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  2. CQM-1262

Procedures & Encounters with no end date

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Minor Minor
    • Measure
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      Questions 1 & 2:
      This is hard to answer. The decision to consider or use start date instead of an end date is a clinical/measure development decision rather than one involving logic. In other words, I have no understanding of the clinical implications caused as a result of using a start date instead of an end date. I looked at the measure guidance and nothing in it states whether you should or should not use the start date. This maybe a question for the measure steward.
      That said, the use of start times for end times is typically less of an issue for short term events or events that are an instant in time. If you do not have an end time for a medication administration that is very different from a diagnosis active.
      Since this particular measure is dealing with outpatient encounters, the encounters are most likely very short events. Therefore, using the start time of the encounter as the end time will likely have minimal to no effect on the accuracy of the calculation. Some procedures or inpatient encounter can be very long in duration. This will cause an assumed end date to calculate improperly. Additionally, for certification, the certification testing for calculation will assume that you can capture and calculate against end dates appropriately.
      I don’t know if policy explicitly allows using start date for end date as part of calculation for short duration events in the case where end date is not available. However, for short duration events, the impact to the accuracy of the calculation is minimized.
      Question 3. The QDM-based HQMF IG states that a procedure "MAY" have an effective time, and if it does, it "SHOULD" have a low (start) and "SHOULD" have a high (end). Note that "SHOULD" is a strong recommendation, but it is still not a "SHALL"-- so it's not required.
      Calculation is possible without the inclusion of either a start date or an end date. However, the measure logic is defined such that all comparisons to an undefined date will evaluate to false. Therefore, any timing relationships that reference an end date (like ends before start, starts before end, during, etc) will evaluate to false.
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      Questions 1 & 2: This is hard to answer. The decision to consider or use start date instead of an end date is a clinical/measure development decision rather than one involving logic. In other words, I have no understanding of the clinical implications caused as a result of using a start date instead of an end date. I looked at the measure guidance and nothing in it states whether you should or should not use the start date. This maybe a question for the measure steward. That said, the use of start times for end times is typically less of an issue for short term events or events that are an instant in time. If you do not have an end time for a medication administration that is very different from a diagnosis active. Since this particular measure is dealing with outpatient encounters, the encounters are most likely very short events. Therefore, using the start time of the encounter as the end time will likely have minimal to no effect on the accuracy of the calculation. Some procedures or inpatient encounter can be very long in duration. This will cause an assumed end date to calculate improperly. Additionally, for certification, the certification testing for calculation will assume that you can capture and calculate against end dates appropriately. I don’t know if policy explicitly allows using start date for end date as part of calculation for short duration events in the case where end date is not available. However, for short duration events, the impact to the accuracy of the calculation is minimized. Question 3. The QDM-based HQMF IG states that a procedure "MAY" have an effective time, and if it does, it "SHOULD" have a low (start) and "SHOULD" have a high (end). Note that "SHOULD" is a strong recommendation, but it is still not a "SHALL"-- so it's not required. Calculation is possible without the inclusion of either a start date or an end date. However, the measure logic is defined such that all comparisons to an undefined date will evaluate to false. Therefore, any timing relationships that reference an end date (like ends before start, starts before end, during, etc) will evaluate to false.
    • CMS66v3/NQFna
    • Development

      For encounters or procedure sections, we are currently looking for the start date if the end date is not populated.
      Questions-
      1. Is this acceptable?
      2. Please advise how to handle encounters or procedures that have no end date/time
      3. Is the time stamp mandatory for Procedure sections ?

      Measure-EP_CMS66v2_NQFXXXX_FSA_Knee_Replacement is a good example- pls see below
      Initial Patient Population =◦AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
      ◦AND: ■OR: "Occurrence A of Procedure, Performed: Primary TKA Procedure" <= 180 day(s) ends before start of "Measurement Period"
      ■OR: "Occurrence A of Procedure, Performed: Primary TKA Procedure" <= 185 day(s) ends after start of "Measurement Period"
      ◦AND: ■OR: ■AND: "Occurrence A of Encounter, Performed: Outpatient Consultation" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Outpatient Consultation" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Outpatient Consultation" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■OR: ■AND: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■OR: ■AND: "Encounter, Performed: Office Visit" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Office Visit" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      •Denominator =◦AND: "Initial Patient Population"
      •Denominator Exclusions =◦AND: ■OR: ■AND: "Occurrence A of Diagnosis, Active: Fracture - Lower Body" < 1 day(s) starts before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence A of Diagnosis, Active: Fracture - Lower Body" >= 1 hour(s) ends after start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Diagnosis, Active: Fracture - Lower Body" < 1 day(s) starts before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■AND: "Occurrence B of Diagnosis, Active: Fracture - Lower Body" >= 1 hour(s) ends after start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ■OR: ■AND NOT: "Occurrence A of Diagnosis, Active: Severe Dementia" ends before start of "Measurement Period"
      ■AND: "Occurrence A of Diagnosis, Active: Severe Dementia" starts before or during "Measurement Period"
      •Numerator =◦AND: "Occurrence A of Functional Status, Result: Functional Status Assessment for Knee Replacement" <= 180 day(s) ends before start of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ◦AND: "Occurrence B of Functional Status, Result: Functional Status Assessment for Knee Replacement" <= 180 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      ◦AND: "Occurrence B of Functional Status, Result: Functional Status Assessment for Knee Replacement" >= 60 day(s) ends after end of "Occurrence A of Procedure, Performed: Primary TKA Procedure"
      •Denominator Exceptions =◦None

            julia.skapik Julia Skapik (Inactive)
            adetola Adetola Adetunji (Inactive)
            Adetola Adetunji (Inactive), Aldo Tinoco (Inactive), Cindy Cullen, Deborah Krauss (Inactive), Kevin Larsen (Inactive), Minet Javellana (Inactive), Rute Martins (Inactive), Samuel Sayer
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