The core issue is related to the use of multiple Specific Occurrences OR’ed together. This issue exists in a number of the EP measures. The problematic Specific Occurrences typically represent various types of encounters although this problem is not specific to encounters.

In the example of the heart failure measures, there are 6 encounters OR’ed together with specific occurrences. When this construct is used it is possible to pass through the IPP using one type of encounter (one of the 6 OR paths), and then satisfy the conditions of the denominator or numerator using a different type of encounter (a different OR path). The types of encounters being Inpatient, Nursing Facility, Face 2 Face, etc.

Therefore you can have an inpatient encounter that satisfies the conditions of the IPP and a Face 2 Face visit that satisfies the conditions of the denominator. However, no single encounter satisfies the conditions of both the IPP and denominator (the intent of the measure).

The use of variable assignments should resolve this issue and simplify the measures that have this issue. Variable assignments is defined in QDM-8 (http://jira.oncprojectracking.org/browse/QDM-8). Variable assignments would allow joining these various encounters into a single variable that could then be referenced throughout the measure as a specific occurrence.