Thank you for your question. For the hospice and palliative care exclusion, an order or referral to palliative or hospice care is sufficient to exclude the patient from the denominator. We received a similar question in CQM-4426 and initially took the position that we would not include consults in exclusions, because as you said, a consult does not mean the patient received hospice or palliative care. However, we updated our answer to accept consultation for hospice and palliative care as an exclusionary event to align with how the STk-5/CMS72 measure handles hospice and palliative care exclusions (please see the logic below referring to orders and referrals to palliative and hospice care). Please let us know if you have additional questions. Denominator Exclusion /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter   where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer       where Cancer.prevalencePeriod overlaps InpatientEncounter.relevantPeriod   )     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter         where exists InpatientEncounter.diagnoses Diagnosis           where Diagnosis.code in "All Primary and Secondary Cancer"     )     or exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder         where PalliativeOrHospiceCareOrder.authorDatetime during InpatientEncounter.relevantPeriod     )     or exists ( ["Intervention, Performed": "Palliative or Hospice Care"] PalliativeOrHospiceCarePerformed         where Global."NormalizeInterval" ( PalliativeOrHospiceCarePerformed.relevantDatetime, PalliativeOrHospiceCarePerformed.relevantPeriod ) overlaps InpatientEncounter.relevantPeriod     )     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter         where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"           or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"           or InpatientEncounter.dischargeDisposition in "Patient Expired"