CMS1218 - HH-RF- Question about need to check "Elective.class" in Encounter Performed in HH-RF eCQM

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your question regarding CMS1218v2, Hospital Harm - Postoperative Respiratory Failure. As documented in the “Elective Inpatient Encounter with Age 18 and Older without ED Visit” logic definition, an encounter performed must have a SNOMED CT code in the “Elective Inpatient Encounter” value set and the encounter class must be equivalent to the “Elective (qualifier value)” SNOMED CT code in order for the encounter to potentially meet the Initial Population criteria. We will consider updates to this logic definition in future iterations of the measure.
      Show
      Thank you for your question regarding CMS1218v2, Hospital Harm - Postoperative Respiratory Failure. As documented in the “Elective Inpatient Encounter with Age 18 and Older without ED Visit” logic definition, an encounter performed must have a SNOMED CT code in the “Elective Inpatient Encounter” value set and the encounter class must be equivalent to the “Elective (qualifier value)” SNOMED CT code in order for the encounter to potentially meet the Initial Population criteria. We will consider updates to this logic definition in future iterations of the measure.
    • CMS1218v2
    • Confusion in the eCQM calculation, potentially contradictory data could lead to inaccuracies in calculations.

       

      For CY2026, in the Hospital Harm - Postoperative Respiratory Failure (HH-RF), an encounter is in the population, if the code is on the "Elective Inpatient Encounter" valueset - 

      All the codes in this valueset are specifically for "elective" admissions. We were thinking this would be enough to identify an Elective encounter. 

      However, the eCQM logic has another check within the encounter for Encounter.class (see image below). The logic is checking that the value for class needs to be "Elective".

      We are trying to understand why the check for "Encounter.Class" is needed since the encounter codes are already indicating that the encounter is an elective encounter. 

      Having 2 different checks could potentially cause a conflict. Say the encounter code provided is from the Elective inpatient encounter valueset, but the value for class is not elective. Should that encounter be treated as "elective"?

      Maybe we are missing something in our understanding. We would appreciate if someone can explain the need for the additional logic to check for "Encounter.class". 

      Thanks

       

       

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            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Manish Parekhji
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