Thank you for your inquiry regarding CMS966: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We have summarized your inquiry and follow-up comment and responded to each point below.   Two of the described issues have previously been brought to CMS’s attention: (1) cases in which STEMI patients do not receive a PCI but receive alternative treatment fail the measure, and (2) no exclusions for patients that refuse treatment or opt for hospice care. The measure developer will continue to investigate these issues to refine the measure specifications in future updates. Regarding cases in which the STEMI diagnosis occurs before or after the ED encounter and are included in the measure; we want to clarify that the measure specifications only capture STEMI diagnosis during the ED encounter. In order to ensure this logic is implemented correctly, the onset and abatement must be populated. For more information, please reference the measure logic: https://ecqi.healthit.gov/mcw/2025/ecqm-dataelement/diagnosisstemi.html   We would also like to clarify that the measure does exclude cases in which aortic dissection occurs 24 hours or less before the start of the ED encounter or during ED encounter. The value set for the aortic dissection ("Aortic Dissection or Ruptured Aortic Aneurysm" (2.16.840.1.113883.3.3157.4028) exclusion can be found in VSAC here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion/Latest . Please note that you may need to create a free account to view the clinical codes. Finally, cases in which patients expire in the ED. To capture this correctly, the patient’s discharge disposition must be documented according to the measure specification. More information about this data element (value set "Patient Expired" (2.16.840.1.113883.3.117.1.7.1.309) can be found in the eCQI resource center: https://ecqi.healthit.gov/mcw/2025/ecqm-dataelement/dischargedispositionpatientexpired.html