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  2. CQM-5598

CRP: Add codes to capture severe cognitive impairment

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    • Resolution: Unresolved
    • Moderate
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      Brief description of measure:
      CMS56: Functional Status Assessment for Total Hip Replacement
      Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery

      CMS66: Functional Status Assessment for Total Knee Replacement
      Percentage of patients 19 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery

      ​CMS90: Functional Status Assessments for Heart Failure
      Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments

      Description of issue:
      ​​​The measure steward received feedback to include additional codes to represent severe cognitive impairment for the denominator exclusions. Currently, only code "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " is a denominator exclusion.

      Goal of review:
      Obtain clinical and technical feedback
      Show
      Brief description of measure: CMS56: Functional Status Assessment for Total Hip Replacement Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery CMS66: Functional Status Assessment for Total Knee Replacement Percentage of patients 19 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery ​CMS90: Functional Status Assessments for Heart Failure Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments Description of issue: ​​​The measure steward received feedback to include additional codes to represent severe cognitive impairment for the denominator exclusions. Currently, only code "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " is a denominator exclusion. Goal of review: Obtain clinical and technical feedback
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      Proposed solution:
      ​​We propose replacing "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " with the Cognitive Impairment value set (2.16.840.1.113883.3.464.1003.1186) in the logic.

      CMS90 Logic before:
      define "Denominator Exclusions":
      Hospice."Has Hospice"
        or exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia
            where Dementia.prevalencePeriod overlaps "Measurement Period"  )

      CMS90 Logic after:
      define "Denominator Exclusions":
      Hospice."Has Hospice"
        or exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment
            where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period"  )


      CMS56 and CMS66 Logic before:
      define "Has Dementia Diagnosis":
      exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia
          where Dementia.prevalencePeriod overlaps "Measurement Period")


      CMS56 and CMS66 Logic after:
      define "Has Dementia Diagnosis":
      exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment
          where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period")


      CMS56, 66, 56 and 90 Terminology before:
      "Severe dementia (disorder)” SNOMEDCT Code 428351000124105 

      CMS56, 66, 56 and 90 Terminology After:
      Cognitive Impairment (2.16.840.1.113883.3.464.1003.1186)

      Rationale for change:
      ​​​We propose including additional codes to better represent the denominator exclusion criteria for severe cognitive impairment. 
      Show
      Proposed solution: ​​We propose replacing "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " with the Cognitive Impairment value set (2.16.840.1.113883.3.464.1003.1186) in the logic. CMS90 Logic before: define "Denominator Exclusions": Hospice."Has Hospice"   or exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia       where Dementia.prevalencePeriod overlaps "Measurement Period"  ) CMS90 Logic after: define "Denominator Exclusions": Hospice."Has Hospice"   or exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment       where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period"  ) CMS56 and CMS66 Logic before: define "Has Dementia Diagnosis": exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia     where Dementia.prevalencePeriod overlaps "Measurement Period") CMS56 and CMS66 Logic after: define "Has Dementia Diagnosis": exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment     where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period") CMS56, 66, 56 and 90 Terminology before: "Severe dementia (disorder)” SNOMEDCT Code 428351000124105  CMS56, 66, 56 and 90 Terminology After: Cognitive Impairment (2.16.840.1.113883.3.464.1003.1186) Rationale for change: ​​​We propose including additional codes to better represent the denominator exclusion criteria for severe cognitive impairment. 

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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            Updated: