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  1. eCQM Issue Tracker
  2. CQM-5539

137v11 Initiation and Engagement of Substance Use Disorder Treatment timing vs measure intent

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • None
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    • Chrystal Vidrine
    • Greenway Health
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      Thank you for your inquiry for CMS137v11 (2023 performance period) regarding the following CQL logic specified in definition "History of SUD Diagnosis or Treatment".

      Please submit issues related to cql predecessor operation to the CQL Issue Tracker: https://oncprojectracking.healthit.gov/support/projects/CQLIT/summary. Please also include examples to help reviewers replicate your findings and address any potential issues.

      To answer your question regarding the intent of this CQL logic, the intent is to disqualify patients from the Initial Population/Denominator who meet this criteria: EncounterWithDiagnosis starting in the 60 days "before the day of" start of FirstSUDEpisode. The logic should look for a 60-day lookback period starting on the day before start of FirstSUDEpisode. EncounterWithDiagnosis starting on the same day as the day of start of FirstSUDEpisode should not disqualify patient from the Initial Population/Denominator. For example, in Bonnie v5.1.2, FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 11/12/2012 12:00AM would not disqualify the patient; FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 11/11/2012 11:59PM would disqualify the patient; FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 9/13/2012 7:00AM would disqualify the patient.

      History of SUD Diagnosis or Treatment
      ...
                union ( ( ( "Qualifying Encounters"
                    except "Emergency Department or Detoxification Visit" ) QualifyingEncounter
                    where ( exists QualifyingEncounter.diagnoses Diagnosis
                        where Diagnosis.code in "Substance Use Disorder"
                    ) ) EncounterWithDiagnosis
                    with "First SUD Episode During Measurement Period" FirstSUDEpisode
                      such that EncounterWithDiagnosis.relevantPeriod starts 60 days or less before day of start of FirstSUDEpisode.relevantPeriod
                )
      ...
      Show
      Thank you for your inquiry for CMS137v11 (2023 performance period) regarding the following CQL logic specified in definition "History of SUD Diagnosis or Treatment". Please submit issues related to cql predecessor operation to the CQL Issue Tracker: https://oncprojectracking.healthit.gov/support/projects/CQLIT/summary . Please also include examples to help reviewers replicate your findings and address any potential issues. To answer your question regarding the intent of this CQL logic, the intent is to disqualify patients from the Initial Population/Denominator who meet this criteria: EncounterWithDiagnosis starting in the 60 days "before the day of" start of FirstSUDEpisode. The logic should look for a 60-day lookback period starting on the day before start of FirstSUDEpisode. EncounterWithDiagnosis starting on the same day as the day of start of FirstSUDEpisode should not disqualify patient from the Initial Population/Denominator. For example, in Bonnie v5.1.2, FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 11/12/2012 12:00AM would not disqualify the patient; FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 11/11/2012 11:59PM would disqualify the patient; FirstSUDEpisode with start of 11/12/2012 8:00AM and EncounterWithDiagnosis with start of 9/13/2012 7:00AM would disqualify the patient. History of SUD Diagnosis or Treatment ...           union ( ( ( "Qualifying Encounters"               except "Emergency Department or Detoxification Visit" ) QualifyingEncounter               where ( exists QualifyingEncounter.diagnoses Diagnosis                   where Diagnosis.code in "Substance Use Disorder"               ) ) EncounterWithDiagnosis               with "First SUD Episode During Measurement Period" FirstSUDEpisode                 such that EncounterWithDiagnosis.relevantPeriod starts 60 days or less before day of start of FirstSUDEpisode.relevantPeriod           ) ...
    • CMS0137v11
    • With CMS137v11 and the typical workflow for documenting encounters and diagnoses, almost all patients will be excluded from the IPP.

      It appears that the 2023 change to use precision=”Day” to evaluate the timing for diagnosis history will not resolve the 137v11 Initiation and Engagement of Substance Use Disorder Treatment timing issue. This is due to the interval order of operations. The In operation is checking if the start of EncounterWithDiagnosis relevantPeriod (this being the historical one) is in an interval that gets created using the IPP encounter relevantPeriod start - 60 days through the relevantPeriod start. Note the type="Interval" line says highClosed="false". When the type="Start" on the <high> element runs, with highClosed being false, it will get the start of the encounter relevantPeriod and subtract one unit from its highest precision. This is the cql predecessor operation. At this point, the data is down to the seconds, so we will subtract one second. This value is handed back as the end of the interval to the In operation. It is only at this point that the day is considered, and In will return true if the single date in the first operand is on the same day as the low/high of the interval or somewhere in between.

      To not count the last day of this interval the belief is we would have to subtract 1 day in the <high> element in the same way it is subtracting 60 days in the <low>

      Is the intent in the History of SUD Diagnosis or Treatment block that historical being on the same day as the IPP data should still exclude the patient?

       

      Related to https://oncprojectracking.healthit.gov/support/browse/CQM-5474 

            edave Mathematica EC eCQM Team
            chrystal.vidrine Chrystal Vidrine
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