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  2. CQM-6947

ePC-07 risk adjustment for the hospital or for individuals?

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    • Thank you for your question about CMS1028/PC-07 Severe Obstetric Complications. Your interpretation is correct that the approach is to risk adjust at the hospital level, based on the risks of the entire population.
    • CMS1028v2
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      The accuracy of the risk adjustment diagnosis codes on the "denominator (not numerator)" encounters are just as important in the risk adjustment calculation as the risk adjustment diagnosis codes for those encounters that fall into the numerator. (I think.)
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      The accuracy of the risk adjustment diagnosis codes on the "denominator (not numerator)" encounters are just as important in the risk adjustment calculation as the risk adjustment diagnosis codes for those encounters that fall into the numerator. (I think.)

      I have tried to understand the methodology report on ePC-07 and I want to make sure I am understanding correctly. (SOC eCQM Methodology Report (healthit.gov)) I believe it's saying on P. 25-26 that risk factors for all the patients in the Denominator are used to adjust the hospitals rate of unexpected complications.  It's not looking at an individual that is a numerator and then adjusting for their individual risk, it's adjusting for the hospital's overall expected rate of complications based on the risks of the entire population. Is that a correct interpretation, or no?

            JLeflore Mathematica EH eCQM Team
            jlharlos Jennifer Harlos
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