PC-07 is risk-adjusted for different case mixes based on comorbidities. From the Measure Methodology Report, Section 2.6 Risk-Adjustment, there are 4 laboratory tests and vital signs upon hospital arrival: 

• Hematocrit
• White blood cell (WBC) count
• Heart rate
• Systolic blood pressure

The timing as intended by the methodology report is as follows:

[first resulted value within 24 hours prior to initial encounter (earliest between inpatient admission, emergency department/obstetric triage, observation stay) and before delivery"].

This is problematic with the eCQM logic when "Time of Obstetric Delivery" is not documented in the EHR. A patient can meet the denominator with either the EGA or GA Based on Coding and NOT have the "Time of Obstetric Delivery" documented.

Would this patient be included which calculating a hospital's risk-adjusted rate reported via HQR reports if the "Time of Obstetric Delivery" is not documented? There are two countering issues at play. A raw performance score is possible without "Time of Obstetric Delivery". Adding an Initial Population/Denominator requirement for "Time of Obstetric Delivery" could unnecessarily depress the calculable patient population. On the other hand, the risk-adjusted calculation for hospitals appears to be inconsistent and may be penalizing hospital performance if "Time of Obstetric Delivery" is not documented.