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  2. CQM-1683

CMS140v3_NQF0387_BrCA_HormonalTherapy_Discrepancy in IPP

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Minor Minor
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    • michelle
    • Citiustech
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      CMS140 has various requirements to meet the IPP:
      1) that the first diagnosis of breast cancer be within 5 years of an office visit or face-to-face encounter.
      2) that the patient had two or more interactions with the provider (thereby implying a patient/provider relationship)
      3) that the patient is female, aged 18 years or older
       
      The values included in "Face-to-Face Interaction" (which would fulfill the 1st criteria noted above) are a subset of those values included in "Patient Provider Interaction" (which would contribute to satisfying the 2nd criteria noted above). So technically, the "Face-to-Face Interaction" is included in the Count >=2: Encounter, Performed. In addition to the values included in the "Face-to-Face Interaction" value set, the "Patient Provider Interaction" value set also includes virtual interactions such as phone, text, email, etc. While we allow these virtual interactions to be counted as the minimum # of visits with the EP during the measurement period, the encounter where the measure action is evaluated needs to occur at a face-to-face interaction, which is why we only include the latter in the logic phrase that references the diagnosis.
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      CMS140 has various requirements to meet the IPP: 1) that the first diagnosis of breast cancer be within 5 years of an office visit or face-to-face encounter. 2) that the patient had two or more interactions with the provider (thereby implying a patient/provider relationship) 3) that the patient is female, aged 18 years or older   The values included in "Face-to-Face Interaction" (which would fulfill the 1st criteria noted above) are a subset of those values included in "Patient Provider Interaction" (which would contribute to satisfying the 2nd criteria noted above). So technically, the "Face-to-Face Interaction" is included in the Count >=2: Encounter, Performed. In addition to the values included in the "Face-to-Face Interaction" value set, the "Patient Provider Interaction" value set also includes virtual interactions such as phone, text, email, etc. While we allow these virtual interactions to be counted as the minimum # of visits with the EP during the measurement period, the encounter where the measure action is evaluated needs to occur at a face-to-face interaction, which is why we only include the latter in the logic phrase that references the diagnosis.
    • CMS140v3/NQF0387
    • High

      AND: FIRST: "Occurrence A of Diagnosis, Active: Breast Cancer" <= 5 year(s) starts before or during
      OR: "Occurrence A of Encounter, Performed: Office Visit"
      OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      during "Measurement Period"
      AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
      AND: Count >= 2 of:
      OR: "Encounter, Performed: Office Visit"
      OR: "Encounter, Performed: Patient Provider Interaction"
      during "Measurement Period"
      AND: "Patient Characteristic Sex: Female"

      IN diagnosis its mentioned for the Encounters of Office visit and Face-to-Face visit.

      The count of the Encounters is required for Office visit and Patient Provider Interaction, the validation in the rest of the measure is done only for "Office visit and Face-to-Face visit."
      There is no validation provided for Patient Provider Interaction encounter

      The Face-to-Face visit is not validated in the IPP

            edave Mathematica EC eCQM Team
            michellen michelle (Inactive)
            Mangala (Inactive)
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