Brief Description of Measure:
CMS249: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture:
Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

Description of Issue:
Risk factors are grouped by when they occur in relation to the measurement period. The measure developer reviewed the groupings and logic behavior of each risk factor and determined that the glucocorticoid exclusion should be regrouped.
 
The glucocorticoid exclusion is currently listed under the following grouping: "the following risk factors may occur any time in the patient's history prior to the start of the measurement period but do not need to be active at the start of the measurement period". In the logic, the glucocorticoid exclusion is evaluated against any time in the patient's history through the end of the measurement period. 
 
The evaluation timeframe is better described by this grouping: "the following risk factors may occur at any time in the patient's history or during the measurement period". Since the glucocorticoid exclusion is better described by the grouping, "the following risk factors may occur at any time in the patient's history or during the measurement period", the measure developer proposes moving the glucocorticoid exclusion to this categorization.
 
The measure developer proposes to update the header and the logic accordingly.
 
There is also an opportunity to improve the logic's readability by aligning the logic definition names to each risk factor grouping.

Proposed Solution:
Below are changes in the header related to regrouping glucocorticoids exclusion.

//Before
//Denominator Exclusions
The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period:
Glucocorticoids [cumulative medication duration >= 90 days]  

//After
The following risk factors may occur at any time in the patient's history or during the measurement period:
Glucocorticoids [cumulative medication duration >= 90 days]   

Below are changes in the logic related to regrouping glucocorticoids exclusion as well as improving readability of logic byaligning the logic definition names to each risk factor grouping.

//Before
define "Has Age Dependent Combination Risk Factors":
... "Has 90 or More Active Glucocorticoid Medication Days" ...

define "Has Independent Risk Factors Applicable Any Time":
...

//After
//Please note that combination risk factor requirement will be removed and glucocorticoid is retained as an independent risk factor.

define "Has Risk Factor Any Time in History or During Measurement Period":
"Has 90 or More Active Glucocorticoid Medication Days"
...

//Before
define "Has Independent Risk Factors Before Measurement Period":
...

//After
define "Has Risk Factor Any Time in History Prior to Start of Measurement Period and Do Not Need to be Active During Measurement Period":
...

//Before
define "Denominator Exclusions":
... or "Has Independent Risk Factors Applicable Any Time"
    or "Has Independent Risk Factors Before Measurement Period"

//After
define "Denominator Exclusions":
... or "Has Risk Factor Any Time in History or During Measurement Period" ...
  or "Has Risk Factor Any Time in History Prior to Start of Measurement Period and Do Not Need to be Active During Measurement Period"

Rationale for Change:
The goal of this change is to ensure that the glucocorticoid exclusion is grouped under the appropriate risk factor grouping based on its logic behavior. This change will also improve logic readability by aligning the logic definition names to each risk factor grouping.