Numerator calculation change may not be intentional

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    • Type: Implementation Problem
    • Resolution: Done
    • Priority: Minor
    • Component/s: Measure
    • Vendor/Epic
    • Clarification
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      1. You are interpreting the new language correctly.
      2. The change to evaluate the last encounter was intentional. This change was made to accommodate encounters where it was unlikely a BP would be taken, for example a behavioral health encounter. The change to require the diagnosis to overlap the visit was not intentional and will be removed in the next annual update. Because the patients are required to have a diagnosis of hypertension to be in the measure, we expect this to only have a small impact on the measure.
      3. With the new constructs available in the new versions of QDM and HQMF, we were able to express the measure intent in the logic portion of the measure. Typically guidance is reserved for directions that can’t be expressed in the logic section of the measure.
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      1. You are interpreting the new language correctly. 2. The change to evaluate the last encounter was intentional. This change was made to accommodate encounters where it was unlikely a BP would be taken, for example a behavioral health encounter. The change to require the diagnosis to overlap the visit was not intentional and will be removed in the next annual update. Because the patients are required to have a diagnosis of hypertension to be in the measure, we expect this to only have a small impact on the measure. 3. With the new constructs available in the new versions of QDM and HQMF, we were able to express the measure intent in the logic portion of the measure. Typically guidance is reserved for directions that can’t be expressed in the logic section of the measure.
    • Change in calculation of numerator

      This is actually regarding CMS 165v4, but that is not an option in the EP measure selector.

      The numerator definition has been changed to the following:

      AND: Most recent: ◾"Occurrence A of Encounter, Performed: Adult Outpatient Visit" satisfies all ◾overlaps "Occurrence A of Diagnosis, Active: Essential Hypertension"
      ◾during "Measurement Period"
      ◾overlaps "Physical Exam, Performed: Diastolic Blood Pressure (result)"
      ◾overlaps "Physical Exam, Performed: Systolic Blood Pressure (result)"
      ◦ AND: "Physical Exam, Performed: Diastolic Blood Pressure" satisfies all ◾Most recent: during "Occurrence A of Encounter, Performed: Adult Outpatient Visit"
      ◾ (result < 90 mmHg)
      ◦ AND: "Physical Exam, Performed: Systolic Blood Pressure" satisfies all ◾Most recent: during "Occurrence A of Encounter, Performed: Adult Outpatient Visit"
      ◾ (result < 140 mmHg)

      If we are interpreting the HQMF correctly, the algorithm can be restated as:

      Take the most recent encounter during MP during which the patient had bp recorded and diagnosis of hypertention.
      Take the last bp sys and dias reading from that encounter.
      Include patient if sys < 140 and dias < 90.

      This represents a change since version 3 in the following aspects:
      1. The hypertension diagnosis must overlap with the encounter, when in version 3 it only had to overlap the measurement period.
      2. Version 3 evaluated the latest encounter for bp below a threshold. Version 4 evaluates the latest encounter with a bp recorded for bp below the threshold. Meaning version 3 would count the last encounter even if no bp was recorded.

      Our questions are:
      1. Are we interpreting the new language correctly?
      2. Were the changes intentional?
      3. If the changes are intentional, why don't they appear in the guidance?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Howard Bregman (Inactive)
            Anne Smith (Inactive), Celia Lam (Inactive), Elissa Chandler (Inactive)
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              Created:
              Updated:
              Resolved:
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