Exclusion lookbacks

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Done
    • Priority: Critical
    • Component/s: Measure
    • Bandish Momin
    • 9099690512
    • Arcadia Solutions
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      The exclusion logic is meant to capture patients who have a previous diagnosis of depression or bipolar at the time of their encounter. A diagnosis is not necessarily related to any particular assessment. The diagnosis should start before and overlap the encounter, meaning that it began at any point prior to the encounter and is still an active problem at the time of the encounter. If a diagnosis was made in the past and has been resolved (it is no longer an active diagnosis at the time of the encounter) it would not overlap and therefore the patient would not be excluded.
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      The exclusion logic is meant to capture patients who have a previous diagnosis of depression or bipolar at the time of their encounter. A diagnosis is not necessarily related to any particular assessment. The diagnosis should start before and overlap the encounter, meaning that it began at any point prior to the encounter and is still an active problem at the time of the encounter. If a diagnosis was made in the past and has been resolved (it is no longer an active diagnosis at the time of the encounter) it would not overlap and therefore the patient would not be excluded.
    • CMS2v6/NQF0418

      eMeasure Title: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
      eMeasure Identifier: 2
      eMeasure Version number: 7.1.000

      Logic for exclusion is as follows:
      Denominator Exclusions =
      OR: "Diagnosis: Depression diagnosis" satisfies all:
      starts before start of ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" )
      overlaps ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" )

      Does the same diagnosis of depression need to satisfy both the conditions (of starting before and overlapping)? Assessments documented in EHRs and claims submitted for depression are usually one-day events, so will never be able to satisfy condition of starting before and overlapping an encounter. Only problem list entries will exclude the patients as they range over multiple days.
      OR can the patient be excluded if different depression diagnoses events satisfy the two conditions separately (eg: patient had depression assessment a month before qualifying encounter and a separate depression assessment on the day of qualifying encounter).

      Please let me know if you need any clarifications before answering the question.

      Thanks!
      Bandish

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Bandish Momin (Inactive)
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