Brief Description of Measure:

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

AND

CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease:
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR
*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR
*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

Description of Issue:

A number of eCQMs currently include denominator exclusions or exceptions for patients receiving hospice or palliative care. However, CMS 69 and CMS 347 currently represent these data elements in a different way than other eCQMs. The measure steward would like to harmonize how these patients are captured in the measure logic.
 
To reduce burden on clinicians and implementers, while promoting consistency across eCQMs, CMS69 and CMS347 will replace their hospice and palliative care CQL logic with NCQA's hospice and palliative care libraries. 

Proposed Solution:

CMS 69 (denominator exclusions) and CMS 347 (denominator exceptions) will replace their hospice and palliative care CQL logic with NCQA's hospice and palliative care libraries.
 
CMS69 Current Logic
Denominator Exclusions
  "Patient Has Order for or Receiving Hospice Care or Palliative Care"
    or exists "Pregnancy at Any Time during the Measurement Period"
 
Patient Has Order for or Receiving Hospice Care or Palliative Care
  exists ( ( ["Intervention, Order": "Hospice Care Ambulatory"]
      union ["Intervention, Order": "Palliative or Hospice Care"] ) PalliativeOrHospiceCareOrder
        with "Qualifying Encounter during Measurement Period" QualifyingEncounter
     such that PalliativeOrHospiceCareOrder.authorDatetime on or before end of QualifyingEncounter.relevantPeriod)
    or exists ( ( ( ["Intervention, Performed": "Hospice Care Ambulatory"]
      union ["Intervention, Performed": "Palliative or Hospice Care"] ) PalliativeInterventions
        with "Qualifying Encounter during Measurement Period" QualifyingEncounter
      such that Global."NormalizeInterval" ( PalliativeInterventions.relevantDatetime, PalliativeInterventions.relevantPeriod ) starts on or before end of QualifyingEncounter.relevantPeriod )
   union ( ["Encounter, Performed": "Encounter for palliative care"] PalliativeCarePerformed
      with "Qualifying Encounter during Measurement Period" QualifyingEncounter
       such that PalliativeCarePerformed.relevantPeriod starts on or before end of QualifyingEncounter.relevantPeriod ) )

CMS347 Current Logic 
Denominator Exceptions
  "Has Allergy to Statin"
   or "Has Order or Receiving Hospice Care or Palliative Care"
   or "Has Hepatitis or Liver Disease Diagnosis"
   or "Has Statin Associated Muscle Symptoms"
   or "Has ESRD Diagnosis"
  or "Has Adverse Reaction to Statin"
 
Has Order or Receiving Hospice Care or Palliative Care
  exists ( ( ["Intervention, Order": "Hospice Care Ambulatory"]
      union ["Intervention, Order": "Palliative or Hospice Care"] ) PalliativeOrHospiceCareOrder
       where PalliativeOrHospiceCareOrder.authorDatetime on or before end of "Measurement Period")
   or exists ( ( ["Intervention, Performed": "Hospice Care Ambulatory"]
     union ["Intervention, Performed": "Palliative or Hospice Care"] ) PalliativeOrHospiceCarePerformed
       where Global."NormalizeInterval" ( PalliativeOrHospiceCarePerformed.relevantDatetime, PalliativeOrHospiceCarePerformed.relevantPeriod ) starts on or before end of "Measurement Period" )
   or exists ( ["Encounter, Performed": "Encounter for palliative care"] PalliativeEncounter
       where PalliativeEncounter.relevantPeriod starts on or before end of "Measurement Period")

Proposed additions for both measures:
Hospice."Has Hospice Services" 
  exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
       where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
         or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"  )
        and InpatientEncounter.relevantPeriod ends during day of "Measurement Period" )
     or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
       where HospiceEncounter.relevantPeriod overlaps "Measurement Period"   )
     or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
         where HospiceAssessment.result ~ "Yes (qualifier value)"
           and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod )overlaps "Measurement Period"  )
     or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
         where HospiceOrder.authorDatetime during day of "Measurement Period"   )
    or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
         where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period" )
 
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 (["Diagnosis": "Encounter for palliative care"] PalliativeDiagnosis
  where PalliativeDiagnosis.prevalencePeriod 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" )
 
Add the following value sets to both measures:
  valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
  valueset "Palliative Care Encounter" (2.16.840.1.113883.3.464.1003.101.12.1090)
  valueset "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135)
 
Proposed changes for CMS 69:
Denominator Exclusions
   Hospice."Has Hospice Services"
     or PalliativeCare."Palliative Care in the Measurement Period"
     or exists "Pregnancy at Any Time during the Measurement Period"
 
Proposed changes for CMS 347:
Denominator Exceptions
  "Has Allergy to Statin"
     or Hospice."Has Hospice Services"
     or PalliativeCare."Palliative Care in the Measurement Period"
     or "Has Hepatitis or Liver Disease Diagnosis"
     or "Has Statin Associated Muscle Symptoms"
     or "Has ESRD Diagnosis"
     or "Has Adverse Reaction to Statin"
     or "Has Medical Reason for Not Ordering Statin Therapy"

Rationale for Change:

​To reduce burden on clinicians and implementers, and promote consistency in eCQMs.