Thank you for your inquiry regarding CMS996v4 and CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures the percentage of ED encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer to acute care within 45 minutes of ED arrival. The first two numerator outcomes capture patients receiving treatment in the ED within the appropriate times, and the third numerator captures patients transferred to inpatient care within 45 minutes. The measure intends to capture STEMI cases in the ED and does not capture patients who develop STEMI after being transferred to inpatient care.

Would like clarification on OP-40's measure population. Does this only include ED patients that were treat and release, or does it include patients who started their journey in the ED but got admitted (inpatients)? If inpatients are included, if the patient did not get the AMI dx during the ED stay would they still counted? Since this measures the early treatment but if the patient did not have signs of AMI in the ED, it does not seem fair for it to count against us.