Need guidance on the measure criteria for CMS measure 55, 111, and others

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Major
    • Component/s: Guidance, Measure
    • None
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      The intent of the logic phrase in the measure population is to ensure ED visit is followed by an inpatient admission. The ED encounter endtime should be before the starttime of inpatient encounter and the gap should be less than or equal to 1 hour. In the scenario in your 2nd question, when ED encounter endtime is same as the startime of inpatient encounter, the difference would be 0 and 0 is < less than 1, so the logic would evaluate true.

      In eCQM, an encounter endtime is defined as when the encounter is closed, often captured as administrative closing time or recorded closing time in EHR. It is not the time when patient leaves the facility. The EHR captures patient departure time which is usually different from encounter closing time, and departure time can even takes place after the start of inpatient encounter. Having considered this scenario, the eCQM requires the ED encounter closed (at least in the EHR from record perspective) before the start of inpatient encounter.

      The similar question is posted on CQM-1013, please feel free to reference that ticket for further information.
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      The intent of the logic phrase in the measure population is to ensure ED visit is followed by an inpatient admission. The ED encounter endtime should be before the starttime of inpatient encounter and the gap should be less than or equal to 1 hour. In the scenario in your 2nd question, when ED encounter endtime is same as the startime of inpatient encounter, the difference would be 0 and 0 is < less than 1, so the logic would evaluate true. In eCQM, an encounter endtime is defined as when the encounter is closed, often captured as administrative closing time or recorded closing time in EHR. It is not the time when patient leaves the facility. The EHR captures patient departure time which is usually different from encounter closing time, and departure time can even takes place after the start of inpatient encounter. Having considered this scenario, the eCQM requires the ED encounter closed (at least in the EHR from record perspective) before the start of inpatient encounter. The similar question is posted on CQM-1013 , please feel free to reference that ticket for further information.
    • CMS111v1/NQF0497, CMS55v1/NQF0495
    • Fewer cases qualified for the measure.

      We have several customers who are challenged with the ED Measure (NQF 0495/0497) set specifically the Measure Population clause for the ED patients who are admitted where the occurrence of encounter A ED visit ends before the Inpatient Encounter. Many sites are not meeting the time limitation and cases are therefore not being evaluated for the measure. There are a few themes we would like guidance on with respect to this clause.

      1. Is it acceptable to report the limited cases (or none at all in some cases) that are appropriately valued where this clause is met or not met….? Providers are concerned as they may have 100+ cases in a day but only a small set or none at all even qualify due to this clause. We are asking for guidance on this concern.
      2. The “ends before start” clause is a contradictory specifically with the < = parameter which one would suspect that the "=" clauses allows for the same time (i.e. end time of ED visit is same as start time of Inpatient visit) but yet the "end before starts" logic is looking for a time difference.
      3. The last question is what is the intent of this clause for patients who are admitted to the inpatient status from the ED…? Typically, patients entered in the ED are evaluated and a decision is made to admit. The ED departure of the patient ends the ED patient portion of care until the patient is transitioned to the inpatient location. Many systems admit the patient to the inpatient status prior to the departure from the ED and therefore creates issues and additionally the creates a time challenge. Sites do not capture a specific field for inpatient encounter start with ED cases yet this is what it would seem is required for these measures based on when the patient ends their ED visit (leaves the ED) and begins their Inpatient encounter (upon entering their inpatient location). We are not clear on the intent of this clause and the 1 hour constraint with respect to the measure population and why this is relevant.

      Measure Clause
      • Measure Population =
      o AND: "Initial Patient Population"
      o AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"

            Assignee:
            Abt Associate (Inactive)
            Reporter:
            Siemens (Inactive)
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