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  2. CQM-1761

CMS-153 Denom Exclusion logic doesn't match intent of the exclusion

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    • Resolution: Answered
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      Thank you for your question. According to QDMv4.2, the Starts After End Of (SAE) timing operator asserts that the start date/time of an event (i.e., X-Ray order) on the left-hand side (LHS) is temporally after the end date/time of an event on the right-hand side (RHS) (Lab test order). The additional comparison operator (<= 7 day(s)) limits the maximum timeframe that the LHS event can start in relationship to the end of the RHS event. However, the LHS event may take place on the same day as the RHS event, but is must start after the end of the RHS event. In this scenario, since both events happen on the same day, the level of granularity need to determine if 'A' SAE 'B' would be time (hour and/or minute if necessary).
       
       
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      Thank you for your question. According to QDMv4.2, the Starts After End Of (SAE) timing operator asserts that the start date/time of an event (i.e., X-Ray order) on the left-hand side (LHS) is temporally after the end date/time of an event on the right-hand side (RHS) (Lab test order). The additional comparison operator (<= 7 day(s)) limits the maximum timeframe that the LHS event can start in relationship to the end of the RHS event. However, the LHS event may take place on the same day as the RHS event, but is must start after the end of the RHS event. In this scenario, since both events happen on the same day, the level of granularity need to determine if 'A' SAE 'B' would be time (hour and/or minute if necessary).     We hope this addresses your question.
    • CMS153v4/NQF0033
    • Measure logic does not match intent

      The logic for the denominator exclusion is as follows:

      Denominator Exclusions =
      • OR:
      o AND: "Occurrence A of Laboratory Test, Order: Pregnancy Test" during "Measurement Period"
      o AND: Union of:
       "Medication, Order: Isotretinoin"
       "Diagnostic Study, Order: X-Ray Study (all inclusive)"
       <= 7 day(s) starts after end of "Occurrence A of Laboratory Test, Order: Pregnancy Test"

      Per Appendix C of the logic guidance, the granularity of the lookback indicates the gruanularoty to be used when computing that portion of the measure. (A lookback of <=7 days indicates we should compute to the granularity of days.) Since the logic for the Laboratory Test, Order data element is ‘start after end of’ and not concurrent, this means that a lab and a med/x-ray on the same day would not count.

      That does not seem in line with the intent of the measure, which likely envisions a workflow where the provider would order an result a pregnancy test, and then order a medication/x-ray upon a negative test result.

            edave Mathematica EC eCQM Team
            KelliKlippenstein Kelli Klippenstein (Inactive)
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