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  1. eCQM Issue Tracker
  2. CQM-6918

CMS108 IP first then OBS

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
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    • Cari Jones
    • 4054738842
    • INTEGRIS Healthcare
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      Thank you for your inquiry on CMS108v12: Venous Thromboembolism Prophylaxis. Since this patient was admitted to Inpatient on 3/27 at 1613 and moved to Observation after, the starting datetime for this whole encounter should be 3/27 at 1613. The logic will not count this Observation according to the function "HospitalizationWithObservation", because the Observation status will be considered only when Observation starts/ends before inpatient admission time. Therefore, the QRDA file information aligns with the measure intent. The denominator exclusion condition "Encounter Less Than 2 Days" is evaluating if inpatient hospital stay is less than 2 days. This patient had LOS = 2 day as 3/29 - 3/27 and is not qualifying for denominator Exclusion population.
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      Thank you for your inquiry on CMS108v12: Venous Thromboembolism Prophylaxis. Since this patient was admitted to Inpatient on 3/27 at 1613 and moved to Observation after, the starting datetime for this whole encounter should be 3/27 at 1613. The logic will not count this Observation according to the function "HospitalizationWithObservation", because the Observation status will be considered only when Observation starts/ends before inpatient admission time. Therefore, the QRDA file information aligns with the measure intent. The denominator exclusion condition "Encounter Less Than 2 Days" is evaluating if inpatient hospital stay is less than 2 days. This patient had LOS = 2 day as 3/29 - 3/27 and is not qualifying for denominator Exclusion population.
    • CMS0108v12
    • Will determine whether or not particular patients will fall into the population based on registration.

      A particular patient was first made IP at 1613 on 3.27, then physician's changed the status to OBS at 1642 same day and the patient remained under OBS status until 3.29-the date of discharge.

      Currently, the QRDA file is showing this patient's IP status to be at the start time of 1613 on 3.27 as stated above, thru the dc date of 3.29 (even though the patient was registered as OBS the majority of the encounter).

      This patient has been billed as an OBS pt.

      Currently, per the report, the patient is falling into the DEN population due to no vte prophylaxis in the specified timeframe.

      Under these circumstances, is it correct that the QRDA file is capturing the entire encounter as IP instead of just 1613 thru 1642 the same day? 

      Should this pt encounter be recognized as IP for <2d thus falling into the DEN EXCLUSION population? 

       

            JLeflore Mathematica EH eCQM Team
            shorca Cari Ann Jones
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