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OQR eCQMs - Outpatient Quality Reporting
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Resolution: Answered
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Moderate
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None
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None
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Alexis Wells
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5863299990
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JPS Health Network
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CMS0996v3
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We are unable to identify certain parameters which is making us unable to validate that the measure is functioning properly
- How is "end of ED encounter" determined? If there are multiple sources, what is the hierarchy of determination?
- When the pt physically leaves the ED? For example, the patient leaves the ED to cath lab at 9:57am, would the time stamp for "ED departure" be the time for "end of ED encounter"?
- When the pt has a decision to admit time? For example, the patient remains in the ED as admit overflow but the inpatient admission order is written at 10:36am, would the admit order time be the time for "end of ED encounter"?
- When an H&P is written? For example, the H&P is filed at 9:55am and the date of service is 9:56am, would this time be "end of ED encounter"?
- What if pts are admitted but are in holding in the ED waiting for an OBS/IP bed and a STEMI happens after admission but before leaving the ED while waiting on a bed? Would this be included as a STEMI prior to "end of ED encounter"?
- With OP-40 being a process measure, how do we handle pts who leave ED with the diagnosis of STEMI, go emergently to the cath lab but do not receive PCI because there is no occlusion? Should these patients be a part of the OP-40 measure, or be excluded? If they should be excluded, what in the methodology would prevent this type of patient from being a fallout?
- Example: Pt comes in with STEMI on ECG, ED dx is STEMI, pt is admitted and transferred emergently to the cath lab. Cath lab diagnosis is vasospasm resolved with intracoronary nitroglycerin. We did not give lytics or transfer the pt because we have a cath lab available 24/7. We performed the process but because the pt did not receive PCI <90 min (because they did not receive any PCI), they are showing as a fallout.
- Is there any consideration of including this type of patient as an exclusion to the measure?
- Does CMS have an algorithm of inclusion/exclusion decision? "If this, then that" or "yes/no" decision tree?
- Would having an ED provider update their note after the cath lab to remove STEMI from the ED diagnosis be the only solution?
- Is the ED expected to change their diagnosis after they leave even though that was the diagnosis when leaving the ED?
- How can we prevent this pt from falling into the measure when the cath lab rules out a STEMI? PCI would not be appropriate for these types of patients.