Comfort Measure Exclusion for HH Hyper

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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 inquiry regarding CMS871, Hospital Harm - Severe Hyperglycemia. In the scenario you described, a hospital consult order alone is not sufficient to meet the measure’s hospice exclusion. To meet the hospice exclusion criterion, the inpatient hospitalization must have a discharge disposition code included in either the "Discharged to Health Care Facility for Hospice Care" (OID: 2.16.840.1.113883.3.117.1.7.1.207) value set or the "Discharged to Home for Hospice Care" (OID: 2.16.840.1.113883.3.117.1.7.1.209) value set.

      The measure also excludes inpatient hospitalizations for patients who have comfort care measures ordered or provided during the hospitalization, as indicated by code in the "Comfort Measures" (OID: 1.3.6.1.4.1.33895.1.3.0.45) value set. If the patient was receiving curative treatment, and hospital providers simultaneously ordered or performed comfort care measures for the patient, the inpatient hospitalization for this patient would meet the measure's comfort care exclusion criterion.
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      Thank you for inquiry regarding CMS871, Hospital Harm - Severe Hyperglycemia. In the scenario you described, a hospital consult order alone is not sufficient to meet the measure’s hospice exclusion. To meet the hospice exclusion criterion, the inpatient hospitalization must have a discharge disposition code included in either the "Discharged to Health Care Facility for Hospice Care" (OID: 2.16.840.1.113883.3.117.1.7.1.207) value set or the "Discharged to Home for Hospice Care" (OID: 2.16.840.1.113883.3.117.1.7.1.209) value set. The measure also excludes inpatient hospitalizations for patients who have comfort care measures ordered or provided during the hospitalization, as indicated by code in the "Comfort Measures" (OID: 1.3.6.1.4.1.33895.1.3.0.45) value set. If the patient was receiving curative treatment, and hospital providers simultaneously ordered or performed comfort care measures for the patient, the inpatient hospitalization for this patient would meet the measure's comfort care exclusion criterion.
    • Not measure related
    • Not measure related
    • CMS0871v5
    • CMS0871v4
    • CMS0871v3
    • Unsure if algorithm is correct resulting in incorrect exclusion

      We have a patient who shows as a Denominator Exclusion For the HH Hyperglycemia Measure.  

      The patient had an order for Hospice Consult that meets the SNOMED value set, but the patient then refused Hospice, never having received any hospice care and aggressive treatment continued.

      Is the order for the Hospice Consult enough to trigger the Exclusion, or does the pt have to receive Hospice care, and how is that captured in the value set.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Susan Duffy
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              Created:
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