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EC eCQMs - Eligible Clinicians
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Resolution: Delivered
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Minor
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None
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Jeff McCartney
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Mathematica
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Addressed during the annual update. See CAU-251.
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CMS90v1/NQFna
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Implementation
The way in which the logic for CMS90 is written is not inline with intent of the measure. This is the IPP for the measure
Initial Patient Population =
AND: FIRST:
OR: "Occurrence A of Encounter, Performed: Office Visit" <= 185 day(s) ends after start of "Measurement Period"
OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" <= 185 day(s) ends after start of "Measurement Period"
AND NOT: "Diagnosis, Active: Heart Failure" ends before start of "Measurement Period"
AND: "Patient Characteristic Birthdate: birth date" >= 65 year(s) starts before start of "Measurement Period"
AND: "Diagnosis, Active: Heart Failure" starts before or during "Measurement Period"
AND:
OR:
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
OR:
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
OR:
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
OR:
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
In the last constraint block for the IPP you see a number of items that appear like this.
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
I believe the intent of the measure is to ensure that a followup has been performed between 30 and 180 days after Occurrence A but the logic here does not quite line up with that intent.
The way in which the MOST RECENT operator has been used here will cause these expression to be evaluated separately. So if you take the first expression.
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
Seeing how this is looking for the MOST RECENT Encounter that occurs >= 30 days after Occurrence A this can match Encounters that are > 180 days after Occurrence A, even if there are Encounters that happen <180 days after A.
The second evaluation is treated individually as well.
AND: MOST RECENT:"Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
If there are encounters that happen >= 30 days and <= 180 days this will choose the MOST RECENT one of those but it is undermined by the first expression as that will choose simply the MOST RECENT encounter >= 30 days.
For the measure logic to follow what I believe the intent of the measure to be it would to be coded along these lines, moving the MOST RECENT operator up one level.
AND:
OR: MOST RECENT:
AND: "Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
OR: MOST RECENT:
AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
AND:"Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
OR: MOST RECENT:
AND: "Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
OR: MOST RECENT:
AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"