Thank you for your inquiry regarding CMS996v4, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure’s initial population includes all emergency department (ED) encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the ED encounter, that ends during the measurement period. Patients who develop a STEMI in the subsequent inpatient setting from the ED should not be included in the measure. We recommend working closely with your electronic health record (EHR) vendor so that ED encounters can be documented and reported to CMS separately from any downstream inpatient encounters.

We are reporting an issue found regarding the OP-40 (STEMI) measure. If a patient comes into the ED and there is no STEMI diagnosis while in the ED but then gets admitted to the hospital as an inpatient (IP) and gets a STEMI diagnosis during that encounter, the patient will be in the IP/Denominator for OP-40 because our EHR shares a hospital account between the ED and IP encounter. This is causing patients to pull in and be evaluated for the measure when they do not have STEMI diagnosis in the ED but rather gets one later while an IP. How can we account for this in our performance for this measure? Have any other organizations reported this issue?