#outcomes: When can a patient be labeled "Gone Elsewhere"?

QUESTION:

If my facility only does screening mammograms and a patient is recommended for additional imaging, can I just state the patient has "Gone Elsewhere" for their diagnostic study? 

ANSWER:

Under MQSA regulations, every facility is responsible for making a reasonable attempt to determine the disposition of a patient assessed as Suspicious or Highly Suggestive of Malignancy. 

A typical operating procedure for making a reasonable effort to ascertain that follow-up is obtained and what the outcome of that follow-up was should consist of, at minimum, 2-3 attempts at contact comprised of lay letter communication to patient, communication to their referring physician, or other outreach such as telephone calls, etc. This same rationale could be applied to patients assessed as Probably Benign and recommended for interval follow-up who don't return.

In addition, those patients with an Incomplete assessment should also have disposition determined to ascertain that they've pursued recommended follow-up. This comes in two forms:

1. If an exam was assessed as Incomplete - Obtain Prior Images, your facility is responsible for creating another report of test results within 30 days to update all parties as to the status of what has occurred in obtaining those films and the findings based on comparisons or lack thereof.
2. If an exam was assessed as Incomplete - Needs Additional Imaging, obtaining disposition as to the outcome of the patient's action based on that recommendation should also be conducted. This could include validating with the referring physician or patient directly to confirm additional imaging was performed or that the patient is in the care of another healthcare provider who will perform the patient's exams going forward. If it has been determined that follow-up has been obtained, it is appropriate to note that the patient has "Gone Elsewhere" for their diagnostic study.

Unlike the mandate to make every effort to discover the resolution of the follow-up based on the suspicious or highly suggestive of malignancy assessments, at the tissue/pathological sampling level, confirmation that the patient has pursued recommended follow-up and care has been transferred to another provider, then the "Gone Elsewhere" label would be acceptable without obtaining the patient's final outcome.

For other questions, contact Mammologix or the MQSA Program directly!