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  2. CQM-7351

OP STEMI Encounter Inclusion RE: CMS 996v3

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    • Icon: OQR eCQMs - Outpatient Quality Reporting OQR eCQMs - Outpatient Quality Reporting
    • Resolution: Answered
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    • Patricia Humiston
    • 4137940194
    • Baystate Medical Center
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      Thanks for your question regarding the CMS996v3: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) measure.

      The measure captures three potential numerators for patients that arrive to the ED with a STEMI diagnoses: PCI procedure within 90 minutes, fibrinolytic therapy in 45 minutes, or discharge to PCI-capable facility within 45 minutes. In the scenario that you outlined, patients are first discharged from the ED into inpatient care, and then receive the PCI. Discharging the patient from the ED to an acute setting within 45 minutes can count towards the numerator as one of the three possible numerator outcomes. In this numerator, a patient will need a disposition plan from the ED and may go on to an acute setting (either on-site or at another setting) to receive further diagnostic or treatment services. In addition, we want to clarify that this measure is specific to the hospital outpatient/ED setting and is not intended to capture inpatients STEMIs.

      We recommend working closely with your EHR vendor so that ED encounters can be documented and reported to CMS separately from any downstream inpatient encounters.
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      Thanks for your question regarding the CMS996v3: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) measure. The measure captures three potential numerators for patients that arrive to the ED with a STEMI diagnoses: PCI procedure within 90 minutes, fibrinolytic therapy in 45 minutes, or discharge to PCI-capable facility within 45 minutes. In the scenario that you outlined, patients are first discharged from the ED into inpatient care, and then receive the PCI. Discharging the patient from the ED to an acute setting within 45 minutes can count towards the numerator as one of the three possible numerator outcomes. In this numerator, a patient will need a disposition plan from the ED and may go on to an acute setting (either on-site or at another setting) to receive further diagnostic or treatment services. In addition, we want to clarify that this measure is specific to the hospital outpatient/ED setting and is not intended to capture inpatients STEMIs. We recommend working closely with your EHR vendor so that ED encounters can be documented and reported to CMS separately from any downstream inpatient encounters.
    • CMS0996v4
    •  RE: CMS 996v3 ...... When running OP -40 STEMI reports we come up with none when following the OP-40 STEMI mapping guidance...

      I've reviewed the multiple JIRAs related to OP STEMI Encounter inclusion and still do not have a grasp on clarifying the population. Our organization does not have separate OP Encounter coding or billing. If a patient is in the ED and STEMI DX they then become inpatient and proceed to the cath lab for intervention, they keep the same account registration encounter number. So when following these encounters they are discharged inpatient not outpatient. When mapping per the eCQM rules we come up with no patients when in fact we do many PCI interventions. Please advise

            aweber Mathematica EH eCQM Team
            patricia.humiston@baystatehealth.org Patricia Humiston
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