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  2. CQM-867

This measure could result in "treatment opportunity" even if the intent of the measure if met

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    • Sheri Saldivar
    • 3604166735
    • North Cascade Eye Associates
    • interpretation of intent of measure
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      CMS167/0088 and CMS 142/0089 do share a significant number of data elements and value sets and yes, 0088 seems to build into 0089, but these two measures are not required to be reported in conjunction and have different foci.

      The intent of NQF 0089 is to ensure the EP who performed the dilated macular or fundus exam communicates the finding to the EP managing the patient’s ongoing care. While the results of these eye exams may allow for treatment opportunities, that would be determined by the EP managing the patient’s ongoing care AFTER the numerator action was completed, meaning the communication piece.

      The biggest difference to highlight between 0088 and 0089 is that while there are shared value sets between these measures, often times the Quality Data Model Category is different OR they are used as a data element in one measure and used as an attribute in the other measure.
      These differences in QDM mean that there is a difference on how or where the data is stored.

      Ongoing improvements to the data model and harmonization across the measures is underway now across both existing measures and measures in development. As those improvements move forward, we expect that there will be greater alignment across similar measures such as this.
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      CMS167/0088 and CMS 142/0089 do share a significant number of data elements and value sets and yes, 0088 seems to build into 0089, but these two measures are not required to be reported in conjunction and have different foci. The intent of NQF 0089 is to ensure the EP who performed the dilated macular or fundus exam communicates the finding to the EP managing the patient’s ongoing care. While the results of these eye exams may allow for treatment opportunities, that would be determined by the EP managing the patient’s ongoing care AFTER the numerator action was completed, meaning the communication piece. The biggest difference to highlight between 0088 and 0089 is that while there are shared value sets between these measures, often times the Quality Data Model Category is different OR they are used as a data element in one measure and used as an attribute in the other measure. These differences in QDM mean that there is a difference on how or where the data is stored. Ongoing improvements to the data model and harmonization across the measures is underway now across both existing measures and measures in development. As those improvements move forward, we expect that there will be greater alignment across similar measures such as this.

      Measure NQF 089 concerns itself with if the provider communicated with the ongoing diabetic provider regarding the findings of a dilated exam (diabetic retinopathy patient). Should the requirements of NQF 088 be repeated on this measure rather than focusing on the intent of the communication. OUr EHR provider requires documentation of macular edema and severity of diabetic retinopathy (just like measuer NQF 088) for this measure so if the provider actual meets the requiremnt of NQF 089 and properly communicates with the primary care provider about the dilated exam findings, they are still reported with a "treatment opportunity". should those requirements be repeated on this measure or should the measure result in "treatment opportunity" only if the communication did not occur?

            rtallapragada Ramya Tallapragada (Inactive)
            sherisaldivar Sheri Saldivar (Inactive)
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