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HEDIS®2017MEASURE:WELL-CHILDVISITSINTHETHIRD,FOURTH,FIFTH,ANDSIXTHYEARSOFLIFE(W34)

Members3-6yearsofagewhoreceivedoneormorewell-childvisitswithaprimarycarepractitionerduringthemeasurementyear.

Inclusionintothemeasurecanincludethefollowingthreeevents:� Childrenwhoturn3-6yearsoldduringthemeasurementyear.� Thewell-childvisitmustoccurwithaprimarycarepractitioner(PCP),butthePCPdoesnothaveto

bethepractitionerassignedtothechild(DonotincludeservicesrenderedduringaninpatientorEDvisit).

� Visitstoschool-basedclinicswithpractitionertypesthattheorganizationwouldconsiderasPCPsmaybecountedifdocumentationofawell-childexamisavailable.ThePCPdoesnothavetobeassignedtothechild.

Exclusions:� Membersinhospicecareareexcludedfromtheeligiblepopulation.

HOWTOIMPROVEYOURHEDISSCORE:• UsecompleteandaccurateValueSetCodes.• Timelysubmitclaimsandencounterdata.• Documentationinthemedicalrecordmustincludeanoteindicatingavisitwithaprimarycare

practitioner,thedatewhenthewell-childvisitoccurred,andevidenceofallofthefollowing:§ Ahealth/intervalhistory.§ Aphysicaldevelopmentalhistory.§ Amentaldevelopmentalhistory.§ Aphysicalexam.§ Healtheducation/anticipatoryguidance.

• Includethefollowinginthemedicalrecord:§ Progressnotesorofficevisitnoteswithdatedgrowthchart.§ CompletePhysicalExaminationForm.§ AnticipatoryGuidanceorDevelopmentalMilestoneForm.

• Pre-schedulethenextwell-visitbeforethepatientleavestheofficeandbeforetheappointmentwheneverpossible.

• Usegapliststohelpmanageyourtotalpopulation.Makeoutreachcallsand/orsendletterstoadvisemembers/parentsoftheneedforavisit.

• Avoidmissedopportunitiesbytakingadvantageofeveryofficevisit(includingsickvisits)toprovidewellcarecomponentswhenapplicable.§ Non-wellvisitswillcounttowardscomplianceaslongasallfive

documentationcomponents(previousslide)areincludedinthevisitnote.

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§ Makesports/daycarephysicalsintowell-carevisitsbyschedulingtheappropriatevisittime,performingtherequiredservices,andsubmittingappropriatecodes.

§ Useallvisitsasteachablemomentstoincreasewell-carevisitsandhealthliteracy.• Activelypursuemissedappointmentswithlettersandremindercalls.

§ Remindercallsmadelaterinthedayorearlyeveningmayresultinmorecontactsbeingmadetothepatients.

§ Remindercallsmadebyofficestafftendtobemoreeffectivethanauto-dialercalls.• Considertheparent’sworkscheduleasabarriertothevisit,andofferextendedeveningorweekend

hours.• Verifyandaddadditionalpatientcontactinformationateachvisitforfuturereminderrecallefforts.• SetEHRalertsto:

§ FlagpatientsdueforimmunizationseitherinpracticemanagementwhenschedulingorwithintheEMRduringthevisit.

§ Triggerstafftomakereminderphonecalls.• UsestandardizedtemplatesinchartsandinEMRsthatallowcheckboxesforstandardcounseling

activities.• Haveprinted,customizedreminderlettersor“reminderbirthdaycards”readytohandoutandmailto

parentsandguardians,notifyingthemwhenchildrenareoverdueforanexam.• Takeadvantageofback-to-schoolseasontodooutreachcampaignsorholdhealthfairsforwell-child

visits.• UsematerialsfromBrightFuturesashealthpromotionmaterialtodisseminatetoparents.• Referencethebelowsummaryofrequireddocumentation.PhysicalExam

HealthHistory PhysicalHealthDevelopment

MentalHealthDevelopment

AnticipatoryGuidance

Weight IntervalhistoryDeveloping

appropriatelyforage

Makinggoodgradesinschool

Safety(carseats,swimminglessons,seatbelts,helmets,kneeandelbowpads,strangers,etc.)

Height Activeproblems Canskip Understandsandrespondstocommands

Nutrition(vitamins,frequencyofeating,snacks,idealweight)

Chest Pastmedicalhistory Hopsononefoot Learningalphabetandnumbers

Discussiononfitnessandtheimportanceofexercise

Heart Surgicalhistory Runsandclimbswell

Competentwithforkandspoon

Oralhealth(Dentalvisits,eatinghabits,needfororthodontics,

etc.)

Lungs Familyhistory Ridesatricycle Veryimaginativeplay MentalHealth(confidence,self-esteem,etc.)

TannerStage Socialhistorywithabove

Standsononefootfor3-5seconds Knowsownsex Preparingforschool

CodesusedtoidentifyWell-Childvisits

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Description CPT HCPCS ICD-10-CM

WELL-CARE 99381-99385,99391-99395,99461

G0438,G0439

Z00.121,Z00.129,Z00.8,Z02.2,Z02.71,Z02.79,Z02.81,Z02.82,Z02.89,Z02.9

CodesusedtoidentifyexclusionsDescription HCPCS

HospiceServices G9702