CMS996v6 Hospice Diagnosis logic

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry regarding CMS996v6: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure intends to exclude documentation of hospice services in the six months within the start of the ED encounter, or active hospice status at the start of the ED encounter. We have created a test case for the example included in the inquiry and have determined that this case is triggering the denominator exclusion, which does not align with the exclusion’s intent. Thank you for bringing this issue to our attention. CMS and the measure developer will consider using the “overlaps” logic for the hospice diagnosis component of this exclusion in a future annual update.
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      Thank you for your inquiry regarding CMS996v6: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure intends to exclude documentation of hospice services in the six months within the start of the ED encounter, or active hospice status at the start of the ED encounter. We have created a test case for the example included in the inquiry and have determined that this case is triggering the denominator exclusion, which does not align with the exclusion’s intent. Thank you for bringing this issue to our attention. CMS and the measure developer will consider using the “overlaps” logic for the hospice diagnosis component of this exclusion in a future annual update.
    • CMS0996v6
    • We are currently blocked from progressing with measure development for client delivery.

      Hello, 
      For the STEMI exclusion logic we would like to know the intent of Hospice Diagnosis logic:

        ) 
          or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
              where ( HospiceCareDiagnosis.prevalencePeriod ends on or after start of EDwSTEMI.relevantPeriod )
          )
        )

       

      The current logic states that the diagnosis must end on or after the start of the EDwSTEMI encounter, which gives the impression that the diagnosis is indefinite. We believe the intended behavior may be for the diagnosis prevalence period to overlap the STEMI encounter—similar to the existing logic that states, “prevalence period overlaps or is within 6 months before the STEMI encounter.”

       

      Please let us know the intent and what is expected in the example below. 

      Example:
      STEMI-ED encounter is January 1, 2025 - January 5, 2025
      Hospice diagnosis period is May 1, 2025 - May 6, 2025.

      The diagnosis ends after the STEMI visit so should we qualify the patient for exclusion? We would argue no, but would like to confirm with you all.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Talisa Williams
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              Created:
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