CMS 147 (0041) Denominator Exclusion

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    • CMS 147 Deceased Patients
    • Jennifer Jones
    • 503-293-0166
    • Providence Health & Services
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      CMS147 assesses whether the flu vaccine was given for the flu season which ends during the measurement period. In CMS147v6, the initial population requires that for certain types of visits, there be at least two visits during the measurement period. CMS147v7 removes this requirement, and requires at least one visit of all types included in the measure to occur during the measurement period. However, in both versions of the measure, the denominator further constrains that a patient must have a visit during the flu season, which allows for visits from October through December of the year prior to the measurement period, as well as January through March of the measurement period. In instances where a patient was seen in February of the measurement period, the initial population and denominator requirements would be met for v7. However, if the patient was not seen until June of the measurement period, they would also need to have a visit between October and December of the year prior in order to meet the denominator criteria.

       

      As this measure primarily focuses on outpatient encounters, the likelihood of a patient dying in between events that would satisfy the measure requirements, or at an encounter during the flu season which ends during the measurement period, is low. While we acknowledge there are some specialists for which this may be a slightly more frequent occurrence, the work group which developed this measure did not believe these types of cases would have a significant impact on a provider’s performance on this measure. Therefore, this measure does not explicitly address instances where a patient dies.

       

      However, in a situation where a patient dies during an encounter which would impact the ability of a provider to administer the flu vaccine, the medical exception would be appropriate. For implementation purposes, PCPI would recommend mapping to a generic concept within the ‘Medical Reason’ value set an appropriate exception. For example, for reporting or submitting purposes for CMS147, a local system could map a concept of ‘patient expired’ to ‘contraindicated’ or ‘not indicated,’ which are included in the value set.
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      CMS147 assesses whether the flu vaccine was given for the flu season which ends during the measurement period. In CMS147v6, the initial population requires that for certain types of visits, there be at least two visits during the measurement period. CMS147v7 removes this requirement, and requires at least one visit of all types included in the measure to occur during the measurement period. However, in both versions of the measure, the denominator further constrains that a patient must have a visit during the flu season, which allows for visits from October through December of the year prior to the measurement period, as well as January through March of the measurement period. In instances where a patient was seen in February of the measurement period, the initial population and denominator requirements would be met for v7. However, if the patient was not seen until June of the measurement period, they would also need to have a visit between October and December of the year prior in order to meet the denominator criteria.   As this measure primarily focuses on outpatient encounters, the likelihood of a patient dying in between events that would satisfy the measure requirements, or at an encounter during the flu season which ends during the measurement period, is low. While we acknowledge there are some specialists for which this may be a slightly more frequent occurrence, the work group which developed this measure did not believe these types of cases would have a significant impact on a provider’s performance on this measure. Therefore, this measure does not explicitly address instances where a patient dies.   However, in a situation where a patient dies during an encounter which would impact the ability of a provider to administer the flu vaccine, the medical exception would be appropriate. For implementation purposes, PCPI would recommend mapping to a generic concept within the ‘Medical Reason’ value set an appropriate exception. For example, for reporting or submitting purposes for CMS147, a local system could map a concept of ‘patient expired’ to ‘contraindicated’ or ‘not indicated,’ which are included in the value set.
    • CMS147v7/NQF0041
    • CMS147v6/NQF0041
    • Impacts the numerator of the Measure as providers are unable to council patients or administer influenza immunizations if they have deceased since the initial visit.

      I noticed that Patient is deceased is not contained in any of the Value Sets for Denominator Exclusion. If a patient has deceased after an initial visit they would not be able to be receive an Influenza immunization <= 89 day(s) starts after or concurrent with start of "Measurement Period". Shouldn't patients that have deceased in this time frame be excluded from the denominator?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Jennifer Jones (Inactive)
            Jennifer Jones (Inactive)
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