In acute care settings, the physical location of a patient is a poor indicator of the level of care they are receiving. A patient in a bed may be receiving ICU-level care based on clinical interventions and patient acuity, whereas a patient but not require ICU-level care. For these reasons, a patient’s location should not be used for a level-of-care concept.

EHR systems have evolved to align ICU designation with patient characteristics such as accommodation codes, patient services, or level of care. This approach offers precision and reflects patient acuity in a way that is impossible if we rely solely on unit assignment.

quality measures no longer reflect real-world patient acuity or billing data. While revenue codes based on level of care may not be affected by MS-DRG for Medicare reimbursement, they do factor into commercial reimbursement, which means that the billing classification and the physical care location may tell different stories about the same patient.

The literal interpretation of QDM attributes described in [CQM-8047] reduces EHR technology to the lowest common denominator. By removing the flexibility of EHRs to classify patient data more accurately, quality measure data consumers such as CMS and Joint Commission are calculating outcomes that don’t reflect actual clinical practice. Should the guidance in CQM-8047 be followed literally by EHRs, resulting in quality outcomes that do not reflect real world variability in care? Or can EHRs continue to leverage enhanced features to highlight patient-centered data to provide more accurate quality outcomes?