CMS 153: use of pregnancy test as proof of sexual activity

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry regarding CMS153v13 (2025 Performance Period). A proxy method is used to identify persons who are sexually active for inclusion in the measure's denominator. While the methodology may result in the inclusion of some patients who are not sexually active, the masure steward, the National Committee for Quality Assurance, believes it is currently the most feasible standardized approach for identifying the denominator population. The number of persons who are prescribed birth control for reasons other than sexual activity is expected to be small.

      Currently, the only exclusions are patients who had a pregnancy test during the measurement year and subsequently received either a prescription for isotretinoin or an x-ray within seven days of the test.
      Show
      Thank you for your inquiry regarding CMS153v13 (2025 Performance Period). A proxy method is used to identify persons who are sexually active for inclusion in the measure's denominator. While the methodology may result in the inclusion of some patients who are not sexually active, the masure steward, the National Committee for Quality Assurance, believes it is currently the most feasible standardized approach for identifying the denominator population. The number of persons who are prescribed birth control for reasons other than sexual activity is expected to be small. Currently, the only exclusions are patients who had a pregnancy test during the measurement year and subsequently received either a prescription for isotretinoin or an x-ray within seven days of the test.
    • CMS0153v13
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      We are having patients pulled into this measure in our adolescent medicine/gynecology practice, who are not sexually active, and attest to this, and report abstinence as their birth control method. However, they get pulled into the measure for one of two reasons I am finding, inaccurately, causing our provider to have inaccurate scores for this measure.
      Show
      We are having patients pulled into this measure in our adolescent medicine/gynecology practice, who are not sexually active, and attest to this, and report abstinence as their birth control method. However, they get pulled into the measure for one of two reasons I am finding, inaccurately, causing our provider to have inaccurate scores for this measure.

      One key reason is if a urine pregnancy test is ordered on these patients, it pulls them into the measure. Urine pregnancy tests are routine screening for all patients that have begun having periods, and are either going to undergo a surgical procedure, or need this as a baseline negative test before they can initiate certain medications. This does not immediately indicate that they are sexually active. It seems this is an inaccurate way to pull patients in to this measure. 

      Additionally, we are finding that patients with abnormal menstrual cycles, or dysmenorrhea, getting started on hormonal treatment (I.e. OCPs) for menstrual regulation, but again, fall into the category of sexual inactivity which is well documented in their charts. This again, is common practice in adolescents with painful or irregular periods. It should not be pulling them into a sexually active category. 

      It seems that this measure could utilize an exclusion of if they are marked as not sexually active in their chart, this somehow pulls them out if for example, they undergo a urine pregnancy test, or are initiated on OCPs for non-sexual related reasons. Please let me know if CMS plans to address these inaccuracies of this measure. 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Emily Ulloa
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