Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure calculates the percentage of emergency department (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 discharge to a PCI-capable acute care facility within 45 minutes of ED arrival. From what the inquiry describes, we interpret that the patient had an initial ED Encounter where they received STEMI treatment, and was then discharged from the ED to a subsequent inpatient encounter. From the inquiry, it seems that both of these encounters are being combined, rather than documented in the EHR as two separate encounters. Therefore, we recommend working with your EHR vendor to document the ED encounter and the inpatient encounter separately, and map the ED encounter to the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” QDM datatype, and the inpatient encounter to the “Encounter, Performed”: “Encounter Inpatient” QDM datatype. Documentation of both of these encounters separately will help ensure that diagnoses occurring during the inpatient encounter are not erroneously pulled into the ED encounter, resulting in denominator exclusions.

STEMI encounters are being excluded from the measure based on inpatient events, ie - cardio/pulmonary arrest on day 10 of inpatient admission - encounter is evaluated as a denominator exclusion when the patient was a numerator based on ED events. Our performance is being negatively impacted by the eCQM evaluating inpatient events rather than the ED-only events.