In the QRDA Category III specification supplemental data items are declared to be patient based. An example of this is the declaration for Administrative Sex reporting

"This observation represents the sex of a person as used for administrative purposes (as opposed to clinical gender) and provides the number of patients in the population that are of that sex."

Does this apply for episode of care based measures as well where the population reporting is not the number of patients but the number of episodes? If not guidance needs to be issued on how to report the supplemental data for such measures.

For example lets say we have an episode of care based measure and we have 4 patients that map into the IPP. 1 patient is African American and has 4 episodes that qualify for the IPP and the other 3 patients are all Caucasian with each having 1 episode that maps into the IPP. The total aggregate for the IPP value is then 7. For supplemental data purposes though how are we to expect the RACE section to be broken down. Is it 4 African American and 3 Caucasian or is it 1 African American and 3 Caucasian ? What is CMS expecting here? If you report on the number of episodes you get skewed demographics of the actual population of patients, there is only 1 African American not 4 in the example.

The QRDA Spec states its the number of patients, but that same sort of wording is used in Episode of Care based measures at times when it is clearly not what is counted. Cypress currently implements supplemental data counting based on number of patients as well, because of the wording in the spec. This can be modified to count based on the number of episodes but I have no plans on changing it until CMS/ONC gives us some guidance on their expectations. The sooner ONC/CMS gives us the answer the better , code freeze is next week.