A group of physicians in our health organization respectfully appeal to CMS’s decision regarding the inclusion of the chronic depression diagnosis in the CMS2 metric population based on several critical points:
 
Firstly, it’s imperative to acknowledge that not excluding active diseases and chronic conditions will inevitably conflate populations. This conflation has the potential for inaccurate decisions in program planning, resource allocation, and access utilization. By including prior and/or an active depression diagnosis without proper consideration of its chronic and relapsing nature, the metric risks misrepresenting the true population in need of screening and intervention.
 
Secondly, when patients have a confirmed diagnosis of depression and are under care, the focus shifts from initial screening to ongoing management of symptoms and appropriate treatment. Therefore, including individuals with existing diagnoses in the screening metric undermines the essence of screening itself and misguides the effort toward monitoring and treatment.
 

Reconsider the removal of the exclusion of the depression diagnosis in the CMS2 metric population. 
Thirdly, the inclusion of depression maintenance in a screening metric is likely to yield an increase in false positives of the depression severity diagnosis in the population. Screening tools are designed to identify potential cases for further evaluation, not to definitively diagnose severity levels. Including individuals with pre-existing diagnoses in the screening pool amplifies the likelihood of false positive, leading to unnecessary intervention and resource utilization.
 
Lastly, while acknowledging the importance of screening individuals who have fully recovered from a single episode of depression, it’s crucial to distinguish this population from those actively managing chronic or relapsing conditions. Including recovered individuals for periodic screening aligns with proactive preventive healthcare measures and ensures timely intervention if symptoms recur.