For 2022, many measures have the Denominator Exclusions updated to add an exclusion for palliative care. For example, CMS 124, CMS 125, CMS 131, CMS 122, CMS 156, CMS 130, CMS 165 all include this new denominator exclusion. 

New Value Sets include:

• Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090)
• Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135)
• Added direct reference code LOINC code (71007-9) Palliative Care Questionnaire (FACIT-Pal)

New Logic Code:

PalliativeCare.Palliative Care in the Measurement Period
exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period"
)
or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
where PalliativeEncounter.relevantPeriod overlaps "Measurement Period"
)
or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period"
)

We are trying to determine what workflows we should be looking to. We noticed this tends to align with the frailty and Hospice exclusions in some cases so we are thinking we would include Orders (ie procedure and referral orders) for palliative care and also palliative care on the problem list. However, there is no "Intervention, ordered" (like there is for Has.Hospice) and there is no "Diagnoses" specific value set included (like there is for Frailty, Frailty Diagnoses). Therefore we are questioning whether we should include Interventions, assessments, and encounters only OR if this can include problems, Orders, interventions, assessments, and encounters. 

Any insight you can provide will be helpful in moving us forward in the right direction for our reports.