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  2. CQM-2374

QRDA I file contains multiple ER Visits which could qualify as "Occurrence A"

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      Thank you for your question! There are two parts to your question and it would be best if the second one is answered first. You are asking about Occurrence A of the ED Encounter and it ending <=6 hrs before or concurrent with the start of the Inpatient Encounter. The way version 5 of ED 3 is written, the AND NOT will exclude an Occurrence A of the ED Encounter which ends within 6 hours of the Inpatient Encounter. There are 2 parts of this--one is that ED 3, CMS32 is an outpatient measure and is only looking for patients who were discharged from the ED, so the logic in the Measure Population will rightly exclude patients who are admitted to an Inpatient Encounter. This logic in version 5 was changed for version 6, and the <=6 hours was changed to the ED Encounter (Occurrence A) <=1 hour ends before or concurrent with the Inpatient Encounter. This was done to align this particular logic with other Eligible Hospital Measures.

       

      As far as the Occurrencing of the ED Encounter, using "Occurrence A" defines one instance of an ED Encounter. Whenever an ED Encounter in the measure is labeled as Occurrence A, it is referring to the original ED Encounter labeled with Occurrence A (in this measure, the ED encounter defined in the Initial Population).
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      Thank you for your question! There are two parts to your question and it would be best if the second one is answered first. You are asking about Occurrence A of the ED Encounter and it ending <=6 hrs before or concurrent with the start of the Inpatient Encounter. The way version 5 of ED 3 is written, the AND NOT will exclude an Occurrence A of the ED Encounter which ends within 6 hours of the Inpatient Encounter. There are 2 parts of this--one is that ED 3, CMS32 is an outpatient measure and is only looking for patients who were discharged from the ED, so the logic in the Measure Population will rightly exclude patients who are admitted to an Inpatient Encounter. This logic in version 5 was changed for version 6, and the <=6 hours was changed to the ED Encounter (Occurrence A) <=1 hour ends before or concurrent with the Inpatient Encounter. This was done to align this particular logic with other Eligible Hospital Measures.   As far as the Occurrencing of the ED Encounter, using "Occurrence A" defines one instance of an ED Encounter. Whenever an ED Encounter in the measure is labeled as Occurrence A, it is referring to the original ED Encounter labeled with Occurrence A (in this measure, the ED encounter defined in the Initial Population).

      Clarification on CMS32v5 and identifying “Occurrence A” in the Initial Patient Population.

      We have a test QRDA file from Cypress containing two separate Emergency Department Visits which fall into the Initial Patient Population, and could be assigned as “Occurrence A”.

      Initial Patient Population definition: “Occurrence A of Encounter, Performed: Emergency Department Visit" during "Measurement Period”

      After this logic, we still have two ER Visits which are applicable.

      When applying this occurrence to the subsequent Measure Population Definition (based on section 2.8.5 of the QDM manual)
      • AND NOT: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 6 hour(s) ends before or concurrent with start of "Encounter, Performed: Encounter Inpatient"

      The earliest ER Visit does not fall within six hours of the Inpatient Encounter (passes the logic), but the second ER Visit does (fails the logic). Cypress is stating that this file should pass the measure logic, and because of how we are evaluating the occurrences, it is failing the measure logic.

      From the documentation I have read on defining occurrences, I have not found any documentation on the proper way to determine “Occurrence A” in an instance such as this. We are looking for further guidance on this. We have referenced the QDM manual (version 4.1.2), but do not see this specific type of instance addressed.

      We have attached the file in question.

            JLeflore Joelencia Leflore
            JLeflore Joelencia Leflore
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