Brief description of measure: ​CMS56: Functional Status Assessment for Total Hip Replacement CMS66: Functional Status Assessment for Total Knee Replacement CMS69: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CMS74: Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists CMS75: Children Who Have Dental Decay or Cavities CMS90: Functional Status Assessments for Congestive Heart Failure CMS117: Childhood Immunization Status CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) CMS124: Cervical Cancer Screening CMS125: Breast Cancer Screening CMS127: Pneumococcal Vaccination Status for Older Adults CMS128: Anti-depressant Medication Management CMS130: Colorectal Cancer Screening CMS131: Diabetes: Eye Exam CMS134: Diabetes: Medical Attention for Nephropathy CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD) CMS137: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment CMS139: Falls: Screening for Future Fall Risk CMS146: Appropriate Testing for Pharyngitis CMS153: Chlamydia Screening for Women CMS154: Appropriate Treatment for Upper Respiratory Infection (URI) CMS155: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents CMS156: Use of High-Risk Medications in Older Adults CMS159: Depression Remission at Twelve Months CMS165: Controlling High Blood Pressure To view individual measure specifications and descriptions, please visit the eCQI Resource Center ( https://ecqi.healthit.gov/ ).   Description of issue: ​Earlier this year, a Jira ticket indicated that the eCQMs do not capture hospice data elements in a way that allows providers who do not order or provide hospice or palliative care to document that the patient is receiving this type of care. The eCQMs currently model hospice and palliative care using the Quality Data Model (QDM) categories of ‘Encounter’ and ‘Intervention.’ However, it has been noted that not all systems may capture this information in this manner, which means the denominator exclusions and/or exceptions may not be able to be met by all those implementing measures with these data elements. The Jira ticket suggested adding another QDM category of ‘Assessment’ to allow clinical documentation of a patient receiving this type of care in order to reduce burden and improve communication. Measure developers have looked into this as a potential update for this annual update cycle; however, it has resulted in some uncertainty over whether this is achievable during this annual update or a future one due to the available coding in the recommended terminology, LOINC. Goal of review: Obtain clinical and technical feedback.  

​Proposed solution: Our review of the LOINC terminology identified some codes related to hospice/palliative care. Below are the findings from our review of hospice/palliative care related codes: 85595-7 describes whether hospice care will be provided. This code is part of a renal care panel. This code, however, does not capture if or when a patient is on hospice and when is not included, making it is hard to know if this would apply to the measurement period. 45755-6 describes Hospice care [minimum data set]. It is unclear when the patient is in hospice which is essential to its inclusion in the measure. Additionally, we believe the assessment behind this is a provider completing information about a patient. We are looking for a patient giving information to a clinician. 55013-7 describes Hospice care in last 14 days - while a resident [MDSv3]. This code is closer to the question we need, but this code only captures a short period of time while the patient was inpatient. Both this question and the one below would have to be asked. Also, this is an assessment the provider completes about a patient, not a patient providing information to a clinician.  55012-9 describes Hospice care in last 14 days - while not a resident [MDSv3]. This is closer to the question we need, but only captures a short period of time and while the patient was not inpatient. Both this question and the question above would have to be asked. Also, this is an assessment the provider completes about a patient, not a patient providing the information to a clinician. Because the developers do not feel these accurately reflect what the intent of the data element would be, we are hesitant to consider adding without further insights from the clinical and technical stakeholders. Although a new LOINC code could be requested, we would require a great deal of guidance on how it should be modeled and written in order to appropriately capture the data element intent based on the QDM usage. Rationale for change: We seek feedback from the CRP community as to whether adding ‘Assessment, Performed’ and applying one or several of the codes noted above, or perhaps beginning the process to request a new LOINC concept for a future annual update cycle, to the measure logic would overcome the challenges noted in the original Jira ticket.