Brief Description of Measure:

EC eCQMs containing non-telehealth eligible encounters

CMS22: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

CMS69: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

CMS75: Children Who Have Dental Decay or Cavities

CMS142: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

CMS143: Primary Open-Angle Glaucoma (POAG) Optic Nerve Evaluation

CMS646: Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer

CMS771: Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia

Description of Issue

An encounter class attribute was added to the updated Quality Data Model (QDM) v5.6. This allows the addition of concepts representing classifications of patient encounters such as ambulatory (outpatient), inpatient, emergency, home health, and virtual visits using a value set (http://terminology.hl7.org/ValueSet/v3-ActEncounterCode) as defined as part of HL7 v3.

Measure developers would like to explore implementer feasibility of incorporating the new QDM encounter class attribute into measure logic, specifically for the purposes of using the 'virtual' encounter class attribute to exclude non-telehealth eligible encounters directly within measure logic.

Proposed Solution:

Use the Encounter.class attribute code "virtual' to exclude non-telehealth eligible encounters within measure logic.

Examples of proposed logic include:

define "Qualifying Encounter During Measurement Period":
["Encounter, Performed": "Encounter to Screen for Blood Pressure"] ValidEncounter
where ValidEncounter.relevantPeriod during "Measurement Period"
and ValidEncounter.class !~ "virtual"

define "Qualifying Encounter during Measurement Period":
["Encounter, Performed": "Encounter to Evaluate BMI"] BMIEncounter
where BMIEncounter.relevantPeriod during "Measurement Period"
and BMIEncounter.class !~ "virtual"

define "Face to Face Encounter During Measurement Period":
( ["Encounter, Performed": "Office Visit"]
union ["Encounter, Performed": "Ophthalmological Services"]
union ["Encounter, Performed": "Outpatient Consultation"]
union ["Encounter, Performed": "Care Services in Long-Term Residential Facility"]
union ["Encounter, Performed": "Nursing Facility Visit"] ) FaceToFaceEncounter
where FaceToFaceEncounter.relevantPeriod during "Measurement Period"
and FaceToFaceEncounter.class !~ "virtual"

define "Has Qualifying Encounter":
exists ["Encounter, Performed": "Office Visit"] ValidEncounter
where ValidEncounter.relevantPeriod during "Measurement Period"
and ValidEncounter.class !~ "virtual"

Rationale for Change:

Measure logic does not currently contain a way to directly exclude virtual encounters in measures that are non-telehealth eligible, which has caused implementer burden. The proposed approach using the new QDM Encounter.class attribute may alleviate this burden.