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Type: Implementation Problem
Resolution: Answered
Priority: Minor
Component/s: Measure
Labels:
- CRP
- Measure

Solution:

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Thank you for your comments. We will consider this for the next annual update.

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Thank you for your comments. We will consider this for the next annual update.
Impact:
EHR vendor implementation of this CQM calculation
CRP Overview:

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Measure Description:

Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.
b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

JIRA Issue Description:

In the population criteria at the end of numerator1 section, OR: "Encounter, Performed: Outpatient Consultation" < = 30 day(s) ends after end of "Occurrence A of Medication, Dispensed: ADHD Medications." The temporal logic "ends after end" between "Encounter, performed" and "Medication, dispensed" compares the end timestamps, which may cause putting patients into numerator by mistake, depending on the system. This temporal logic is intended to consider the patient who has a "follow-up" visit after the ADHD medication dispense. However, the comparison "ends after end" may include the encounter (by mistake) during which the provider prescribes or dispenses the medication. For EP, an encounter is usually a 'one day' event. The fact a patient visits the same provider twice or three times within the same day constitutes only one encounter—only one CPT code instance is allowed. Thus, ambulatory systems usually by default set the encounter as one day event, starting at 00:00 and ending at 00:00 the next day (or 23:59 the same day). For example, if the patient had a visit on 1/30/2012, the start/end times could be recorded as "00:00 1/30/2012" and "00:00 1/31/2012". The ADHD may be dispensed at "20:00 1/30/2012" per the provider's order. The end time stamp will qualify the patient into the numerator but the patient doesn't have a follow-up visit. In the denominator section, there is a line of rule AND: "Occurrence A of Encounter, Performed: Inpatient Encounter" <= 30 day(s) starts after end of "Occurrence A of Medication, Dispensed: ADHD Medications", which use "starts after end" to compare two events. We feel "starts after end" will better serve the purpose for other instances in this eCQM rules and will resolve the unexpected result in the example. Please take this into consideration into the measure update.

https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/adhd-follow-care-children-prescribed-attention-deficithyperactivity

Change Description:
We changed the timing operator from for ADHD medications from "ends after end of" to "starts after end of."

The updated numerator 1 logic will be as follows:

•$Encounter30DaysAfterInitialADHDMed =
◦Union of:
◾"Encounter, Performed: Office Visit"
◾"Encounter, Performed: Hospital Observation Care - Initial"
◾"Encounter, Performed: Preventive Care Services - Group Counseling"
◾"Encounter, Performed: Behavioral Health Follow-up Visit"
◾"Encounter, Performed: Preventive Care Services-Individual Counseling"
◾"Encounter, Performed: Psychotherapy and Pharmacologic Management (facility location: Ambulatory)"
◾"Encounter, Performed: Face-to-Face Interaction"
◾"Encounter, Performed: Discharge Services- Observation Care"
◾"Encounter, Performed: Outpatient Consultation"
◾"Encounter, Performed: Home Healthcare Services"
◾"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17"
◾"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17"
◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation"
◾"Encounter, Performed: Psych Visit - Psychotherapy"
◾<= 30 day(s) starts after end of $InitialADHDMedication
Similar timing change will be made to numerator 2 as well.

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Measure Description: Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. JIRA Issue Description: In the population criteria at the end of numerator1 section, OR: "Encounter, Performed: Outpatient Consultation" < = 30 day(s) ends after end of "Occurrence A of Medication, Dispensed: ADHD Medications." The temporal logic "ends after end" between "Encounter, performed" and "Medication, dispensed" compares the end timestamps, which may cause putting patients into numerator by mistake, depending on the system. This temporal logic is intended to consider the patient who has a "follow-up" visit after the ADHD medication dispense. However, the comparison "ends after end" may include the encounter (by mistake) during which the provider prescribes or dispenses the medication. For EP, an encounter is usually a 'one day' event. The fact a patient visits the same provider twice or three times within the same day constitutes only one encounter—only one CPT code instance is allowed. Thus, ambulatory systems usually by default set the encounter as one day event, starting at 00:00 and ending at 00:00 the next day (or 23:59 the same day). For example, if the patient had a visit on 1/30/2012, the start/end times could be recorded as "00:00 1/30/2012" and "00:00 1/31/2012". The ADHD may be dispensed at "20:00 1/30/2012" per the provider's order. The end time stamp will qualify the patient into the numerator but the patient doesn't have a follow-up visit. In the denominator section, there is a line of rule AND: "Occurrence A of Encounter, Performed: Inpatient Encounter" <= 30 day(s) starts after end of "Occurrence A of Medication, Dispensed: ADHD Medications", which use "starts after end" to compare two events. We feel "starts after end" will better serve the purpose for other instances in this eCQM rules and will resolve the unexpected result in the example. Please take this into consideration into the measure update. https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/adhd-follow-care-children-prescribed-attention-deficithyperactivity Change Description: We changed the timing operator from for ADHD medications from "ends after end of" to "starts after end of." The updated numerator 1 logic will be as follows: •$Encounter30DaysAfterInitialADHDMed = ◦Union of: ◾"Encounter, Performed: Office Visit" ◾"Encounter, Performed: Hospital Observation Care - Initial" ◾"Encounter, Performed: Preventive Care Services - Group Counseling" ◾"Encounter, Performed: Behavioral Health Follow-up Visit" ◾"Encounter, Performed: Preventive Care Services-Individual Counseling" ◾"Encounter, Performed: Psychotherapy and Pharmacologic Management (facility location: Ambulatory)" ◾"Encounter, Performed: Face-to-Face Interaction" ◾"Encounter, Performed: Discharge Services- Observation Care" ◾"Encounter, Performed: Outpatient Consultation" ◾"Encounter, Performed: Home Healthcare Services" ◾"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17" ◾"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17" ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation" ◾"Encounter, Performed: Psych Visit - Psychotherapy" ◾<= 30 day(s) starts after end of $InitialADHDMedication Similar timing change will be made to numerator 2 as well.
CRP Recommendations:

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We changed the timing operator from for ADHD medications from "ends after end of" to "starts after end of."

The updated numerator 1 logic will be as follows:

•$Encounter30DaysAfterInitialADHDMed =
◦Union of:
◾"Encounter, Performed: Office Visit"
◾"Encounter, Performed: Hospital Observation Care - Initial"
◾"Encounter, Performed: Preventive Care Services - Group Counseling"
◾"Encounter, Performed: Behavioral Health Follow-up Visit"
◾"Encounter, Performed: Preventive Care Services-Individual Counseling"
◾"Encounter, Performed: Psychotherapy and Pharmacologic Management (facility location: Ambulatory)"
◾"Encounter, Performed: Face-to-Face Interaction"
◾"Encounter, Performed: Discharge Services- Observation Care"
◾"Encounter, Performed: Outpatient Consultation"
◾"Encounter, Performed: Home Healthcare Services"
◾"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17"
◾"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17"
◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation"
◾"Encounter, Performed: Psych Visit - Psychotherapy"
◾<= 30 day(s) starts after end of $InitialADHDMedication
Similar timing change will be made to numerator 2 as well.

Show
We changed the timing operator from for ADHD medications from "ends after end of" to "starts after end of." The updated numerator 1 logic will be as follows: •$Encounter30DaysAfterInitialADHDMed = ◦Union of: ◾"Encounter, Performed: Office Visit" ◾"Encounter, Performed: Hospital Observation Care - Initial" ◾"Encounter, Performed: Preventive Care Services - Group Counseling" ◾"Encounter, Performed: Behavioral Health Follow-up Visit" ◾"Encounter, Performed: Preventive Care Services-Individual Counseling" ◾"Encounter, Performed: Psychotherapy and Pharmacologic Management (facility location: Ambulatory)" ◾"Encounter, Performed: Face-to-Face Interaction" ◾"Encounter, Performed: Discharge Services- Observation Care" ◾"Encounter, Performed: Outpatient Consultation" ◾"Encounter, Performed: Home Healthcare Services" ◾"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17" ◾"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17" ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation" ◾"Encounter, Performed: Psych Visit - Psychotherapy" ◾<= 30 day(s) starts after end of $InitialADHDMedication Similar timing change will be made to numerator 2 as well.

In the population criteria at the end of numerator1 section,

OR: "Encounter, Performed: Outpatient Consultation"
<= 30 day(s) ends after end of "Occurrence A of Medication, Dispensed: ADHD Medications"

The temporal logic "ends after end" between "Encounter, performed" and "Medication, dispensed" compares the end timestamps, which may cause putting patients into numerator by mistake, depending on the system.

This temporal logic is intended to consider the patient who has a "follow-up" visit after the ADHD medication dispense. However, the comparison "ends after end" may include the encounter (by mistake) during which the provider prescribes or dispenses the medication.
For EP, an encounter is usually a 'one day' event. The fact a patient visits the same provider twice or three times within the same day constitutes only one encounter—only one CPT code instance is allowed. Thus, ambulatory systems usually by default set the encounter as one day event, starting at 00:00 and ending at 00:00 the next day (or 23:59 the same day).
For example, if the patient had a visit on 1/30/2012, the start/end times could be recorded as "00:00 1/30/2012" and "00:00 1/31/2012". The ADHD may be dispensed at "20:00 1/30/2012" per the provider's order.
The end time stamp will qualify the patient into the numerator but the patient doesn't have a follow-up visit.

In the denominator section, there is a line of rule
AND: "Occurrence A of Encounter, Performed: Inpatient Encounter" <= 30 day(s) starts after end of "Occurrence A of Medication, Dispensed: ADHD Medications",
which use "starts after end" to compare two events.

We feel "starts after end" will better serve the purpose for other instances in this eCQM rules and will resolve the unexpected result in the example. Please take this into consideration into the measure update.

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