Geriatrics and Palliative Care

We support the endorsement recommendation for NQF #3726 Serious Illness Survey for Home-Based Programs and NQF #2651 CAHPS® Hospice Survey, Version 9.0

NQF #3726 Serious Illness Survey for Home-Based Programs – Support

The American Geriatrics Society (AGS) supports Serious Illness Survey for Home-Based Programs, which may be a helpful tool to assess the severity of the illness as well as ensure seriously ill patients receive appropriate care. While we are concerned that patients and their families may not consistently judge care for serious illness appropriately, patient and family input are not typically nor sufficiently incorporated, the AGS believes the benefits outweigh the harms for this measure. In addition, we recommend clarifying the definition of home-based serious illness programs, particularly to differentiate from home-based primary care programs which also generally serve seriously sick individuals.   

NQF #0091 COPD: Spirometry Evaluation – Support 

While the AGS supports COPD: Spirometry Evaluation given the importance of documenting that an individual with a diagnosis of chronic obstructive pulmonary disease (COPD) actually meets the criteria, we are concerned about individuals who have established COPD for years. If any of these individuals are clinically and have imaging consistent with COPD, respond well to COPD treatment, frail and sick, it may be burdensome to the patient to get a spirometry evaluation, or any pulmonary function test (PFT) that would not lead to a change in COPD management. The benefit of documentation does not outweigh the burden these patients would face from a PFT.   

NQF #3707 Ratio of Observed Over Predicted Rates for Diagnosis of Mild Cognitive Impairment – Do not support

The AGS does not support the Ratio of Observed Over Predicted Rates for Diagnosis of Mild Cognitive Impairment measure. The utility of the measure as well as the accuracy of measuring missed diagnoses of MCI is not clear. As an example, if a clinic has lower rates, would that mean that the clinic is doing a better job of controlling risk factors thus preventing MCI or the clinic is not checking cognition thus unable to identify MCI?

NQF #3672 Ratio of Observed Over Predicted Rates for Diagnosis of Dementia – Do not support

Similar to the previous measure related to MCI, the AGS believes the utility of the measure as well as the accuracy to measure missed diagnoses of dementia is unclear. While improving upon under-diagnosis is important, these measures seem to have the potential to incentivize merely to increase diagnosis rates. Furthermore, individuals with possible dementia would more likely visit a geriatrics medicine practice and it is not clear these practices are excluded in the measure. As the MCI measure, further clarification would be needed on whether a clinic with lower rates is considered as doing a better job of controlling risk factors thus preventing dementia or that they are not checking cognition and therefore not identifying dementia.

NQF #3729 Ratio of Observed Over Predicted Rates for Diagnosis of Cognitive Impairment of Any Stage – Do not support

Akin to the previous two measures related to the ratio of observed over predicted rates of diagnosis of MCI and dementia, the AGS does not support this measure for diagnosis of cognitive impairment of any stage due to the uncertainty of the measure’s utility and accuracy.

NQF #2651 CAHPS® Hospice Survey, Version 9.0 – Support 

The AGS believes the CAHPS Hospice Survey, Version 9.0 is important during the end of life so that all patients who need this care receive it. We would like to note that it will be important to reconcile this measure to be seamless with the nursing home pressure ulcers measure given the challenges distinguishing between avoidable and unavoidable around end of life. Further, end of life was not included in the pressure ulcer measure eligibility. The AGS suggests that hospice or comfort care patients be excluded from the denominator or that a comfort care exclusion is operationalized.

NQF #3726 Serious Illness Survey for Home-Based Programs – Support

The American Geriatrics Society (AGS) supports Serious Illness Survey for Home-Based Programs, which may be a helpful tool to assess the severity of the illness as well as ensure seriously ill patients receive appropriate care. While we are concerned that patients and their families may not consistently judge care for serious illness appropriately, patient and family input are not typically nor sufficiently incorporated, the AGS believes the benefits outweigh the harms for this measure. In addition, we recommend clarifying the definition of home-based serious illness programs, particularly to differentiate from home-based primary care programs which also generally serve seriously sick individuals.   

NQF #0091 COPD: Spirometry Evaluation – Support 

While the AGS supports COPD: Spirometry Evaluation given the importance of documenting that an individual with a diagnosis of chronic obstructive pulmonary disease (COPD) actually meets the criteria, we are concerned about individuals who have established COPD for years. If any of these individuals are clinically and have imaging consistent with COPD, respond well to COPD treatment, frail and sick, it may be burdensome to the patient to get a spirometry evaluation, or any pulmonary function test (PFT) that would not lead to a change in COPD management. The benefit of documentation does not outweigh the burden these patients would face from a PFT.   

NQF #3707 Ratio of Observed Over Predicted Rates for Diagnosis of Mild Cognitive Impairment – Do not support

The AGS does not support the Ratio of Observed Over Predicted Rates for Diagnosis of Mild Cognitive Impairment measure. The utility of the measure as well as the accuracy of measuring missed diagnoses of MCI is not clear. As an example, if a clinic has lower rates, would that mean that the clinic is doing a better job of controlling risk factors thus preventing MCI or the clinic is not checking cognition thus unable to identify MCI?

NQF #3672 Ratio of Observed Over Predicted Rates for Diagnosis of Dementia – Do not support

Similar to the previous measure related to MCI, the AGS believes the utility of the measure as well as the accuracy to measure missed diagnoses of dementia is unclear. While improving upon under-diagnosis is important, these measures seem to have the potential to incentivize merely to increase diagnosis rates. Furthermore, individuals with possible dementia would more likely visit a geriatrics medicine practice and it is not clear these practices are excluded in the measure. As the MCI measure, further clarification would be needed on whether a clinic with lower rates is considered as doing a better job of controlling risk factors thus preventing dementia or that they are not checking cognition and therefore not identifying dementia.

NQF #3729 Ratio of Observed Over Predicted Rates for Diagnosis of Cognitive Impairment of Any Stage – Do not support

Akin to the previous two measures related to the ratio of observed over predicted rates of diagnosis of MCI and dementia, the AGS does not support this measure for diagnosis of cognitive impairment of any stage due to the uncertainty of the measure’s utility and accuracy.

NQF #2651 CAHPS® Hospice Survey, Version 9.0 – Support 

The AGS believes the CAHPS Hospice Survey, Version 9.0 is important during the end of life so that all patients who need this care receive it. We would like to note that it will be important to reconcile this measure to be seamless with the nursing home pressure ulcers measure given the challenges distinguishing between avoidable and unavoidable around end of life. Further, end of life was not included in the pressure ulcer measure eligibility. The AGS suggests that hospice or comfort care patients be excluded from the denominator or that a comfort care exclusion is operationalized.