Brief Description of Measure: CMS1028/PC-07: Severe Obstetric Complications Patients with severe obstetric complications which occur during the inpatient delivery hospitalization CMS334/PC-02: Cesarean Birth Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth Description of Issue: Perinatal care measures share the same initial patient population. Shared logic is stored in the PCMaternal library that is used by numerous measures. During pilot testing of CMS1028/PC-07, hospitals were using claims data to determine if a delivery procedure was performed. Typically, claims data only has a procedure date and no procedure time. If the patient delivered the same day as admission and no time was associated with the procedure, the case would not meet the "Delivery Encounter with Age Range" definition, as the time could default to 0000. Therefore, the logic did not recognize that the procedure was performed during the encounter. As a result, the "day of" operator was added for reporting year 2022 so that procedures performed on the day of admission without an associated time would still meet the definition. This change resulted in unintended results whereby the procedure could qualify for the denominator but not qualify for the numerator. For example, if a patient had a c-section with only date submitted, day of is applied and the patient is included in the initial population. When processing the numerator, the "day of" operator is not included in the logic and therefore, the C-section must be performed during the hospitalization. This is an issue only when time is not submitted with the procedure date.

Proposed Solution: The measure steward proposes removing "day of" from the initial population definition and instructing hospitals to map the time of delivery to the delivery procedure and c-section procedure date/time. Asterisks designate a strike-through: >PCMaternal.Delivery Encounter with Age Range "Encounter with Age Range" EncounterWithAge   with ["Procedure, Performed": "Delivery Procedures"] DeliveryProcedure     such that Global."NormalizeInterval" ( DeliveryProcedure.relevantDatetime, DeliveryProcedure.relevantPeriod ) starts during **day of** "HospitalizationWithEDOBTriageObservation"(EncounterWithAge) Rationale for Change: This proposed update will align the timing of procedures in the denominator with the timing of procedures in the numerator. This proposed update will aid in appropriate data capture.