Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting. J Pain Symp Manage. 2016;51(2):150–154. Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. National Academies Press 2015.

Murray CD, McDonald C, Atkin H. The communication experiences of patients with palliative care needs: A systematic review and meta-synthesis of qualitative findings. Palliat Support Care. 2015;13(2):369–383. National Coalition for Hospice and Palliative Care. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition.

2018. https://www.nationalcoalitionhpc.org/ncp-guidelines-2018/ National Quality Forum. A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report. 2006. Street RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns.

2009;74(3):295–301. COPYRIGHT: “Feeling Heard and Understood: A Patient-Reported Quality Measure for the Ambulatory Palliative Care Setting” (the “Measure”) is jointly copyrighted in 2021 by the American Academy of Hospice and Palliative Medicine (“AAHPM”) and RAND Health (“RAND”). All rights reserved. The Measure is not clinical guidelines, does not establish a standard of medical care, and has not been tested for all potential applications.

The Measure, while copyrighted, can be reproduced and distributed for noncommercial purposes, e.g., use by health care providers in connection with their practices, clinical trials, etc. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measure require a license agreement between the user, AAHPM and RAND. Neither AAHPM nor RAND, nor their respective officers, directors, owners, or members shall be responsible for any use of the Measure. AAHPM is the sole Measure steward for this Measure and responsible for Measure maintenance. AAHPM encourages use of the Measure by any and all health care professionals, where appropriate.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specification for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. AAHPM, RAND and their respective officers, directors, owners, and members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specification.

The Measure project was supported by Funding Opportunity Number 1V1CMS331639-01-00 from the U.S. Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services. The Measure contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 2026 Clinical Quality Measure Flow Narrative for Quality ID #495 (CBE 3665): Ambulatory Palliative Care Patients' Experience of Feeling Heard and Understood Disclaimer: Refer to the measure specification for specific coding and instructions to submit this measure.

Multiple Performance Rates Accountability Reporting in the CMS MIPS Program: Sample Calculations: Overall Data Completeness (All Submission Criteria) equals Performance Met (a1 plus a2 plus a3 plus a4 equals 160 patients) plus Denominator Exception (b1 plus b2 plus b3 plus b4 equals 40 patients) plus Performance Not Met (c1 plus c2 plus c3 plus c4 equals 80 patients) divided by Eligible Population/Denominator (d1 plus d2 plus d3 plus d4 equals 320 patients).

All equals 280 patients divided by 320 patients. All equals 87.50 percent. Overall Performance Rate (Weighted Average) equals Performance Met (a1 plus a2 plus a3 plus a4 equals 160 patients) divided by Data Completeness Numerator (280 patients) minus Denominator Exception (b1 plus b2 plus b3 plus b4 equals 40 patients). All equals 160 patients divided by 240 patients.

All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure. *Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance.

The same denominator is used for all submission criterion. NOTE: Submission Frequency: Patient-Periodic Submission Criteria One: 1. Start with Denominator (Denominator is the same for all four Submission Criteria) 2. Check Patients aged greater than or equal to 18 years on date of encounter: a. If Patients aged greater than or equal to 18 years on date of encounter equals No, do not include in Eligible Population/Denominator.

Stop processing. b. If Patients aged greater than or equal to 18 years on date of encounter equals Yes, proceed to check Diagnosis for palliative care. 3. Check Diagnosis for palliative care: a. If Diagnosis for palliative care equals Yes, proceed to check Patient encounter during the performance period as listed in the Denominator*. b. If Diagnosis for palliative care equals No, proceed to check Patient encounter during the performance period with Hospice and Palliative Care Specialty Code 17.

4. Check Patient encounter during the performance period with Hospice and Palliative Care Specialty Code 17: a. If Patient encounter during the performance period with Hospice and Palliative Care Specialty Code 17 equals No, do not include in Eligible Population/Denominator. Stop processing. b. If Patient encounter during the performance period with Hospice and Palliative Care Specialty Code 17 equals Yes, proceed to check Patient encounter during the performance period as listed in the Denominator*.

5. Check Patient encounter during the performance period as listed in the Denominator*: a. If Patient encounter during the performance period as listed in the Denominator* equals No, do not include in Eligible Population/Denominator. Stop processing. b. If Patient encounter during the performance period as listed in the Denominator* equals Yes, proceed to check Encounters conducted via telehealth.

6. Check Encounters conducted via telehealth: a. If Encounters conducted via telehealth equals Yes, stop processing. b. If Encounters conducted via telehealth equals No, proceed to check Patient encounter during the performance period with place of service code 11. 7. Check Patient encounter during the performance period with place of service code 11: a.

If Patient encounter during the performance period with place of service code 11 equals Yes, stop processing. b. If Patient encounter during the performance period with place of service code 11 equals No, proceed to check Patients who did not complete at least one of the four patient experience HU survey items and return the HU survey within 60 days of the ambulatory palliative care visit.

8. Check Patients who did not complete at least one of the four patient experience HU survey items and return the HU survey within 60 days of the ambulatory palliative care visit. a. If Patients who did not complete at least one of the four patient experience HU survey items and return the HU survey within 60 days of the ambulatory palliative care visit equals Yes, do not include in Eligible Population/Denominator.

Stop processing. b. If Patients who did not complete at least one of the four patient experience HU survey items and return the HU survey within 60 days of the ambulatory palliative care visit equals No, proceed to check Patients who respond on the patient experience HU survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal).

9. Check Patients who respond on the patient experience HU survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal). a. If Patients who respond on the patient experience HU survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal) equals Yes, do not include in Eligible Population/Denominator.

Stop processing. b. If Patients who respond on the patient experience HU survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal) equals No, proceed to check Patients who were deceased when the HU survey reached them. 10. Check Patients who were deceased when the HU survey reached them.

a. If Patients who were deceased when the HU survey reached them equals Yes, do not include in Eligible Population/Denominator. Stop processing. b. If Patients who were deceased when the HU survey reached them equals No, proceed to check Patients for whom a proxy completed the entire HU survey on their behalf for any reason (no patient involvement).

11. Check Patients for whom a proxy completed the entire HU survey on their behalf for any reason (no patient involvement): a. If Patients for whom a proxy completed the entire HU survey on their behalf for any reason (no patient involvement) equals Yes, do not include in Eligible Population/Denominator. Stop processing. b. If Patients for whom a proxy completed the entire HU survey on their behalf for any reason (no patient involvement) equals No, include in Eligible Population/Denominator.

12. Denominator Population: a. Denominator Population is all Eligible Patients in the Denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d1-4 equals 80 patients in the Sample Calculation. 13. Start Numerator 14. Check Patient responded as “completely true” for the question of patient felt heard and understood by this provider and team: a.

If Patient responded as “completely true” for the question of patient felt heard and understood by this provider and team equal Yes, include in Data Completeness Met and Performance Met. • Data Completeness Met and Performance Met letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document.

Letter a1 equals 40 patients in the Sample Calculation. b. If Patient responded as “completely true” for the question of patient felt heard and understood by this provider and team equals No, proceed to check Patient did not respond to the question of patient felt heard and understood by this provider and team. 15. Check Patient did not respond to the question of patient felt heard and understood by this provider and team: a.

If Patient did not respond to the question of patient felt heard and understood by this provider and team equals Yes, include in Data Completeness Met and Denominator Exception. • Data Completeness Met and Denominator Exception letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document.

Letter b1 equals 10 patients in the Sample Calculation. b. If Patient did not respond to the question of patient felt heard and understood by this provider and team equals No, proceed to check Patient provided a response other than “completely true” for the question of patient felt heard and understood by this provider and team. 16. Check Patient provided a response other than “completely true” for the question of patient felt heard and understood by this provider and team: a.

If Patient provided a response other than “completely true” for the question of patient felt heard and understood by this provider and team equals Yes, include in Data Completeness Met and Performance Not Met. • Data Completeness Met and Performance Not Met letter is represented as Data Completeness in the Sample Calculation listed at the end of this document.

Letter c1 equals 20 patients in the Sample Calculation. b. If Patient provided a response other than “completely true” for the question of patient felt heard and understood by this provider and team equals No, proceed to check Data Completeness Not Met. 17. Check Data Completeness Not Met: 18. If Data Completeness Not Met, the Quality Data Code or equivalent was not submitted.

10 patients have been subtracted from the Data Completeness Numerator in the Sample Calculation. Sample Calculations: Submission Criteria One Data Completeness equals Performance Met (a1 equals 40 patients) plus Denominator Exception (b1 equals 10) Performance Not Met (c1 equals 20 patients) divided by Eligible Population/Denominator (d1 equals 80 patients).

All equals 70 patients divided by 80 patients. All equals 87.50 percent. Performance Rate equals Performance Met (a1 equals 40 patients) divided by Data Completeness Numerator (70 patients) minus Denominator Exception (b1 equals 10). All equals 40 patients divided by 60 patients. All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure.

*Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance. The same denominator is used for all submission criterion. NOTE: Submission Frequency: Patient-Periodic 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 alone or as a substitution for the measure specification. Submission Criteria Two: 1. Denominator is the same as Submission Criteria One. a. Denominator Population is all Eligible Patients in the Denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d2 equals 80 patients in the Sample Calculation.

2. Start Numerator 3. Check Patient responded “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care: a. If Patient responded “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care equals Yes, include in Data Completeness Met and Performance Met.

• Data Completeness Met and Performance Met letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter a2 equals 40 patients in the Sample Calculation. b. If Patient responded “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care equals No, proceed to check Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care.

4. Check Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care: a. If Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care equals Yes, include in Data Completeness Met and Denominator Exception.

• Data Completeness Met and Denominator Exception letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter b2 equals 10 patients in the Sample Calculation. b. If Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care equals No, proceed to check Patient provided a response other than “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care.

5. Check Patient provided a response other than “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care: a. If Patient provided a response other than “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care equals Yes, include in Data Completeness Met and Performance Not Met.

• Data Completeness Met and Performance Not Met letter is represented as Data Completeness in the Sample Calculation listed at the end of this document. Letter c2 equals 20 patients in the Sample Calculation. b. If Patient provided a response other than “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care equals No, proceed to check Data Completeness Not Met.

6. Check Data Completeness Not Met: 7. If Data Completeness Not Met, the Quality Data Code or equivalent was not submitted. 10 patients have been subtracted from the Data Completeness Numerator in the Sample Calculation. Sample Calculations: Submission Criteria Two Data Completeness equals Performance Met (a2 equals 40 patients) plus Denominator Exception (b2 equals 10) Performance Not Met (c2 equals 20 patients) divided by Eligible Population/Denominator (d2 equals 80 patients).

All equals 70 patients divided by 80 patients. All equals 87.50 percent. Performance Rate equals Performance Met (a2 equals 40 patients) divided by Data Completeness Numerator (70 patients) minus Denominator Exception (b2 equals 10). All equals 40 patients divided by 60 patients. All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure.

*Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance. The same denominator is used for all submission criterion. NOTE: Submission Frequency: Patient-Periodic 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 alone or as a substitution for the measure specification. Submission Criteria Three: 1. Denominator is the same as Submission Criteria One. a. Denominator Population is all Eligible Patients in the Denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d3 equals 80 patients in the Sample Calculation.

2. Start Numerator 3. Check Patient responded “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem: a. If Patient responded “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals Yes, include in Data Completeness Met and Performance Met.

• Data Completeness Met and Performance Met letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter a3 equals 40 patients in the Sample Calculation. b. If Patient responded “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals No, proceed to check Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem.

4. Check Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem: a. If Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals Yes, include in Data Completeness Met and Denominator Exception.

• Data Completeness Met and Denominator Exception letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter b3 equals 10 patients in the Sample Calculation. b. If Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals No, proceed to check Patient provided a response other than “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem.

5. Check Patient provided a response other than “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem: a. If Patient provided a response other than “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals Yes, include in Data Completeness Met and Performance Not Met.

• Data Completeness Met and Performance Not Met letter is represented as Data Completeness in the Sample Calculation listed at the end of this document. Letter c3 equals 20 patients in the Sample Calculation. b. If Patient provided a response other than “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem equals No, proceed to check Data Completeness Not Met.

6. Check Data Completeness Not Met: 7. If Data Completeness Not Met, the Quality Data Code or equivalent was not submitted. 10 patients have been subtracted from the Data Completeness Numerator in the Sample Calculation. Sample Calculations: Submission Criteria Three Data Completeness equals Performance Met (a3 equals 40 patients) plus Denominator Exception (b3 equals 10) Performance Not Met (c3 equals 20 patients) divided by Eligible Population/Denominator (d3 equals 80 patients).

All equals 70 patients divided by 80 patients. All equals 87.50 percent. Performance Rate equals Performance Met (a3 equals 40 patients) divided by Data Completeness Numerator (70 patients) minus Denominator Exception (b3 equals 10). All equals 40 patients divided by 60 patients. All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure.

*Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance. The same denominator is used for all submission criterion. NOTE: Submission Frequency: Patient-Periodic 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 alone or as a substitution for the measure specification. Submission Criteria Four: 1. Denominator is the same as Submission Criteria One. a. Denominator Population is all Eligible Patients in the Denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d4 equals 80 patients in the Sample Calculation.

2. Start Numerator 3. Check Patient responded “completely true” for the question of patient felt this provider and team understood what is important to me in my life: a. If Patient responded “completely true” for the question of patient felt this provider and team understood what is important to me in my life equals Yes, include in Data Completeness Met and Performance Met.

• Data Completeness Met and Performance Met letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter a4 equals 40 patients in the Sample Calculation. b. If Patient responded “completely true” for the question of patient felt this provider and team understood what is important to me in my life equals No, proceed to check Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life.

4. Check Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life: a. If Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life Yes, include in Data Completeness Met and Denominator Exception. • Data Completeness Met and Denominator Exception letter is represented as Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document.

Letter b4 equals 10 patients in the Sample Calculation. b. If Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life equals No, proceed to check Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life.

5. Check Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life: a. If Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life equals Yes, include in Data Completeness Met and Performance Not Met.

• Data Completeness Met and Performance Not Met letter is represented as Data Completeness in the Sample Calculation listed at the end of this document. Letter c4 equals 20 patients in the Sample Calculation. b. If Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life equals No, proceed to check Data Completeness Not Met.

6. Check Data Completeness Not Met: 7. If Data Completeness Not Met, the Quality Data Code or equivalent was not submitted. 10 patients have been subtracted from the Data Completeness Numerator in the Sample Calculation. Sample Calculations: Submission Criteria Four Data Completeness equals Performance Met (a4 equals 40 patients) plus Denominator Exception (b4 equals 10) Performance Not Met (c4 equals 20 patients) divided by Eligible Population/Denominator (d4 equals 80 patients).

All equals 70 patients divided by 80 patients. All equals 87.50 percent. Performance Rate equals Performance Met (a4 equals 40 patients) divided by Data Completeness Numerator (70 patients) minus Denominator Exception (b4 equals 10). All equals 40 patients divided by 60 patients. All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure.

NOTE: Submission Frequency: Patient-Periodic *Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance. The same denominator is used for all submission criterion. 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 alone or as a substitution for the measure specification.

This measure contains four strata defined by four submission criteria. This measure produces four performance rates. There are 4 Submission Criteria for this measure: 1) Patient felt heard and understood by this provider and team AND 2) Patient felt this provider and team put my best interests first when making recommendations about my care AND 3) Patient felt this provider and team saw me as a person, not just someone with a medical problem AND 4) Patient felt this provider and team understood what is important to me in my life This measure will be calculated with 4 performance rates: 1) Top-box response to Q1- "I felt heard and understood by this provider and team.

" 2) Top-box response to Q2- "I felt this provider and team put my best interests first when making recommendations about my care." 3) Top-box response to Q3- "I felt this provider and team saw me as a person, not just someone with a medical problem." 4) Top-box response to Q4- "I felt this provider and team understood what is important to me in my life.

" Submission of all 4 performance rates is required for this measure. For accountability reporting in the CMS MIPS program, a weighted average will be used. Implementation Consideration: All valid Feeling Heard and Understood (HU) survey results (as defined in the specification) should be included in the aggregate score. The survey tool and recommended survey administration procedures are found in the appendix of Quality ID #495 (CBE 3665): Ambulatory Palliative Care Patients’ Experience of Feeling Heard and Understood American Academy of Hospice and Palliative Medicine’s Implementation Guide- https://aahpm.

org/uploads/AAHPM22_PRO-PM_IMPLEMENTATION_GUIDE.pdf. Although the implementation guide recommends a survey vendor, this is not required for MIPS reporting. • For MIPS eligible individual clinicians, a minimum of 12 HU surveys would need to be received in order to submit this measure. • For MIPS eligible groups, subgroups*, virtual groups, and APM entities, a minimum of 38 HU surveys would need to be received in order to submit this measure.

• If the MIPS eligible clinician, group, subgroup*, virtual group, and APM entity encompasses multiple sites/locations, each site/location would need to meet the HU survey requirements as stated. *Subgroups are only available through MVP reporting. All measure-specific criteria must be met by the subgroup. For the purposes of MIPS implementation of this measure, this patient-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure during the performance period.

The most advantageous quality data code will be used if the measure is submitted more than once. If more than one quality data code is submitted during the episode time period, performance rates shall be calculated by the most advantageous quality data code. Telehealth: NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting.

Patient encounters for this measure conducted via telehealth should be removed from the denominator eligible patient population. Therefore, if the patient meets all denominator criteria but the encounter is conducted via telehealth, it would be appropriate to remove them from the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

Measure Submission: The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic.

When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.