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  2. CQM-7387

CMS1074v2 eCQM modification is needed to streamline generating QRDA-1 Files, while accommodating two different types of Episodes

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
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      Thank you for your question regarding CMS1074v2 (Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Facility IQR)). You are correct. The current measure logic for definition ‘Qualifying Inpatient Encounters’, found within the definition for ‘Qualifying Scan During Inpatient Encounter’, overlaps the measurement period. Therefore, there could be instances when an encounter ends after the measurement period and includes CT scans that occurred before the end of the measurement period. We are aware of this issue and are working on a solution for a future update.
      Show
      Thank you for your question regarding CMS1074v2 (Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Facility IQR)). You are correct. The current measure logic for definition ‘Qualifying Inpatient Encounters’, found within the definition for ‘Qualifying Scan During Inpatient Encounter’, overlaps the measurement period. Therefore, there could be instances when an encounter ends after the measurement period and includes CT scans that occurred before the end of the measurement period. We are aware of this issue and are working on a solution for a future update.
    • CMS1074v2
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      The use of above logic in Qualifying Inpatient Encounter definition, will impact how CT-Scan measure data is submitted to Receivers in QRDA-I files.
      If the measure is implemented as is with current logic, it will require the hospitals/vendors to submit multiple QRDA I files for a given patient, as the inpatient CT Scan episode can be reported in a different quarter from the inpatient episode's discharge date .
      Show
      The use of above logic in Qualifying Inpatient Encounter definition, will impact how CT-Scan measure data is submitted to Receivers in QRDA-I files. If the measure is implemented as is with current logic, it will require the hospitals/vendors to submit multiple QRDA I files for a given patient, as the inpatient CT Scan episode can be reported in a different quarter from the inpatient episode's discharge date .

      Our current understanding is that each diagnostic CT scan is considered one diagnostic episode. This is in addition to the inpatient encounter episode. The following table shows the data collection scenarios and created QRDA files for the example.

       

      Example:

      • A patient has 4 CT scans (see start, end time below), and 1 inpatient encounter (start: 12/20/2023 end: 01/15/2024)
      • The hospital for that patient will report following measures:

                   - CT scan IQR (Diagnostic Study episode/ inpatient measure)

                   - CT scans OQR (Diagnostic Study episode/outpatient measure)

                   - eSTK-3 and ED-1 (encounter episode/inpatient measures)

       

      The table below shows number of QRDA I files created according to the CT scans and their inpatient encounter, if any, and the episodes included in the QRDA I.

       

      As you can see from the QRDA file creation, inpatient CT Scan episode can be reported in a different quarter from the inpatient discharge if those CT scan falls into different quarter. 

      *Total
      Episodes*      		 Start Stop  **  CT scan starts during
      Inpatient Encounter
      (Start: 12/20/2023  End: 1/15/2024)      		 Quarter
      Episode Ends on      		 QRDA I Created Episodes
      CT Scan 1 12/19/2023 12/19/2024   No Q4 1 QRDA for Q4 (OQR)
      Data elements included: CT Scan 1      		 contains one CT scan OQR episode
      CT Scan 2 12/20/2024 12/20/2024   Yes Q4 1 QRDA for Q4 (IQR)
      Data elements included: CT Scan 2, 3 and their associated Encounter 1.      		 contains two CT scan IQR episode
      CT Scan 3 12/21/2024 12/21/2024   Yes Q4
      CT Scan 4 1/13/2024 1/13/2024   Yes Q1 1 QRDA for Q1 (IQR)
      Data elements included: CT Scan 4,  and its associated Encounter 1.      		 contains one inpatient episode (eSTK-3 and ED-1)
      and one CT scan IQR episode

            aweber Mathematica EH eCQM Team
            hsubhan_JC Hafsa Subhan (Inactive)
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