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  2. CQM-7564

Clarification for CMS137v13

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Sam Ross
    • Esperanza Health Centers
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      Thank you for your inquiry regarding CMS137v13 (2025 Performance Period). The intent of the measure's Initial Population criteria is to capture patients who are diagnosed with a new episode of substance use disorder (SUD) during a visit that occurs between January 1 and November 14 of the measurement period. As noted, the logic 'SUDDiagnosis.prevalencePeriod starts during ValidEncounters.relevantPeriod' specifies that the SUD diagnosis must begin during a valid encounter. Therefore, an SUD diagnosis listed on the problem list with an onset date of 7/1/2024 and no stop date does not satisfy this criteria.

      If an SUD diagnosis was included in the qualifying encounter on 2/1/2025, this would meet the criteria for a "First SUD Episode During the Measurement Period," as the prevalence period would start on 2/1/2025.

      For further clarification on the measure’s intent, please refer to the full measure specification here: https://ecqi.healthit.gov/ecqm/ec/2025/cms0137v13?qt-tabs_measure=specifications-and-data-elements
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      Thank you for your inquiry regarding CMS137v13 (2025 Performance Period). The intent of the measure's Initial Population criteria is to capture patients who are diagnosed with a new episode of substance use disorder (SUD) during a visit that occurs between January 1 and November 14 of the measurement period. As noted, the logic 'SUDDiagnosis.prevalencePeriod starts during ValidEncounters.relevantPeriod' specifies that the SUD diagnosis must begin during a valid encounter. Therefore, an SUD diagnosis listed on the problem list with an onset date of 7/1/2024 and no stop date does not satisfy this criteria. If an SUD diagnosis was included in the qualifying encounter on 2/1/2025, this would meet the criteria for a "First SUD Episode During the Measurement Period," as the prevalence period would start on 2/1/2025. For further clarification on the measure’s intent, please refer to the full measure specification here: https://ecqi.healthit.gov/ecqm/ec/2025/cms0137v13?qt-tabs_measure=specifications-and-data-elements
    • CMS0137v13
    • We are a Federally Qualified Health Center and this eCQM has been added to Uniform Data System reporting for 2025. Our EMR and population health tool (Azara) will not have data on this measure until Spring and we would like to begin evaluating sooner.

      I'm seeking clarification on the definition of "First SUD Episode During Measurement Period." For purpose of example:

      • Patient is age >=13 on 1/1/2025
      • Patient has an SUD diagnosis on the problem list with an onset date of 7/1/2024 and no stop date
      • Patient's first valid encounter (e.g. office visit) during the measurement period occurs on 2/1/2025, without the presence of an SUD diagnosis on the encounter
      • Patient has no valid encounters with an SUD diagnosis during the 60 days prior to the 2/1/205 encounter
      • Patient has no documentation of anything from the value sets Intervention, Performed: Substance Use Disorder Treatment or Medication, Order: Substance Use Disorder Long Acting Medication at any time

      Does the 2/1/2025 encounter qualify as a First SUD Episode During the Measurement Period? My interpretation is that it does not because of the following CQL statement: SUDDiagnosis.prevalencePeriod starts during ValidEncounters.relevantPeriod. The problem list prevalence period starts on 7/1/2024, and the valid encounter relevant period is 2/1/2025.

      What if the 2/1/2025 encounter included an SUD diagnosis? Does that create a First SUD Episode During the Measurement Period because its prevalence period starts 2/1/2025 and "overrides" the problem list prevalence period that starts on 7/1/2024?

            AIR EC eCQM Team AIR EC eCQM Team
            samuelmross Sam Ross
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