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CMS136: Numerator

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Icon: Minor Minor
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    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare
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      Thank you for your question. The measure assesses whether patients had a visit with a provider who has prescribing authority within 30 days of ADHD medication being dispensed (i.e., ADHD medication was prescribed by practitioner, and subsequently picked up at the pharmacy by patient or patient proxy). Therefore, in both examples, the patient would fall into the numerator 1.
       
      There are two components required for Numerator 2: 1) a face-to-face encounter within 30 days after the index prescription start date and 2) at least two follow-up visits within 31 and 300 days after the index prescription start date. Providing the medications are dispensed (as opposed to just being prescribed), both situations described in the examples would only satisfy the first component and not the second component of Numerator 2. Thus, neither example would be compliant for Numerator 2.
       
      It is important to mention that we are considering the following change: timing operator for medications changed from "ends after end of" to "starts after end of." This update would be made during the 2017 annual update cycle.
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      Thank you for your question. The measure assesses whether patients had a visit with a provider who has prescribing authority within 30 days of ADHD medication being dispensed (i.e., ADHD medication was prescribed by practitioner, and subsequently picked up at the pharmacy by patient or patient proxy). Therefore, in both examples, the patient would fall into the numerator 1.   There are two components required for Numerator 2: 1) a face-to-face encounter within 30 days after the index prescription start date and 2) at least two follow-up visits within 31 and 300 days after the index prescription start date. Providing the medications are dispensed (as opposed to just being prescribed), both situations described in the examples would only satisfy the first component and not the second component of Numerator 2. Thus, neither example would be compliant for Numerator 2.   It is important to mention that we are considering the following change: timing operator for medications changed from "ends after end of" to "starts after end of." This update would be made during the 2017 annual update cycle.
    • CMS136v6/NQF0108
    • CMS136v5
    • high impacts measure development

      QUESTION: CMS136v5

      Per the specification for the Numerator the encounter performed “ends after end of $InitialADHDMedication”.
      1. Does this mean that the medication must have a stop date and the encounter must be documented during or after the medication stop date? OR
      2. Can the medication continue to be active without having a medication stop date and the encounter can be performed within the specified timeframe after the FIRST medication has been prescribed?

      Example1:
      Numerator 1:
      • Patient has FIRST ADHD medication ($InitialADHDMedication) prescribed on 1/1/2016 which is within 60 days after the start of the measurement period with no medication stop date documented.
      • Patient then has an encounter Office Visit on 1/20/2016 which is within 30 days after the FIRST ADHD medication ($InitialADHDMedication) prescribed on 1/1/2016.
      • Will this patient meet Numerator even if there are no medication stop date documented?

      Example2:
      Numerator 1:
      • Patient has FIRST ADHD medication ($InitialADHDMedication) prescribed on 1/1/2016 which is within 60 days after the start of the measurement period with medication stop date of 1/15/2016.
      • Patient then has an encounter Office Visit on 1/20/2016 which is within 30 days after the stop date of 1/15/2016 of the FIRST ADHD medication ($InitialADHDMedication).
      • Will this patient meet Numerator because it was performed within 30 days after the medication has been stopped?

      Will your response also apply to Numerator Criteria 2 for any of the above examples?

        1. 12_8_16_CMS136_NUM_FOLLOW UP QUESTION.docx
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            edave Mathematica EC eCQM Team
            elissa Elissa Chandler (Inactive)
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