HH-FI Numerator Logic POA Intent

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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      Thank you for your feedback regarding CMS1017v2, Hospital Harm - Falls with Injury. CMS826 – Pressure Injury is a proportion measure, where the denominator is a subset of the initial population. Exclusions are applied at the denominator level only. CMS1017 is a ratio measure, which means the numerator and denominator are calculated separately from the same initial population. The exclusion criteria must be applied to both numerator and denominator to prevent excluded cases from being considered. The exclusions consider a fall present on admission using value set "Present on Admission or Clinically Undetermined" (2.16.840.1.113762.1.4.1147.197).

      The numerator evaluates diagnosis codes with a POA of "Not Present On Admission or Documentation Insufficient to Determine” and considers when the POA indicator is null. Please see below for the relevant logic:

      Numerator:
        "Encounter where a Fall and Major Injury Occurred"
          union "Encounter where a Fall and Moderate Injury Occurred"

      Encounter where a Fall and Major Injury Occurred:
        "Encounter where a Fall Occurred" FallOccurred
          where exists FallOccurred.diagnoses MajorInjury
            where MajorInjury.code in "Major Injuries"
              and ( MajorInjury.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine"
                  or MajorInjury.presentOnAdmissionIndicator is null
              )

      Encounter where a Fall and Moderate Injury Occurred:
         "Encounter where a Fall Occurred" FallOccurred
         where exists FallOccurred.diagnoses ModerateInjury
            where ModerateInjury.code in "Moderate Injuries"
              and ( ModerateInjury.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine"
                  or ModerateInjury.presentOnAdmissionIndicator is null
              )
      Show
      Thank you for your feedback regarding CMS1017v2, Hospital Harm - Falls with Injury. CMS826 – Pressure Injury is a proportion measure, where the denominator is a subset of the initial population. Exclusions are applied at the denominator level only. CMS1017 is a ratio measure, which means the numerator and denominator are calculated separately from the same initial population. The exclusion criteria must be applied to both numerator and denominator to prevent excluded cases from being considered. The exclusions consider a fall present on admission using value set "Present on Admission or Clinically Undetermined" (2.16.840.1.113762.1.4.1147.197). The numerator evaluates diagnosis codes with a POA of "Not Present On Admission or Documentation Insufficient to Determine” and considers when the POA indicator is null. Please see below for the relevant logic: Numerator:   "Encounter where a Fall and Major Injury Occurred"     union "Encounter where a Fall and Moderate Injury Occurred" Encounter where a Fall and Major Injury Occurred:   "Encounter where a Fall Occurred" FallOccurred     where exists FallOccurred.diagnoses MajorInjury       where MajorInjury.code in "Major Injuries"         and ( MajorInjury.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine"             or MajorInjury.presentOnAdmissionIndicator is null         ) Encounter where a Fall and Moderate Injury Occurred:    "Encounter where a Fall Occurred" FallOccurred    where exists FallOccurred.diagnoses ModerateInjury       where ModerateInjury.code in "Moderate Injuries"         and ( ModerateInjury.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine"             or ModerateInjury.presentOnAdmissionIndicator is null         )
    • CMS1017v2

      Hello,

      In CMS 1017, the denominator exclusions require a valid POA indicator for qualifying diagnosis codes, while the numerator allows diagnosis codes with either a valid POA or a null POA. This differs from CMS 826, where POA is required consistently for qualifying diagnosis codes.

      We're looking to understand the intent behind this difference and why POA requirements are not handled consistently across the numerator and denominator exclusions in CMS 1017 v2. Allowing null POA values in the numerator may help avoid undercounting when POA data is missing, but it also means "Inpatient Falls" diagnoses could be included in the numerator even if they were present on admission due to the missing POA value. Shouldn't the numerator only evaluate diagnosis codes with a POA of "Not Present On Admission or Documentation Insufficient to Determine, similar to CMS 826?

      Can you clarify the rationale for not requiring POA for diagnosis codes in the numerator?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Talisa Williams
            Votes:
            1 Vote for this issue
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: