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Proposed solution
Revise the fracture exclusion from two fractures at the time of procedure to one fracture at the time of procedure and revise the value set to target specific lower body fractures that are more closely associated with nonelective THA and TKA.
Terminology before for both CMS56/66:
valueset "Lower Body Fracture" (2.16.840.1.113883.3.464.1003.113.12.1037)
Terminology after for both CMS56/66:
valueset “Lower Body Fractures Excluding Ankle and Foot” (2.16.840.1.113883.3.464.1003.1178)
See changes below for CMS56. Similar changes will also apply to CMS66.
Denominator Exclusion Header before:
Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty […]
Denominator Exclusion Header after:
Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty
Logic before:
Denominator Exclusions
[...]
or "Has Total Hip Arthroplasty with 2 or More Lower Body Fractures"
[...]
Has Total Hip Arthroplasty with 2 or More Lower Body Fractures
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture
where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
)>= 2)
Logic after:
Denominator Exclusions
[...]
or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
[...]
Has Total Hip Arthroplasty with 1 or More Lower Body Fractures
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
where Count(["Diagnosis": " Lower Body Fractures Excluding Ankle and Foot "] LowerBodyFracture
where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
)>= 1)
Rationale for change
These changes align with the number of fractures required for exclusion in a related measure in development. Additionally, interested parties agreed that one fracture alone is associated with an emergent injury and can affect function following THA and TKA.
Show
Proposed solution
Revise the fracture exclusion from two fractures at the time of procedure to one fracture at the time of procedure and revise the value set to target specific lower body fractures that are more closely associated with nonelective THA and TKA.
Terminology before for both CMS56/66:
valueset "Lower Body Fracture" (2.16.840.1.113883.3.464.1003.113.12.1037)
Terminology after for both CMS56/66:
valueset “Lower Body Fractures Excluding Ankle and Foot” (2.16.840.1.113883.3.464.1003.1178)
See changes below for CMS56. Similar changes will also apply to CMS66.
Denominator Exclusion Header before:
Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty […]
Denominator Exclusion Header after:
Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty
Logic before:
Denominator Exclusions
[...]
or "Has Total Hip Arthroplasty with 2 or More Lower Body Fractures"
[...]
Has Total Hip Arthroplasty with 2 or More Lower Body Fractures
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
where Count(["Diagnosis": "Lower Body Fracture"] LowerBodyFracture
where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
)>= 2)
Logic after:
Denominator Exclusions
[...]
or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
[...]
Has Total Hip Arthroplasty with 1 or More Lower Body Fractures
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
where Count(["Diagnosis": " Lower Body Fractures Excluding Ankle and Foot "] LowerBodyFracture
where LowerBodyFracture.prevalencePeriod starts 24 hours or less on or before start of Global."NormalizeInterval"(THAProcedure.relevantDatetime, THAProcedure.relevantPeriod)
)>= 1)
Rationale for change
These changes align with the number of fractures required for exclusion in a related measure in development. Additionally, interested parties agreed that one fracture alone is associated with an emergent injury and can affect function following THA and TKA.