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EC eCQMs - Eligible Clinicians
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Resolution: Done
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Moderate
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CMS-90 logic clarification
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Catherine Koop
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Rush Health
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see above
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We are assessing the implications of problem list diagnoses vs. encounter diagnoses across all our measures. We will reach out to vendors and others to aid in that assessment. Any updates will be included with the 2019 Annual Update
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CMS90v6/NQFna
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In our EMR, patients are incorrectly being included in the denominator for CMS-90 Functional Status Assessments for Congestive Heart Failure making scores invalid.
Our EMR (Epic) is counting ALL VISITS for a patient with CHF on the Problem List rather than just those visits where CHF was the Visit Diagnosis. That means a Dermatologist who sees a patient for a rash and also happens to have CHF would be expected to perform a Functional Status Assessment. That clearly does not make sense clinically! Please clarify if the logic should be looking to the Problem List or the Visit Diagnosis for inclusion into the denominator for this measure.
Here is an actual example of the issue:
Patient "X" was seen by Dr. "A" on 4/5/2017, 8/8/2017, and 11/17/2017. CHF was on the problem list the whole time.
The measure is counting 4/5/17 as the initial encounter, and 8/8/2017 as the follow-up encounter even though CHF was not the reason for the visit. The only encounter in which CHF was on the visit diagnosis was the 11/17/17 encounter, so it certainly seems problematic that the measure would be looking for functional assessments on the two visits PRIOR to that one.