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  2. CQM-5448

eSTK-6 Specification and CDL Mismatch for Denominator Exclusions

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
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    • Rebecca Panruk
    • 9077294549
    • Alaska Native Medical Center
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      ​Thank you for your question. There have been no changes in the specification for eSTK-6/CMS105 related to the wording of the denominator exclusion "Inpatient hospitalizations for patients discharged to another hospital", or the logic (CDL), or the content or intent of the value set in the past few years.

      The measure excludes patients discharged to an inpatient facility, identified by the valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87). This value set includes concepts that represent an encounter with a discharge to a short-term acute care hospital, including a specialty hospital ( e.g. Cancer Hospitals or Department of Defense/Veterans Administration Hospitals). It includes codes for three facility types - community hospitals, tertiary referral hospitals, and acute care hospitals. Patients discharged to a critical access hospital that can be mapped to one of these three facility types should be excluded from the measure.

      LTCH discharge disposition would not be excluded per the current measure logic and value set. Just transfers to the acute care facilities identified by codes in valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87) will be excluded for the denominator exclusion "Inpatient hospitalizations for patients discharged to another hospital". We will consider changing the wording aligning the general wording of the denominator exclusion to the logic definition and valueset during the next annual update.
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      ​Thank you for your question. There have been no changes in the specification for eSTK-6/CMS105 related to the wording of the denominator exclusion "Inpatient hospitalizations for patients discharged to another hospital", or the logic (CDL), or the content or intent of the value set in the past few years. The measure excludes patients discharged to an inpatient facility, identified by the valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87). This value set includes concepts that represent an encounter with a discharge to a short-term acute care hospital, including a specialty hospital ( e.g. Cancer Hospitals or Department of Defense/Veterans Administration Hospitals). It includes codes for three facility types - community hospitals, tertiary referral hospitals, and acute care hospitals. Patients discharged to a critical access hospital that can be mapped to one of these three facility types should be excluded from the measure. LTCH discharge disposition would not be excluded per the current measure logic and value set. Just transfers to the acute care facilities identified by codes in valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87) will be excluded for the denominator exclusion "Inpatient hospitalizations for patients discharged to another hospital". We will consider changing the wording aligning the general wording of the denominator exclusion to the logic definition and valueset during the next annual update.
    • CMS0105v10
    • There is a mismatch from the gray section of the eSTK-6 specifications and CDL section as it pertains to the "Denominator Exclusions" section for both.

      The issue I am seeing with the mismatch of the specifications and the CDL for the eSTK-6 measure is in reference to the denominator exclusion that pertains to patients discharged to another hospital. The gray section wording states, "Inpatient hospitalizations for patients discharged to another hospital". The CDL section states, "Discharge To Acute Care Facility". From what I remember over the years, this exclusion criteria used to just pertain to acute care facilities. Now the wording in the gray section is different, it opens it up to any hospital. We had an encounter that discharged to a LTCH, technically from what the gray section states, this would exclude the patient from the measure because the patient discharged to "another hospital". It does not specify in the specifications that it has to be "acute care hospital" anymore. Should the definition match the CDL language, or should the CDL language match the specifications? This is confusing. Our group was curious if maybe the CDL got missed as far as being updated, or if in fact it is still supposed to just be transfers to "acute care facilities" that would exclude the patient?

            JLeflore Joelencia Leflore
            rajohn Rebecca A John
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