Brief description of measure CMS646: Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer: Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging. Description of issue The current measure logic looks for a bladder cancer staging procedure that overlaps the start of bladder cancer diagnosis. However, the measure developer has received feedback indicating that EHRs/patient records may not always capture the bladder cancer diagnosis starting prior to the end of the staging procedure. To address this issue, the measure developer proposes removing the timing constraint that the staging procedure must overlap the diagnosis. Goal of review Obtain clinical and technical feedback

Proposed solution ​​Change the logic to anchor the first qualifying bladder cancer to the diagnosis. CURRENT LOGIC: define "First Bladder Cancer Staging Procedure"    First(["Procedure, Performed": "Tumor staging (tumor staging)"] BladderCancerStaging        with "Bladder Cancer Diagnoses" BladderCancer          such that Global."NormalizeInterval"(BladderCancerStaging.relevantDatetime, BladderCancerStaging.relevantPeriod)starts on or before day of start BladderCancer.prevalencePeriod            and Global."NormalizeInterval"(BladderCancerStaging.relevantDatetime, BladderCancerStaging.relevantPeriod)overlaps day of BladderCancer.prevalencePeriod        sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod))   PROPOSED LOGIC: define "First Bladder Cancer Staging Procedure"     First(["Procedure, Performed": "Tumor staging (tumor staging)"] BladderCancerStaging        with "Bladder Cancer Diagnoses" BladderCancer          such that Global."NormalizeInterval"(BladderCancerStaging.relevantDatetime, BladderCancerStaging.relevantPeriod)starts on or before day of start BladderCancer.prevalencePeriod        sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)) Rationale for change ​Some EHRs may not have the bladder cancer diagnosis entered prior to the end of the staging procedure