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  2. CQM-6687

ePC-07 Anemia risk adjustment

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      Thank you for your question about the risk adjustment variables for CMS 1028/PC-07 Severe Obstetric Conditions. The presence of anemia on admission or a low hematocrit lab result within 24 hours of the encounter are separate variables that were tested independently as well as together in combination with other variables during the measure development process. The results of testing supported the decision to require reporting both variables as risk adjustment variables with different coefficients. We will continue to monitor the data and hospital feedback to see if the risk adjustment model needs to be modified in the future.

      Considering each variable’s significance, thorough and complete documentation are ideal for good quality data analytics to determine effective changes to improve care.
      Show
      Thank you for your question about the risk adjustment variables for CMS 1028/PC-07 Severe Obstetric Conditions. The presence of anemia on admission or a low hematocrit lab result within 24 hours of the encounter are separate variables that were tested independently as well as together in combination with other variables during the measure development process. The results of testing supported the decision to require reporting both variables as risk adjustment variables with different coefficients. We will continue to monitor the data and hospital feedback to see if the risk adjustment model needs to be modified in the future. Considering each variable’s significance, thorough and complete documentation are ideal for good quality data analytics to determine effective changes to improve care.
    • CMS1028v2
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      I need to understand how the anemia risk adjustment is done...do you need a low Hematocrit on admission as well as a diagnosis code that is POA? If you just have the hematocrit low will that adjust the risk to the same level as if anemia is coded on final coding?
      Show
      I need to understand how the anemia risk adjustment is done...do you need a low Hematocrit on admission as well as a diagnosis code that is POA? If you just have the hematocrit low will that adjust the risk to the same level as if anemia is coded on final coding?

      We have issues with our providers not documenting "anemia" but instead documenting their H&H only. Our coding department says they need to write "anemia" in their H&P to get coding for anemia. But I know the measure is also looking at the first Hematocrit from 24 hours before admission to delivery.  Is that automatically adjusting for anemia when the hematocrit is low?  Does it adjust to the same degree as it would if there was also an anemia diagnosis code?  If the hematocrit we are reporting in the measure has the same effect, I'm not going to bend over backwards to get the providers to write the word anemia in the H&Ps.  Thanks.

            JLeflore Mathematica EH eCQM Team
            jlharlos Jennifer Harlos
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