Brief Description of Measure: CMS1028/PC-07: Severe Obstetric Complications Patients with severe obstetric complications which occur during the inpatient delivery hospitalization Description of Issue: To alleviate confusion about the measure stratification, the measure steward proposes creating two numerators instead of stratifying the measure. This proposed change will impact measure scoring.

Proposed Solution: The measure steward proposes updating the measure to replace the stratification with two numerators as follows: Stratification Metadata Before: Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. Additionally, this measure will be stratified by race and ethnicity after measure submission. After: This measure will be stratified by race and ethnicity after measure submission. Rate Aggregation Metadata Before: Hospital-level measure scores are calculated as a risk-adjusted proportion of the number of delivery hospitalizations for women who experience a severe obstetric complication, as defined by the numerator, by the total number of delivery hospitalizations in the denominator during the measurement period. The hospital-level measure score will be reported as a rate per 10,000 delivery hospitalizations. Stratum 1 is a subset of the numerator population: (Number of delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication / (Number of encounters in Denominator - Number of encounters in Denominator Exclusions)) * 10,000 After: Two hospital-level measure scores are calculated as a risk-adjusted proportion: 1. All Severe Obstetric Complications (SOC) 2. SOC excluding encounters where transfusion was the only SOC The denominator for both calculations are the same (total number of delivery hospitalizations during the measurement period less denominator exclusions).  The hospital-level measure scores will be reported as a rate per 10,000 delivery hospitalizations. Numerator Metadata The following will be added to the numerator metadata section: Two numerator populations are defined for this measure: 1. All Severe Obstetric Complications (SOC) 2. SOC excluding encounters where transfusion was the only SOC Population Criteria Logic A second population criteria will be added to reflect the 2 numerators. All populations will be the same between the 2 population criteria with the exception of the numerators. The numerator for the first population will be expressed in the "Delivery Encounters with Severe Obstetric Complications" definition. The numerator for the second population will be expressed in the "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" definition. Proposed Updated Logic: Numerator (#1) "Delivery Encounters with Severe Obstetric Complications" Delivery Encounters with Severe Obstetric Complications "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration"  union "Delivery Encounters with Blood Transfusion" Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses where EncounterDiagnoses.code in "Severe Maternal Morbidity Diagnoses" and EncounterDiagnoses.presentOnAdmissionIndicator in "Present on Admission is No or Unable To Determine"   ) or exists ( ["Procedure, Performed": "Severe Maternal Morbidity Procedures"] EncounterProcedures where Global."NormalizeInterval" ( EncounterProcedures.relevantDatetime, EncounterProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )  ) Delivery Encounters with Expiration "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter where TwentyWeeksPlusEncounter.dischargeDisposition in "Patient Expired" Delivery Encounters with Blood Transfusion "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter with ["Procedure, Performed": "Blood Transfusion"] BloodTransfusion such that Global."NormalizeInterval" ( BloodTransfusion.relevantDatetime, BloodTransfusion.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter ) Numerator (#2) "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only "Delivery Encounters with Severe Obstetric Complications" intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions" Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" union "Delivery Encounters with Expiration" Rationale for Change: Replacing stratification with multiple numerators will alleviate confusion from the reporting community and simplify the measure construct.