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  1. eCQM Issue Tracker
  2. CQM-4961

Add guidance to include patients from Acute Hospital Care at Home programs in denominator

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Details

    • EH/CAH eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None

    Description

      Brief Description of Measure:
      ​Multiple EH eCQMs

      Description of Issue:
      ​Several Jira inquiries have asked whether these patients who receive care at home should be included in the denominator eligible population of the EH eCQMs.
       
      The CMS Acute Hospital Care at Home Program allows patients who ordinarily would be housed within a hospital to receive care at home, provided specific criteria are met.  Since the CMS Acute Hospital Care at Home Program is relatively new, the logic and guidance for eCQMs does not address whether these patients should be excluded from the measure populations.  The intended population for these measures, as stated in the measure guidance, is inpatient hospitalizations.
       
      If the same codes are used for acute hospital care at home patients as are used for patients in inpatient hospital beds, they would qualify for these measures. Since they are not being cared for in an inpatient hospital bed, but rather at home, it is not clear whether the facility should remove these patients from the measures.
       
      We propose adding clarifying text to the Guidance section of each applicable measure header to indicate when both sets of patients are appropriate to include in the denominator eligible population.

      Proposed Solution:
      ​Add clarifying text to the Guidance section of each applicable measure header: 
      The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

      Rationale for Change:
      Provide clarification as to which measures should include patients from Acute Hospital Care at Home programs in the denominator population.

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            sgearhart Mathematica EH eCQM Team
            sgearhart Mathematica EH eCQM Team
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            Dates

              Created:
              Updated: