Thank you for your insightful feedback. We will assess and determine whether there are alternate approaches to express the intent of the measure in the upcoming annual update. We welcome suggestions for alternate approaches from other measure developers and measurement experts as well. Furthermore, we think this would need broader discussion with measure development and eCQM community. We are open to receiving feedback from vendors and implementers on how their system handles CMS161.

CMS161 looks at the Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified.   This measure is intended to only require a suicide risk assessment at the visit where a new or recurrent episode of Major Depressive Disorder (MDD) is started. Measure implementers have given us feedback that capturing a new or recurrent episode of Major Depressive Disorder (MDD) to identify the initial population/denominator has been challenging, as MDD diagnosis starts and stops during the encounter. Every visit for MDD is showing up as a new episode of MDD. After discussion, the clinical experts agreed that the logic should be modified and to introduce a look back period of 105 days, such that an episode of MDD would only be considered to be a recurrence if the patient has not had an MDD-related encounter within the past 105 days, thus eliminating routine visits for an ongoing case of MDD from the measure. https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/adult-major-depressive-disorder-mdd-suicide-risk-assessment Propose revising the initial population logic by introducing a look back period of 105 days in order to limit the initial population to patients with a new or recurrent episode of MDD (if there is a gap of >=105 days between visits for MDD, clinical experts suggest that would imply a recurrent episode). PCPI also proposes to revise the classification of the ‘Major Depressive Disorder-Active’ diagnosis as an attribute of an encounter to ensure that the encounter is related to patient’s MDD. We seek feedback on the following proposed logic:   Current logic: •Initial Population = ◦AND: Age>= 17 year(s) at: "Measurement Period" ◦AND: "Diagnosis: Major Depressive Disorder-Active" starts during Occurrence A of $MDDEncounters161 •Denominator = ◦AND: Initial Population Variable: •$MDDEncounters161 = ◦Union of: ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation" ◾"Encounter, Performed: Psych Visit - Psychotherapy" ◾"Encounter, Performed: Emergency Department Visit" ◾"Encounter, Performed: Office Visit" ◾"Encounter, Performed: Outpatient Consultation" ◾"Encounter, Performed: Psychoanalysis" ◾"Encounter, Performed: Face-to-Face Interaction" ◾during "Measurement Period"   Proposed logic:   •Initial Population = ◦AND: Age>= 17 year(s) at: "Measurement Period" ◦AND: Occurrence A of $MDDEncounters161 ◦AND NOT: Occurrence B of $MDDEncounters161 < 105 days ends before start of Occurrence A of $MDDEncounters161 •Denominator = ◦AND: Initial Population   Variable: •$MDDEncounters161 = ◦Union of: ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Psych Visit – Psychotherapy (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Emergency Department Visit (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Office Visit (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Outpatient Consultation (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Psychoanalysis (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Face-to-Face Interaction (diagnosis: Major Depressive Disorder-Active)” ◾during "Measurement Period"

PCPI proposes revising the initial population logic by introducing a look back period of 105 days in order to limit the initial population to patients with a new or recurrent episode of MDD (if there is a gap of >=105 days between visits for MDD, clinical experts suggest that would imply a recurrent episode). PCPI also proposes to revise the classification of the ‘Major Depressive Disorder-Active’ diagnosis as an attribute of an encounter to ensure that the encounter is related to patient’s MDD.     Current logic: •Initial Population = ◦AND: Age>= 17 year(s) at: "Measurement Period" ◦AND: "Diagnosis: Major Depressive Disorder-Active" starts during Occurrence A of $MDDEncounters161 •Denominator = ◦AND: Initial Population Variable: •$MDDEncounters161 = ◦Union of: ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation" ◾"Encounter, Performed: Psych Visit - Psychotherapy" ◾"Encounter, Performed: Emergency Department Visit" ◾"Encounter, Performed: Office Visit" ◾"Encounter, Performed: Outpatient Consultation" ◾"Encounter, Performed: Psychoanalysis" ◾"Encounter, Performed: Face-to-Face Interaction" ◾during "Measurement Period"   Proposed logic:   •Initial Population = ◦AND: Age>= 17 year(s) at: "Measurement Period" ◦AND: Occurrence A of $MDDEncounters161 ◦AND NOT: Occurrence B of $MDDEncounters161 < 105 days ends before start of Occurrence A of $MDDEncounters161 •Denominator = ◦AND: Initial Population   Variable: •$MDDEncounters161 = ◦Union of: ◾"Encounter, Performed: Psych Visit - Diagnostic Evaluation (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Psych Visit – Psychotherapy (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Emergency Department Visit (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Office Visit (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Outpatient Consultation (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Psychoanalysis (diagnosis: Major Depressive Disorder-Active)” ◾"Encounter, Performed: Face-to-Face Interaction (diagnosis: Major Depressive Disorder-Active)” ◾during "Measurement Period"