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  2. CQM-1703

CMS128:Need clarification on Startdate validation for Medication Active Antidepressant Medication

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    • Resolution: Answered
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    • Mangala Mayekar
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      According to the QDM, cumulative medication duration should generally be calculated as the number of doses in the interval of interest, divided by the doses per day. Therefore, only knowing the start and end dates does not allow you to calculate the cumulative medication duration. In addition, you cannot count a single calendar day more than once.

      Your example does not provide enough information to determine if a medication active starting 91 days before Occurrence A of medication dispensed would count towards the numerator.
       
      Let’s assume that medication is dispensed (Occurrence A) on January 1 of MY and a 31-day prescription is given to the patient (1pill per day). Now, assume that the medication is active on October 2 of previous year (or 91 days before the Occurrence A of medication dispensed) and a 121-day prescription is provided to that patient. Under this scenario, the patient will have a cumulative medication duration of only 31 days, and will hence not be in the numerator.
       
      For the scenario you have provided, the only way the patient makes it in the numerator is that the patient was given a 6-month (or 180-day) prescription on October 2, a highly unlikely scenario.
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      According to the QDM, cumulative medication duration should generally be calculated as the number of doses in the interval of interest, divided by the doses per day. Therefore, only knowing the start and end dates does not allow you to calculate the cumulative medication duration. In addition, you cannot count a single calendar day more than once. Your example does not provide enough information to determine if a medication active starting 91 days before Occurrence A of medication dispensed would count towards the numerator.   Let’s assume that medication is dispensed (Occurrence A) on January 1 of MY and a 31-day prescription is given to the patient (1pill per day). Now, assume that the medication is active on October 2 of previous year (or 91 days before the Occurrence A of medication dispensed) and a 121-day prescription is provided to that patient. Under this scenario, the patient will have a cumulative medication duration of only 31 days, and will hence not be in the numerator.   For the scenario you have provided, the only way the patient makes it in the numerator is that the patient was given a 6-month (or 180-day) prescription on October 2, a highly unlikely scenario.
    • CMS128v3/NQF0105
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      Denominator Exclusions =

      AND: "Medication, Active: Antidepressant Medication" <= 90 day(s) starts before start of "Occurrence A of Medication, Dispensed: Antidepressant Medication"

      Guidance states below:

      Numerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date

      Numerator under Population criteria states "Medication, Active: Antidepressant Medication (cumulative medication duration >= 84 day(s))" <= 114 day(s) ends after start of "Occurrence A of Medication, Dispensed: Antidepressant Medication"

      Document doesn't state anything regarding startdate of Medication, Active: Antidepressant Medication.Kindly suggest

      Scenario wherein a patient has medication Active which starts before 91 days of medication dispensed and ends within 114 days of medication dispensed then would this patient needs to be consider for Numerator validation cumulative duration calculation.

      Kindly suggest.

            edave Mathematica EC eCQM Team
            mangalam Mangala (Inactive)
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