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  2. CQM-6253

Depression screening and follow-up for CY24 no longer excludes people with pre-existing depression, and issue with numerator satisfier

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      ​​Thank you for your inquiry on CMS2v13 - Preventative Care and Screening: Screening for Depression and Follow-Up Plan.
      Screening is not only used for identifying new cases but also for monitoring ongoing treatment. The rationale behind removing depression as a denominator exclusion was to ensure patients previously diagnosed with depression that resolved and then reoccurred (requiring reinitiating of treatment), were captured in the measure.

      That said, we do recognize the issue with removing patients with a previous diagnosis of depression and your input is helpful in understanding the extent of this issue. The team will review this issue in the next annual update.
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      ​​Thank you for your inquiry on CMS2v13 - Preventative Care and Screening: Screening for Depression and Follow-Up Plan. Screening is not only used for identifying new cases but also for monitoring ongoing treatment. The rationale behind removing depression as a denominator exclusion was to ensure patients previously diagnosed with depression that resolved and then reoccurred (requiring reinitiating of treatment), were captured in the measure. That said, we do recognize the issue with removing patients with a previous diagnosis of depression and your input is helpful in understanding the extent of this issue. The team will review this issue in the next annual update.
    • CMS0002v13
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      #1 - the denominator for depression screening for CY24 will include people already diagnosed with and being treated for depression. This will increase the volume of depression screening, with no benefit to patients.
      #2 - for the current CY, CY24, and beyond - if this issue is not fixed, documentation of appropriate follow-up for patients with a positive screen (and thus measure MET status) will inappropriately show as UNMET, unless with each screen a patient is repetitively referred for treatment, even when they are already in treatment. My team will either have to suppress screening when one has already been done for the year, and we will not do that! Or, we will have to train doctors to duplicatively refer with each screen, even when a referral is not necessary. This is burdensome to clinicians, and may create confusion to patients ("why is my doctor referring me to someone when I am already in treatment? Does she want me to see someone else?")
      Show
      #1 - the denominator for depression screening for CY24 will include people already diagnosed with and being treated for depression. This will increase the volume of depression screening, with no benefit to patients. #2 - for the current CY, CY24, and beyond - if this issue is not fixed, documentation of appropriate follow-up for patients with a positive screen (and thus measure MET status) will inappropriately show as UNMET, unless with each screen a patient is repetitively referred for treatment, even when they are already in treatment. My team will either have to suppress screening when one has already been done for the year, and we will not do that! Or, we will have to train doctors to duplicatively refer with each screen, even when a referral is not necessary. This is burdensome to clinicians, and may create confusion to patients ("why is my doctor referring me to someone when I am already in treatment? Does she want me to see someone else?")

      New issue - CMS2v13 differs from every prior instance of the measure, by REMOVING prior diagnosis of depression from the exclusion list. Thus, all patients 12 and older, even those who are diagnosed with, and/or being treated for depression would now be subject to depression screening. The only exclusion is for bipolar disorder. I hope I am misreading this 2024 update, as if not, how does this make sense?

      Screening is designed for people who don't already have the diagnosis.

      And assuming the measure steward feels differently - what is the appropriate follow-up action for someone with depression who is already in treatment? Referring for treatment? Sounds like wasted effort JUST to "treat" the measure - and does nothing for patients.

      Second issue - and I have raised this before. For other screening measures where a follow-up is done and documented, there is clarity that repeated follow-ups are not necessary during the measure year... To the contrary, for both BMI and smoking / tobacco use - documented follow-up / guidance / cessation activity (for tobacco use) - appropriate follow-up during the measure year counts. I recall guidance on this site that it made no sense to require it after each screening (BMI and smoking/tobacco screening are often done multiple times during the measure year) - something to the effect... "if the patient has already been referred to a nutritionist / quitline, etc. why would you re-refer after each screening - they are already in treatment..." And yet, with depression screening - a follow-up is required after every screening.

      And please don't point out that depression screening is only required by the measure annually... That's also true for BMI and tobacco. Clinicians will (thank God) screen not just for floor measure requirements - but when they feel it's appropriate. So no, telling clinicians to stop following clinical judgment is not an acceptable answer.

      And yet, placing an unreasonable burden on clinicians who screen for depression more than once during the CY is what this measure does. Perhaps there is a satisfier that is the equivalent of "continue seeing the same person I referred you to last week/month, etc." But what's the point - the patient was screened and appropriately followed-up; but without burdensome click-boxing that adds nothing to patient care - the clinician fails the measure.

            edave Mathematica EC eCQM Team
            pbasch1 Peter Basch
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