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  2. CQM-1335

Exception guidance conflicts with measure logic

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Minor Minor
    • Measure
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      In preparation for the Annual Update cycle taking place in 2016, the PCPI wanted to do our due diligence in closing out this issue surrounding how the Limited Life Expectancy denominator exception is applied. Historically, this measure has only allowed for this as an exception for not screening a patient for tobacco use; however, as evidenced in the comments of this JIRA ticket, there is a strong desire to have this exception applicable to both the screening and cessation intervention components of the measure.
       
       
      We reached out to clinical experts involved in the development of this measure and provided them with background information on this issue and asked for their expert feedback to help determine if it would be appropriate to modify how this exception is applied. There was consensus that Limited Life Expectancy should be a valid denominator exception for the overall measure, and not limited to the screening. Therefore, in the upcoming round of annual updates, we will modify CMS138 and apply the denominator exception of Limited Life Expectancy broadly to the measure as a whole, and modify the guidance statement to align with this change.
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      In preparation for the Annual Update cycle taking place in 2016, the PCPI wanted to do our due diligence in closing out this issue surrounding how the Limited Life Expectancy denominator exception is applied. Historically, this measure has only allowed for this as an exception for not screening a patient for tobacco use; however, as evidenced in the comments of this JIRA ticket, there is a strong desire to have this exception applicable to both the screening and cessation intervention components of the measure.     We reached out to clinical experts involved in the development of this measure and provided them with background information on this issue and asked for their expert feedback to help determine if it would be appropriate to modify how this exception is applied. There was consensus that Limited Life Expectancy should be a valid denominator exception for the overall measure, and not limited to the screening. Therefore, in the upcoming round of annual updates, we will modify CMS138 and apply the denominator exception of Limited Life Expectancy broadly to the measure as a whole, and modify the guidance statement to align with this change.
    • CMS138v3/NQF0028
    • Incorrect data

      The guidance for this measure states: "Exceptions only apply to the screening data element of the measure; once a patient has been screened, there are no allowable exceptions for not providing the intervention." However there is nothing in the Population Criteria that enforces this guidance. Specifically, if the patient has a limited life expectancy diagnosis and is screened but receives no intervention, the logic requires that he be excluded. Test patients will certainly be excluded. We have been told in the past that guidance is not to be followed if it is not reflected in the population criteria.

      Furthermore, the logic guidance states:  Denominator Exceptions (DException): A subset of the Denominator. Only those members of the Denominator that are considered for Numerator membership and are not included are considered for membership in the Denominator Exceptions.

        1. 2015-0204 CMS 138-Tobacco Measure CRP Presentation.pdf
          243 kB

            edave Mathematica EC eCQM Team
            hbregman Howard Bregman (Inactive)
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