Use of Present on Admission (POA) diagnosis-based Exclusions

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Sora Park
    • 9178902742
    • NYP
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The current measure specifications do not use the present on admission (POA) indicator equals YES to identify diagnoses meeting the diagnoses exclusion criteria.

      All definitions for exclusion diagnoses use the “Diagnosis” data type and the prevalencePeriod (or time from diagnosis onset to abatement) attribute to identify whether it started during a given timeframe before the ED encounter or during the ED encounter relevantPeriod (or the time the encounter began to the time the encounter ended). We highlight that the Quality Data Model does not support a presentOnAdmissionIndicator for the “Diagnosis” data type and is only available as a component of the “Encounter, Performed” diagnoses attribute. Since the “Encounter, Performed” diagnoses attribute is intended to include only diagnoses addressed during the encounter, this attribute is not appropriate to capture any diagnoses that started before the encounter and were not addressed during the ED encounter.

      For more information on the “Diagnosis” data type and the “Encounter, Performed” presentOnAdmissionIndicator component, please refer to the QDM 5.6: https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The current measure specifications do not use the present on admission (POA) indicator equals YES to identify diagnoses meeting the diagnoses exclusion criteria. All definitions for exclusion diagnoses use the “Diagnosis” data type and the prevalencePeriod (or time from diagnosis onset to abatement) attribute to identify whether it started during a given timeframe before the ED encounter or during the ED encounter relevantPeriod (or the time the encounter began to the time the encounter ended). We highlight that the Quality Data Model does not support a presentOnAdmissionIndicator for the “Diagnosis” data type and is only available as a component of the “Encounter, Performed” diagnoses attribute. Since the “Encounter, Performed” diagnoses attribute is intended to include only diagnoses addressed during the encounter, this attribute is not appropriate to capture any diagnoses that started before the encounter and were not addressed during the ED encounter. For more information on the “Diagnosis” data type and the “Encounter, Performed” presentOnAdmissionIndicator component, please refer to the QDM 5.6: https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf
    • CMS0996v6
    • CMS0996v5
    • Exclusion and/or inclusion of patients appropriately

      We are requesting consideration regarding the use of Present on Admission (POA) indicators for diagnosis-based exclusions within the STEMI eCQM specifications.

      In current eCQM logic, many diagnosis-based exclusions require a discrete diagnosis date/time to determine whether the condition occurred prior to or during the ED encounter. In most cases, ICD diagnosis codes do not carry an inherent timestamp beyond the encounter context, and many clinically relevant diagnoses are appropriately documented and coded with a POA indicator rather than a precise onset datetime.

      We respectfully request clarification on the following:

      1. Whether POA = YES may be used to infer that a diagnosis occurred prior to the ED encounter for the purposes of exclusion logic
      2. If not currently permitted, whether CMS would consider updating future eCQM specification to allow POA to be used as a valid proxy for diagnosis timing when explicit onset date/time is unavailable

      Thank you for your consideration.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Sora Park
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