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  2. CQM-2279

EP_142v4 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

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      ​The scenario presented in the issue notes that the macular exam is performed during the second encounter (July 10th, 2015). Based on the measure logic, and using the second encounter as the ‘Occurrence A of $EyeCareEncounters’, the numerator would be met only if the communication occurred after the start of that encounter. If the first encounter (March 2nd, 2015) were used to assess the ‘Occurrence A of $EyeCareEncounters’, the denominator criteria would not be met since the macular exam did not occur during that encounter.

      The macular exam must be performed during the encounter used to determine whether or not the communication happened after the start of that encounter.
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      ​The scenario presented in the issue notes that the macular exam is performed during the second encounter (July 10th, 2015). Based on the measure logic, and using the second encounter as the ‘Occurrence A of $EyeCareEncounters’, the numerator would be met only if the communication occurred after the start of that encounter. If the first encounter (March 2nd, 2015) were used to assess the ‘Occurrence A of $EyeCareEncounters’, the denominator criteria would not be met since the macular exam did not occur during that encounter. The macular exam must be performed during the encounter used to determine whether or not the communication happened after the start of that encounter.

      As per CMS142v4

      Denominator =
      ◦AND: Initial Population
      ◦AND: "Diagnostic Study, Performed: Macular Exam (result)" during Occurrence A of $EyeCareEncounters

      Numerator =
      ◦AND: "Communication: From Provider to Provider: Level of Severity of Retinopathy Findings" starts after start of Occurrence A of $EyeCareEncounters
      ◦AND: Union of:
      "Communication: From Provider to Provider: Macular Edema Findings Present"
      "Communication: From Provider to Provider: Macular Edema Findings Absent"
      starts after start of Occurrence A of $EyeCareEncounters

      In case of two encounters like

      EyeCare Encounter 1 – startdate 2nd Mar 2015 2:00 PM

      EyeCare Encounter 2 – startdate 10th Jul 2015 5:00 PM

      Diagnostic Study Macular Exam (result) is Performed during EyeCare Encounter 2 i.e. startdate 10th Jul 2015 5:00 PM

      As per Numerator it has been mentioned that Communication: From Provider to Provider starts after start of Occurrence A of $EyeCareEncounters

      So If Communication is done on 5th Mar 2015 10:00 AM (after EyeCare Encounter 1 and before EyeCare Encounter 2) shall that pass numerator condition?

            edave Mathematica EC eCQM Team
            pradnyag Pradnya Gokhale (Inactive)
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