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  2. CQM-6652

CMS 128v11 Anti-depressant Medication Management: Exclusion criteria discrepancy logic vs description

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    • Heather Clodfeler
    • JHM
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      Thank you for your question regarding CMS128v11 (2023 performance period) Anti-depressant Medication Management. In the scenario provided, a patient with an IPSD of 5/6/2023, actively on antidepressants from 12/28/2021 to 2/4/2022, would not meet the Initial Population criteria for CMS128v11. Considering the 2023 performance period, the IPSD within the intake period should initiate between May 1 of the year prior of the Measurement Period through April 30 of the Measurement Period. The patient in the described scenario should not be passing the intake period criteria in the first place, and thus should not meet the Initial Population criteria.
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      Thank you for your question regarding CMS128v11 (2023 performance period) Anti-depressant Medication Management. In the scenario provided, a patient with an IPSD of 5/6/2023, actively on antidepressants from 12/28/2021 to 2/4/2022, would not meet the Initial Population criteria for CMS128v11. Considering the 2023 performance period, the IPSD within the intake period should initiate between May 1 of the year prior of the Measurement Period through April 30 of the Measurement Period. The patient in the described scenario should not be passing the intake period criteria in the first place, and thus should not meet the Initial Population criteria.
    • CMS0128v11
    • There appears to be a misalignment between the exclusion criteria description for CMS128v11 and what is written in the logic. This is causing patients to not be excluded when it seems they should be, per metric description

      CMS128v11 description of denominator exclusion: Patients who were actively on an antidepressant medication in the 105 days prior to the Index prescription start date.

      A patient with an IPSD of 5/6/2023 was actively on an anti-depressant from 12/28/2021 to 2/4/2022 which is within 105 days prior to the IPSD of 5/6/2023. By denominator exclusion criteria outlined above in the description this patient should be excluded from the denominator. However they are not being excluded. When looking into the logic for CMS128v11 it reads that the active medication needs to also overlap the intake period in order for it to exclude the patient. The metric denominaor exclusion description makes no mention that the active medication also needs to overlap both the intake period AND the IPSD-105 days.

       

            edave Mathematica EC eCQM Team
            hclodfe1 Heather Clodfeler
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