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  1. eCQM Issue Tracker
  2. CQM-5729

CRP: Removal of long-term care denominator exclusion

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    • Other
    • Resolution: Resolved
    • Moderate
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      Brief description of measure
      ​​CMS159: Depression Remission at Twelve Months:
      The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event

      Description of issue
      ​​The measure developer proposes removing the exclusion for patients who are permanent nursing home residents. Many facilities that offer skilled nursing care do so for patients with a transitional need, recovery after hospital stay or procedure. According to the National Quality Forum's guidance around the use of exclusion in a measure, an exclusion or exception needs to be of sufficient volume that without then the result would be significantly distorted. Data demonstrates low usage - 0.07% - of this exclusion based on statewide Minnesota data collection analysis of exclusions in over 140,000 patients.
      Based on this, it is expected that removing this exclusion will have very minimal to no impact on the measure.

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure ​​CMS159: Depression Remission at Twelve Months: The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event Description of issue ​​The measure developer proposes removing the exclusion for patients who are permanent nursing home residents. Many facilities that offer skilled nursing care do so for patients with a transitional need, recovery after hospital stay or procedure. According to the National Quality Forum's guidance around the use of exclusion in a measure, an exclusion or exception needs to be of sufficient volume that without then the result would be significantly distorted. Data demonstrates low usage - 0.07% - of this exclusion based on statewide Minnesota data collection analysis of exclusions in over 140,000 patients. Based on this, it is expected that removing this exclusion will have very minimal to no impact on the measure. Goal of review Obtain clinical and technical feedback
    • Hide
      Proposed solution
      ​HEADER CHANGE:
      Denominator Exclusions: Remove

      "3: Patients who were permanent nursing home residents between the start of the denominator period and the end of the measurement assessment period"



      CURRENT LOGIC:

      define "Denominator Exclusions"


         "Has Hospice Services"
           or "Palliative Care in the Measure Assessment Period"
           or "Has Long Term Care Encounter"
           or "Patient Expired"
           or "Has Mental Health Disorder Diagnoses"
      define "Has Long Term Care Encounter"

         exists ( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] EncounterLongTermCare
             where ToDate(start of EncounterLongTermCare.relevantPeriod)on or before
             end of "Measure Assessment Period")


      PROPOSED LOGIC:

      define "Denominator Exclusions"

         "Has Hospice Services"
           or "Palliative Care in the Measure Assessment Period"
           or "Patient Expired"
           or "Has Mental Health Disorder Diagnoses"
      TERMINOLOGY: Remove

      value set "Care Services in Long-Term Residential Facility" (OID: 2.16.840.1.113883.3.464.1003.101.12.1014)

      Rationale for change
      ​​The measure developer proposes removing the exclusion of patients who are permanent nursing home residents due to the low use of this exclusion and methodology for when exclusions should be applied.
      Show
      Proposed solution ​HEADER CHANGE: Denominator Exclusions: Remove "3: Patients who were permanent nursing home residents between the start of the denominator period and the end of the measurement assessment period" CURRENT LOGIC: define "Denominator Exclusions"    "Has Hospice Services"      or "Palliative Care in the Measure Assessment Period"      or "Has Long Term Care Encounter"      or "Patient Expired"      or "Has Mental Health Disorder Diagnoses" define "Has Long Term Care Encounter"    exists ( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] EncounterLongTermCare        where ToDate(start of EncounterLongTermCare.relevantPeriod)on or before        end of "Measure Assessment Period") PROPOSED LOGIC: define "Denominator Exclusions"    "Has Hospice Services"      or "Palliative Care in the Measure Assessment Period"      or "Patient Expired"      or "Has Mental Health Disorder Diagnoses" TERMINOLOGY: Remove value set "Care Services in Long-Term Residential Facility" (OID: 2.16.840.1.113883.3.464.1003.101.12.1014) Rationale for change ​​The measure developer proposes removing the exclusion of patients who are permanent nursing home residents due to the low use of this exclusion and methodology for when exclusions should be applied.

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