POA

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry about CMS1028v3/PC-07, Severe Obstetric Complications. We previously investigated the impact of moving code W (clinically undetermined, provider unable to clinically determine whether the condition was present at the time of inpatient admission) from the “POA is No or Unable to Determine” value set to “POA is Yes or Exempt” to more closely align with the value sets used by the hospital harm measures. The decision to not harmonize was made for the following reasons:

      When the value sets were first established, U&W were purposely grouped together as they both essentially indicate the same outcome (unable to determine). This rationale is still valid.
      It may not be relevant to compare maternal measures to hospital harm measures. We understand why the hospital harm measures need to align with the CMS payment model, but this is not relevant to CMS1028/PC-07.

      The measure developers are committed to harmonizing value sets if appropriate based on the individual measure's clinical intent. If deemed appropriate, changes will be considered during the next annual update cycle. We hope this helps.
      Show
      Thank you for your inquiry about CMS1028v3/PC-07, Severe Obstetric Complications. We previously investigated the impact of moving code W (clinically undetermined, provider unable to clinically determine whether the condition was present at the time of inpatient admission) from the “POA is No or Unable to Determine” value set to “POA is Yes or Exempt” to more closely align with the value sets used by the hospital harm measures. The decision to not harmonize was made for the following reasons: When the value sets were first established, U&W were purposely grouped together as they both essentially indicate the same outcome (unable to determine). This rationale is still valid. It may not be relevant to compare maternal measures to hospital harm measures. We understand why the hospital harm measures need to align with the CMS payment model, but this is not relevant to CMS1028/PC-07. The measure developers are committed to harmonizing value sets if appropriate based on the individual measure's clinical intent. If deemed appropriate, changes will be considered during the next annual update cycle. We hope this helps.
    • CMS1028v4
    • CMS1028v3
    • Difference between understanding of POA for coding and POA eCQM mapping

      I am still not understanding why "W" is grouped as a complication "not POA" for PC-07.  With the PC-07 the value set "Present on Admisison is No or UTD" (2.16.840.1.113762.1.4.1029.370) and "Present On Admission is Yes or Exempt" (2.16.840.1.113762.1.4.1110.63).  

      However, HH-PI uses the value sets  "Present on Admission or Clinically Undetermined" (2.16.840.1.113762.1.4.1147.197) and  "Not Present On Admission or Documentation Insufficient to Determine" (2.16.840.1.113762.1.4.1147.198) where "W" would not be POA.  This does not seem to streamline all eCQMs to use the same "language" of how to determine POA.

      Below is my original question for CQM-8208.POA

      The CMS POA Indicator definitions:
      Y=Yes, the diagnosis was POA
      W=Clinically undetermined.  Provider unable to clinically determine whether the condition was present at the time of inpatient admission.
      U=Documentation insufficient to determine if the condition was present at the time of inpatient admission.
      N=Diagnosis was NOT present at the time of inpatient admission.
      1= Exempt from POA reporting

      Y, W, and 1 would all be listed as "yes" or "n/a" for POA.  
      U, N would count as "NO" not POA.
      For the eCQM mapping, why is W (clinically undetermined) listed with U, N as Diagnosis Not present on Admission or UTD?  This would be considered a complication in the mapping.
      A diagnosis coded as W in the hospital record would not count as POA, but it would be mapped as a complication for the eCQM???

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            jaime zirkle
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