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  2. CQM-7295

CMS131v12 Blindness Diagnosis Exclusion

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    • Resolution: Answered
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      Thank you for your inquiry regarding CMS131v12 (2024 Performance Period) and CMS131v13 (2025 Performance Period). NCQA has explored the possibility of excluding individuals who are blind from the measure. However, it was concluded that such an exclusion would be rare and would not significantly affect the overall measure.

      It is important to note that blindness can present in various ways – such as level of light perception, the involvement of one or both eyes, and level of vision in the better eye. In some cases, patients who are classified as blind may still benefit from ongoing eye exams.

      We will revisit this exclusion, considering your use case for a future iteration of the measure.
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      Thank you for your inquiry regarding CMS131v12 (2024 Performance Period) and CMS131v13 (2025 Performance Period). NCQA has explored the possibility of excluding individuals who are blind from the measure. However, it was concluded that such an exclusion would be rare and would not significantly affect the overall measure. It is important to note that blindness can present in various ways – such as level of light perception, the involvement of one or both eyes, and level of vision in the better eye. In some cases, patients who are classified as blind may still benefit from ongoing eye exams. We will revisit this exclusion, considering your use case for a future iteration of the measure.
    • CMS0131v13
    • CMS0131v12
    • Measure score is lower on CMS 131 because blind patients are being included in the measure population with no exclusion or exception logic available.

      Back in version 5 of the measure, there was a ticket opened to address a diagnosis of blindness missing from the measure exclusion. It was noted in the solution that "NCQA is planning to review appropriate methods of excluding individuals who are blind from the measure during the next reevaluation." https://oncprojectracking.healthit.gov/support/browse/CQM-2934

      I'm noting that blindness is still not included in the measure exclusion logic AND also noted that "Blindness due to type 2 diabetes mellitus (disorder)" and "Blindness due to type 1 diabetes mellitus (disorder)" are both included in the measure INCLUSION value set for diabetes diagnosis. 

      Is there any plan for blindness as a diagnosis to be added to the exclusion logic for future versions of this measure?

            AIR EC eCQM Team AIR EC eCQM Team
            EBosko Erica Bosko
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