NQF0081 Initial population question

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: Measure
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      The values included in "Face to Face Interaction" are a subset of those values included in "Patient Provider Interaction". So technically, the "face to face interaction" is included in the Count >=2: Encounter, Performed.
      In addition to the values included in the "Face to Face Interaction" value set, the "Patient Provider Interaction" value set also includes virtual interactions such as phone, text, email, etc. While we allow these virtual interactions to be counted as the minimum # of visits with the EP during the measurement period, the encounter where the measure action is evaluated needs to occur at a face to face interaction, which is why we only include the latter in the logic phrase that references the diagnosis.

      To answer the specific question asked, if the patient has >=2 Patient Provider Interactions, they also need to have one of the encounters included in the "Diagnosis, Active" (or procedure performed) that starts before or during the listed encounters.
      ◦AND:
      ■OR: "Diagnosis, Active: Coronary Artery Disease No MI"
      ■OR: "Procedure, Performed: Cardiac Surgery"
      ■starts before or during
      ■OR: "Occurrence A of Encounter, Performed: Office Visit"
      ■OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
      ■OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
      ■OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
      ■OR: "Occurrence A of Encounter, Performed: Home Healthcare Services"
      ■OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      ■during "Measurement Period"

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      The values included in "Face to Face Interaction" are a subset of those values included in "Patient Provider Interaction". So technically, the "face to face interaction" is included in the Count >=2: Encounter, Performed. In addition to the values included in the "Face to Face Interaction" value set, the "Patient Provider Interaction" value set also includes virtual interactions such as phone, text, email, etc. While we allow these virtual interactions to be counted as the minimum # of visits with the EP during the measurement period, the encounter where the measure action is evaluated needs to occur at a face to face interaction, which is why we only include the latter in the logic phrase that references the diagnosis. To answer the specific question asked, if the patient has >=2 Patient Provider Interactions, they also need to have one of the encounters included in the "Diagnosis, Active" (or procedure performed) that starts before or during the listed encounters. ◦AND: ■OR: "Diagnosis, Active: Coronary Artery Disease No MI" ■OR: "Procedure, Performed: Cardiac Surgery" ■starts before or during ■OR: "Occurrence A of Encounter, Performed: Office Visit" ■OR: "Occurrence A of Encounter, Performed: Outpatient Consultation" ■OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit" ■OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility" ■OR: "Occurrence A of Encounter, Performed: Home Healthcare Services" ■OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" ■during "Measurement Period"
    • CMS135v1/NQF0081, CMS145v1/NQF0070

      The initial population mentions active diagnosis before or during encounter perfomed: Face to face interaction. But the list of encounters (need >=2) does not contain encounter perfomed: Face to face interaction. The list of encounters performed contains Patient Provider Interaction but the diagnosis condition does not look for this encounter.Does this mean that if a patient had 2 or more Patient Provider interactions, to meet the active diagnosis criteria they need to have either one of the follwing along with the Patient Provider Interaction:
      ■Care Services in Long-Term Residential Facility"
      ■OR: Discharge Services - Hospital Inpatient"
      ■OR: Home Healthcare Services"
      ■OR: Nursing Facility Visit"
      ■OR: Office Visit"
      ■OR: Outpatient Consultation"
      ■OR: Face-to-Face Interaction

            Assignee:
            Ramya Tallapragada (Inactive)
            Reporter:
            Deepti Kumar (Inactive)
            Kimberly Schwartz (Inactive), Minet Javellana (Inactive), Patricia Lawson (Inactive), Rob McClure
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              Created:
              Updated:
              Resolved: