These are the differences (between what the current version of the measures calculate and the test measures would calculate) in the measure calculation logic that we observed in CMS 31 and CMS 111 – no other measures were evaluated:

1. CMS 111: A patient who has multiple ED visits, each of which are followed by an Inpatient visit within an hour, within a reporting period – WILL ONLY HAVE A SINGLE MEASURE OBSERVATION RECORDED for use in the Median Calculation, in the measurement period. This is due to the use of the “Last” subset operator in the Measure Observation section. In the current CMS 111, EVERY qualifying ED visit would have a Measure Observation calculated for it, in the measurement period.
2. CMS 111: A patient who has an ED visit AFTER the Measurement Period, but before the submission deadline, who also has a qualifying ED visit DURING the Measurement Period, will only calculate a Measure Observation for the ED Visit that is after the Measurement Period. This Measure Observation will not be in any of the stratifications, because those are constrained by the Measurement Period – but the Last subset operator is in a sub-query that is NOT constrained to end during Reporting Period.
3. CMS 111:The measure definition now includes 3 stratifications vs 2 stratifications for the current version. Secondly, as currently defined, all patients in Stratification 3 will also be in Stratification 1. Stratification 1 does not qualify on NOT NULL Principal Diagnosis.
4. CMS31: Constrain the measure to encounters which end in the measurement period.
5. CMS 31: Constrain the measure to encounters fewer than a length of stay of 120 days, per the header.
6. CMS 31: Numerator criteria currently requires both a Negation Rationale AND a measure result, for each ear. The current measure requires EITHER a negation rationale or a result, for each ear. It would be impossible to document both that you performed a test and why you did not perform the test.

See other JIRA CCQLIT-46 for more information about Human Readable feedback and JIRA CQLIT-47 for General Feedback with an attached document for additional details.