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  2. CQM-6206

CMS 154 CMS 154 Problem Attribution to Providers

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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    • Debbie McKay
    • 3124656609
    • Altera Digital Health
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      ​Thank you for your question for CMS154v12 Appropriate Treatment for Upper Respiratory Infection (URI). The intent of the measure is looking for an active diagnosis during a visit in the measurement period. In your example, there is a historical but active diagnosis of URI. Although the diagnosis occurred outside of the measurement period, it meets the criteria of URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod because the diagnosis is still active during a visit within the measurement period. As such, the response to CQM-5411 remains appropriate.


      To address your specific questions:
      1. To determine the measure calculation logic in the current reporting period, the active URI problem should be attributed to all providers who have an encounter during the reporting period with an active URI problem on the problem list, regardless of whether they evaluated or treated the URI.
      2. In the given scenario, where Provider A recorded an active URI problem in 2020 and Provider B has an encounter with the same patient in 2023, the patient would be included in the Initial Population and Denominator for Provider B for reporting on this eCQM. This is because the active diagnosis of URI, although not the reason for the visit to Provider B, remains still present on the problem list during the reporting period.

      We will consider this use case during updates to the measure in a future annual update cycle.

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      ​Thank you for your question for CMS154v12 Appropriate Treatment for Upper Respiratory Infection (URI). The intent of the measure is looking for an active diagnosis during a visit in the measurement period. In your example, there is a historical but active diagnosis of URI. Although the diagnosis occurred outside of the measurement period, it meets the criteria of URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod because the diagnosis is still active during a visit within the measurement period. As such, the response to CQM-5411 remains appropriate. To address your specific questions: 1. To determine the measure calculation logic in the current reporting period, the active URI problem should be attributed to all providers who have an encounter during the reporting period with an active URI problem on the problem list, regardless of whether they evaluated or treated the URI. 2. In the given scenario, where Provider A recorded an active URI problem in 2020 and Provider B has an encounter with the same patient in 2023, the patient would be included in the Initial Population and Denominator for Provider B for reporting on this eCQM. This is because the active diagnosis of URI, although not the reason for the visit to Provider B, remains still present on the problem list during the reporting period. We will consider this use case during updates to the measure in a future annual update cycle.
    • CMS0154v12
    • CMS0154v11
    • Accuracy in reporting logic for calculation of the Initial Patient Population and Denominator

      We are seeking guidance on the logic for eCQM CMS 154 related to attributing active problems to a provider for inclusion or exclusion in the reporting on this measure. 

      There are two scenarios where the active problem of URI comes into play: 
      1.    An active problem recorded during the reporting period by a provider who evaluated the patient for URI 
      2.    A problem recorded historically but that is still active during the current reporting period
      •    2020 Provider A had a patient encounter during which the patient was evaluated for a URI and recorded the problem of f URI (the problem was not documented as resolved and remains active)
      •    2023 Provider B has an encounter with this patient during the 2023 reporting period and does not evaluate or treat the active URI problem that is still on the problem list

      QUESTION: For determining the measure calculation logic for a current reporting period, should the active URI problem be attributed only to providers who evaluated/treated the URI or to any provider reporting on this measure who had an encounter during the reporting period with an active URI problem on the problem list? 

      In case it is helpful, here's another way of framing this issue: 
      2020 Provider A has a patient encounter and records a problem of URI which is not resolved and remains active on the problem list
      2023 Provider B has an encounter with this patient during the 2023 reporting period and the diagnosis or reason for visit is NOT related to an upper respiratory infection

      QUESTION: In this scenario, would this patient be included or excluded from the Initial Patient Population and Denominator for Provider B for reporting on this eCQM?

      If it is possible to have a call to discuss this issue, that would be very helpful and appreciated. 

      This is related to previous case CQM-5411. 

            edave Mathematica EC eCQM Team
            dlmckay DL McKay
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