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EC eCQMs - Eligible Clinicians
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Resolution: Done
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Minor
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None
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​Thanks for the observation. This issue was resolved in later versions of the measure (CMS182v5 and later).
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CMS182v4/NQF0075
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Patients can incorrectly fall out of Numerator 2 if they have a reported LDL-C Laboratory Test after the Measurement Period has ended. This does not match the intent of the measure.
CMS182v4 contains the following narrative regarding Numerator 2:
Numerator 2: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL
The corresponding QDM measure logic in CMS182v4 is as follows:
- Numerator 2 =
- AND: MOST RECENT: "Occurrence A of Laboratory Test, Result: LDL-C Laboratory Test"
- AND: "Occurrence A of Laboratory Test, Result: LDL-C Laboratory Test (result < 100 mg/dL)" during "Measurement Period"
The logic doesn't correctly match the intent in the narrative. Here's why: If you look at the order of operations described in section 3.7 of the QDM 4.1 specification, you'll see that the MOST RECENT subset filter is applied before the occurrence label is applied. So the first AND statement basically ensures that Occurrence A can only be the most recent lab test-- but since it doesn't restrict it to be during the Measurement Period in that line, Occurrence A could be after the Measurement Period. Now the second line tries to ensure that Occurrence A has a result < 100 mg/dL and is during the Measurement Period. If the first line resolved to an Occurrence A after the Measurement Period, then the second line will always be false.
Or to put it another way: this logic works as intended as long as the most recent test is during the Measurement Period. If there is a more recent test after the Measurement Period (and it is reported in the QRDA Cat I), then this logic will not work as intended.