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Type: EC eCQMs - Eligible Clinicians
Resolution: Answered
Priority: Moderate
Component/s: None
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Thank you for your inquiry about CMS165v12 for 2024 performance period.

As noted in ~~CQM-6854~~ and ~~CQM-6821~~, in relation to the "Outpatient Encounters with Advanced Illness" criteria, the measure logic looks for at least two outpatient encounters with an Advanced Illness diagnosis documented for the visit. The measure does not prescribe how this information should be documented in structured fields of EHRs, but the diagnosis needs to be associated with the encounters.

The logic in this criteria is specifically looking for QDM datatype "Encounter, Performed" where the QDM attribute component "Diagnosis.code" is using any ICD10 or SNOMEDCT codes from the "Advanced Illness" value set located here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion/eCQM%20Update%202023-05-04). The QDM attribute "diagnoses" is defined in QDM v5.6 4.3 (https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf#page=63) as: "The “Encounter, Performed” diagnoses attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression."

Also as noted in ~~CQM-6854~~, revision to reduce the complexity of the specification (of requiring encounter visits) is currently under consideration for future publication. We hope this helps.

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Thank you for your inquiry about CMS165v12 for 2024 performance period. As noted in CQM-6854 and CQM-6821 , in relation to the "Outpatient Encounters with Advanced Illness" criteria, the measure logic looks for at least two outpatient encounters with an Advanced Illness diagnosis documented for the visit. The measure does not prescribe how this information should be documented in structured fields of EHRs, but the diagnosis needs to be associated with the encounters. The logic in this criteria is specifically looking for QDM datatype "Encounter, Performed" where the QDM attribute component "Diagnosis.code" is using any ICD10 or SNOMEDCT codes from the "Advanced Illness" value set located here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion/eCQM%20Update%202023-05-04) . The QDM attribute "diagnoses" is defined in QDM v5.6 4.3 ( https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf#page=63 ) as: "The “Encounter, Performed” diagnoses attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression." Also as noted in CQM-6854 , revision to reduce the complexity of the specification (of requiring encounter visits) is currently under consideration for future publication. We hope this helps.
2024 Performance Period EC eCQMs:

CMS0165v12
2023 Performance Period EC eCQMs:

CMS0165v11
Impact:
High impact related to large decrease in numbers of patients that will fall out of advance illness logic and possibly be a not met outcome fir many measures, not just CMS165.

We are sending another inquiry and would like to see if you can compare these two listed JIRAs for your next response, please. Comparison of JIRA’s ~~CQM-6854~~ and ~~CQM-6821~~

We are looking for clarification on use of SNOMED codes in the active Problem lists in our patients EHR as qualifying for advance illness on qualifying outpatient encounters (2) to satisfy the logic for Advance Illness.

JIRA ~~CQM-6821~~ was placed by me.

JIRA ~~CQM-6854~~ was placed by our vendor.

In JIRA ~~CQM-6854~~ our vendor gave a scenario; can you look again at this scenario and see if it would meet the logic requirements for "Outpatient Encounters with Advanced Illness". Once you review the screen shots (2) I have below to show you how the CHF SNOMED CT code (code is in advance illness valueset) shows active and shows the provider does pull all these active SNOMED codes over to their provider clinical note on the day of the qualifying outpatient encounter. We would like clarification after you review this scenario with all the details, we see in the EHR per patient. Our clinical background feels like advance illness diagnosis do not every leave the patient, once you have i.e. as CHF, heart failure, Parkinson’s disease, or metastatic cancers – they are always with you and an active condition on the problem list should count if still in active status and brought into the providers clinical note and signed by this provider in the EHR.

For outpatients visits below on 1/1/24 & 3/1/24 they both have active codes of “'Chronic right-sided heart failure (10335000)” on problem list and has been brought over to the providers clinical note for that day of service (see examples on attachment of what appears in the patient’s chart EHR)

“Scenario:
-A patient has documentation of 'Chronic right-sided heart failure (10335000) in the problem list, active since 2019 (this code is included in the advanced illness valueset)
-Patient has an Outpatient visit on 1/1/2024 - Diagnosis documented for the visit was J45.20 (Mild intermittent asthma - not in the advanced illness valueset)
-Patient has an Outpatient visit on 3/1/2024 - Diagnosis documented for the visit was D50.9 (Iron deficiency anemia - not in the advanced illness valueset)”

And can you answer our vendor’s question of - Is it intended to evaluate the active conditions documented in the patient's problem list (the EHR problem list tracks the patient's conditions) even when some of those conditions were not addressed during a particular visit?

This question was asked by our Vendor, we would like to know the answer to this question after looking at what we see in the EHR per patient and how the active problem list is used on the EHR.

We also reviewed and highlighted a couple areas of QDM V5.6 for CQL on page 28 (see attachment/link).

Thank you for your clarification in this matter.

New ONC JIRA 4.2.24.docx