CMS137v14 Initiation and Engagement of SUD Treatment

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Donna Canalizo
    • 5043015224
    • Access Health Louisiana
    • Hide
      Thank you for your inquiry regarding CMS137v14 (2026 performance period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. We understand your concerns and appreciate your feedback. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit. Please refer to the measure specification to review the measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS137-v14.0.000-QDM.html.

      If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs.
      Show
      Thank you for your inquiry regarding CMS137v14 (2026 performance period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. We understand your concerns and appreciate your feedback. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit. Please refer to the measure specification to review the measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS137-v14.0.000-QDM.html . If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .
    • CMS0137v14
    • Hide
      This impacts our practice in that we have been struggling to accurately capture our performance considering the challenges of documenting previous SUD diagnoses occurring outside our practice and/or current valid SUD treatment medications prescribed and falling within the 60 day window. Additionally, the visit codes and valid treatment medications are outside the scope of our primary care providers' practice, creating an overly burdensome measure to meet given the current specifications.
      Show
      This impacts our practice in that we have been struggling to accurately capture our performance considering the challenges of documenting previous SUD diagnoses occurring outside our practice and/or current valid SUD treatment medications prescribed and falling within the 60 day window. Additionally, the visit codes and valid treatment medications are outside the scope of our primary care providers' practice, creating an overly burdensome measure to meet given the current specifications.

      In our practice providers encounter patients who may receive a SUD diagnosis at the time of the visit. The SUD diagnosis may appear to be a "new" SUD diagnosis if this is the first encounter for the patient with one of our providers; however, for some of these patients, it is not truly a new diagnosis if they are coming to us for continuation of treatment or are already in treatment outside of our practice and/or have a valid treatment medication prescription fill history. We are struggling with successfully documenting current or previous SUD diagnoses and current medications that would indicate patient should not be included in the denominator. Additionally, the visit codes that satisfy this measure are not codes used by our primary care providers and the valid treatment medications are not usually prescribed by our primary care providers since they are not included in their scope of practice. This is an overly burdensome measure to meet given the specifications and time frame.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Donna Canalizo
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              Created:
              Updated:
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