Brief Description of Measures: CMS125: Breast Cancer Screening CMS130: Colorectal Cancer Screening CMS165: Controlling High Blood Pressure CMS131: Diabetes: Eye Exam CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) Description of Issue: Removing visit requirements will reduce the complexity of identifying advanced illness. Instead of looking for at least one inpatient encounter or two outpatient encounters with an advanced illness diagnosis, the provider-level eCQMs will now look for one advanced illness diagnosis during the measurement period or the year prior. Early testing showed that this method in HEDIS led to very minimal impact on exclusion rates.

Proposed Solution: Example in CMS125: //Header - before Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior //Header - after Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior //Logic - before AIFrailLTCF.Is Age 66 or Older with Advanced Illness and Frailty         ... and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"                 or "Has Inpatient Encounter with Advanced Illness"                 ... AIFrailLTCF.Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service         exists (         from           "Outpatient Encounters with Advanced Illness" OutpatientEncounter1,           "Outpatient Encounters with Advanced Illness" OutpatientEncounter2           where OutpatientEncounter2.relevantPeriod ends 1 day or more after day of           end of OutpatientEncounter1.relevantPeriod           return OutpatientEncounter1           ) AIFrailLTCF.Outpatient Encounters with Advanced Illness         ( ["Encounter, Performed": "Outpatient"]           union ["Encounter, Performed": "Observation"]           union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]           union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter           where exists ( OutpatientEncounter.diagnoses Diagnosis               where Diagnosis.code in "Advanced Illness"           )             and OutpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,             end of "Measurement Period"] AIFrailLTCF.Has Inpatient Encounter with Advanced Illness          exists( ["Encounter, Performed": "Acute Inpatient"] InpatientEncounter           where exists ( InpatientEncounter.diagnoses Diagnosis               where Diagnosis.code in "Advanced Illness"           )             and InpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,             end of "Measurement Period"]) //Logic - after AIFrailLTCF.Is Age 66 or Older with Advanced Illness and Frailty [...]and ( "Has Advanced Illness in Year Before or During Measurement Period" [...] AIFrailLTCF.Has Advanced Illness in Year Before or During Measurement Period           exists( ["Diagnosis": " Advanced Illness "] AdvancedIllnessDiagnosis               where AdvancedIllnessDiagnosis.prevalencePeriod starts during day of Interval[start of "Measurement Period" - 1 year,                 end of "Measurement Period"]) Rationale for Change: This change will reduce the complexity of identifying advanced illness in the Denominator Exclusion.