2016 PQRS Measure #181: Elder Maltreatment Screen and Follow-Up Plan


Percentage of patients aged 65 years and older with a documented elder maltreatment screen using an Elder Maltreatment Screening Tool on the date of encounter AND a documented follow-up plan on the date of the positive screen


This measure is to be reported once during the reporting period for patients seen during the reporting period. This measure may be reported by eligible professionals who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding at the time of the qualifying visit. The documented follow up plan must be related to positive elder maltreatment screening, example: “Patient referred for protective services due to positive elder maltreatment screening.”


All patients aged 65 years and older on date of encounter


Patient encounter during the reporting period (CPT or HCPCS):
90791, 90792, 90832, 90834, 90837, 96116, 96150, 96151, 97003, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0270, G0402, G0438, G0439


Patients with a documented elder maltreatment screen using an Elder Maltreatment Screening Tool on the date of the encounter and follow-up plan documented on the date of the positive screen

Screen for Elder Maltreatment – An elder maltreatment screen should include assessment and documentation of all of the following components: (1) physical abuse, (2) emotional or psychological abuse, (3) neglect (active or passive), (4) sexual abuse, (5) abandonment, (6) financial or material exploitation and (7) unwarranted control.
Physical Abuse – Infliction of physical injury by punching, beating, kicking, biting, burning, shaking, or other actions that result in harm.
Emotional or Psychological Abuse – Involves psychological abuse, verbal abuse, or mental injury and includes acts or omissions by loved ones or caregivers that have caused or could cause serious behavioral, cognitive, emotional, or mental disorders.
Neglect – Involves attitudes of others or actions caused by others-such as family members, friends, or institutional caregivers-that have an extremely detrimental effect upon well-being.
Active – Behavior that is willful or when the caregiver intentionally withholds care or necessities. The neglect may be motivated by financial gain or reflect interpersonal conflicts.
Passive – Situations where the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources.
Sexual Abuse – The forcing of undesired sexual behavior by one person upon another against their will who are either competent or unable to fully comprehend and/or give consent. This may also be called molestation.
Elder Abandonment – Desertion of an elderly person by an individual who has assumedresponsibility for providing care for an elder, or by a person with physical custody of an elder.
Financial or Material Exploitation – Taking advantage of a person for monetary gain or profit.
Unwarranted Control – Controlling a person’s ability to make choices about living situations, household finances, and medical care.

Note: Self neglect is a prevalent form of abuse in the elderly population. Screening for self neglect and screening tools for self neglect are not included in this measure. Resources for suspected self neglect are listed below.

Follow-Up Plan – Must include a documented report to state or local Adult Protective Services (APS) agency.
Note: APS does not have jurisdiction in all states to investigate maltreatment of patients in long-term care facilities. In those states where APS does not have jurisdiction, APS may refer the provider to another state agency -- such as the state facility licensure agency – for appropriate reporting.
Federal reporting: In addition to state requirements, some types of providers are required by federal law to report suspected maltreatment. For example, nursing facilities certified by Medicare and/or Medicaid are required to report suspected maltreatment to the applicable State Survey and Certification Agency.
For state-specific information to report suspected elder maltreatment, including self neglect, the following resources are available:
1. National Adult Protective Services Association- http://www.napsa-now.org/get-help/help-in-your-area/
2. Eldercare Locater: 1-800-677-1116 www.eldercare.gov
3. National Center on Elder Abuse http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx

Disclaimer: The follow-up plan recommendations set forth in this quality measure are not intended to supersede any mandatory state, local or federal reporting requirements.

Not Eligible – A patient is not eligible if one or more of the following reasons is documented:
• Patient refuses to participate
• Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status

Numerator Note: Documentation of an elder maltreatment screening must include identification of the tool used. Examples of screening tools for elder maltreatment include, but are not limited to: Elder Abuse Suspicion Index (EASI), Vulnerability to Abuse Screening Scale (VASS) and Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).

Elder Maltreatment Screen Documented as Positive AND Follow-Up Plan Documented
Elder Maltreatment Screen Documented as Negative, Follow-Up Plan not Required
Elder Maltreatment Screen not Documented, Patient not Eligible
Elder Maltreatment Screen Documented as Positive, Follow-Up Plan not Documented, Patient not Eligible for Follow-Up Plan
Elder Maltreatment Screen not Documented, Reason not Given
No documentation of an elder maltreatment screen, reason not given
Elder Maltreatment Screen Documented as Positive, Follow-Up Plan not Documented, Reason not Given
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Elder Maltreatment Screen and Follow-Up Plan

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