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  2. CQM-1722

CMS136:Need clarification on Denominator Exclusion condition

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Mangala Mayekar
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      The intent of this measure is to assess follow-up care for children newly prescribed ADHD medication. Children who received ADHD medications during the 120 days prior to the medication dispensed in the Initial Patient Population logic are excluded because they would not be considered to be newly prescribed the medication.
      In the case you describe, the patient would be picked up by the IP logic first and then excluded from the denominator because there was an active ADHD medication prior to the one dispensed in the IP logic.
        
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      The intent of this measure is to assess follow-up care for children newly prescribed ADHD medication. Children who received ADHD medications during the 120 days prior to the medication dispensed in the Initial Patient Population logic are excluded because they would not be considered to be newly prescribed the medication. In the case you describe, the patient would be picked up by the IP logic first and then excluded from the denominator because there was an active ADHD medication prior to the one dispensed in the IP logic.   
    • CMS136v4/NQF0108
    • High

      In HTML doc, Initial Patient Population 2 states below

      OR: "Occurrence A of Medication, Active: ADHD Medications (cumulative medication duration >= 210 day(s))" starts after start of "Occurrence A of Medication, Dispensed: ADHD Medications"
      OR: "Occurrence A of Medication, Active: ADHD Medications (cumulative medication duration >= 210 day(s))" starts concurrent with "Occurrence A of Medication, Dispensed: ADHD Medications"

      whereas Denominator exclusion 2 states below
      Medication, Active: ADHD Medications" <= 120 day(s) starts before start of "Occurrence A of Medication, Dispensed: ADHD Medications"

      So if a patient has Medication, Active: ADHD Medications which starts before Medication, Dispensed: ADHD Medication then the patient would get excluded from Initial Population criteria and would never fall under Denominator exclusion .

      Kindly suggest if the above understanding is correct

        1. CMS136v4.html
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            edave Mathematica EC eCQM Team
            mangalam Mangala (Inactive)
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