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Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
Resolution: Answered
Priority: Moderate
Component/s: None
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Solution:

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Thank you for questions about CMS506v6 Safe Use of Opioids - Concurrent Prescribing. The measure excludes inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are ordered or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department encounter or observation stay immediately prior to hospitalization, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay.

For palliative and hospice care, the denominator exclusion captures patients who have a hospice referral or admission with the value set "Hospice Care Referral or Admission" (OID 2.16.840.1.113762.1.4.1116.365) and patients receiving palliative or hospice care with value set "Palliative or Hospice Care" (OID 2.16.840.1.113883.3.600.1.1579), which includes interventions ordered or performed during the inpatient hospitalization. You can reference the codes contained in these value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/. Click on the “Search Value Sets” tab and enter the value set ID to review codes included in the respective value set. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit. We hope this helps.

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Thank you for questions about CMS506v6 Safe Use of Opioids - Concurrent Prescribing. The measure excludes inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are ordered or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department encounter or observation stay immediately prior to hospitalization, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay. For palliative and hospice care, the denominator exclusion captures patients who have a hospice referral or admission with the value set "Hospice Care Referral or Admission" (OID 2.16.840.1.113762.1.4.1116.365) and patients receiving palliative or hospice care with value set "Palliative or Hospice Care" (OID 2.16.840.1.113883.3.600.1.1579), which includes interventions ordered or performed during the inpatient hospitalization. You can reference the codes contained in these value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/ . Click on the “Search Value Sets” tab and enter the value set ID to review codes included in the respective value set. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit. We hope this helps.
2024 Reporting Period EH/CAH eCQMs:

CMS0506v6
Impact:

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When CDAC validates our eCQM charts, they don't account for documentation that may not be discrete, meaning we have no way to capture via QRDA, such as "comfort measures" in free text provider notes. We're trying to identify all possible discrete areas (flowsheets, orders, ADT) where these terms within the comfort measures value set could be mapped to in order to try preventing some of these failures.

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When CDAC validates our eCQM charts, they don't account for documentation that may not be discrete, meaning we have no way to capture via QRDA, such as "comfort measures" in free text provider notes. We're trying to identify all possible discrete areas (flowsheets, orders, ADT) where these terms within the comfort measures value set could be mapped to in order to try preventing some of these failures.

I have a few questions around hospice/palliative care/comfort measures.

For Safe Use of Opioids (CMS 506) there is denominator exclusion of "Intervention Palliative or Hospice Care" and "Discharge Disposition of "Hospice Care Referral or admission."

1. On the patient's Admission/Discharge/Transfer report, it shows the discharge disposition as "Home Care" and there is also a field for "Discharge Destination" that states "Home Health/Hospice." Should the "discharge destination" be a field we map to for a "hospice" inclusion term?" We currently only map to discharge disposition so in this instance the discharge disposition would map to "Home", but if CDAC were to review our chart for validation purposes, they would see the documentation of "home health/hospice" in the discharge destination field.

2. In the Discharge order, there is also a field for "discharge destination" that includes option of "home health/hospice." Is this something we should map to? I think it comes from the same background location/code as #1 above.

3. This question is for both Safe Use of Opioids and VTE-1, -2 measures. There is a "Service to Home Care" order on day of IP admission or day after. There is a questionnaire within this order with a question "Agency Information" and the response is "Kathy Hospice." There is also a question of "Hospice Services Needed" and if this is answered 'yes' should we be mapping to the field if discrete to use as an inclusion of the value set for the denominator exclusion criteria?

4. There is a flowsheet called "Initial Assessment" and a row of "Discharge Goals" with a response of "hospice". If the "hospice" documentation is discrete to be map to that flowsheet row, should we be including this as a denominator exclusion?

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