The measure algorithm lists Occurrence B of Encounter, Performed: Hospital Measures - Encounter ED" as a Denominator Exclusion for Population 1 & 2 for this measure. The Hospital Measures - Encounter ED Value Set OID 2.16.840.1.113883.3.526.2.900 only includes “Emergency Department Patient Visit”. However, the written guidance states “Patients received as a transfer from the emergency/observation department of another hospital.” The written guidance and the algorithm do not align.

We believe that this statement should read as the other Transfer statements in this section. This would accurately exclude any transfers from another ED.

Scenario:
Patient is seen in the ED for a laceration. Patient returns 8 hours later and is admitted to the Hospital as an Inpatient. This patient would be excluded according to the algorithm. If we only look at ED visits within the last 24 hours and not ‘transfers’ from an ED.

OR:
o OR: "Transfer From: Hospital Measures-Acute care hospital"
o OR: "Transfer From: Hospital Measures-Ambulatory surgical center"
o OR: "Occurrence B of Encounter, Performed: Hospital Measures - Encounter ED"
o OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay < 24 hour(s))"
o < 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"

1.) What development guidance can you offer?