For the Outpatient eCQM - CMS 996v4 - This topic was discussed in https://oncprojectracking.healthit.gov/support/browse/CQM-5630 but it seems to me that the resolution provided in it may be incorrect.

The logic in question is the following - 

Global.HospitalizationLocations(Encounter "Encounter, Performed")

let EDVisit: Last(["Encounter, Performed": "Emergency Department Visit"] LastED

where LastED.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod

Question is – What is this Visit?

The response provided stated that the Visit refers to Inpatient Visit. **

But this does not seem correct.

The Data Criteria in the eCQM does not include Inpatient Encounter, so how can one evaluate an inpatient encounter within the eCQM logic if this data is not even included in the data criteria. In line with the smoking gun philosophy, the inpatient encounter would not even be included in the exported QRDA CAT I files since it is not defined in the data criteria.

So, I’m still trying to understand how to evaluate this piece of logic from the eCQM – 

What is Visit here? Since it cannot be an inpatient encounter, what else can it be?

Additionally, the above logic for Encounter, Performed only looks at one Value set – Emergency Department Visit. What if the Encounter, Performed is for an ED encounter with CPT codes from the Emergency Department Evaluation and Management Visit value set? Does the logic not look for Facility Locations if the ED encounter uses one of the CPT codes?

We created test cases in Cypress 7.2.0.1 for this eCQM and none of the episodes have an inpatient encounter which makes sense.

We also created test cases in Bonnie, and even Bonnie does not allow addition of an inpatient encounter for this eCQM and again that makes sense because inpatient encounter is not part of the data criteria for this eCQM.

We would appreciate if someone can help provide clarification for this question and how to interpret this logic.

Thanks!