[CQM-4668] CMS122- Numerator Guidance- Min/Max Value for HbA1c Laboratory Test Created: 06/16/21  Updated: 07/09/21  Resolved: 06/30/21

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: EC eCQMs - Eligible Clinicians Priority: Moderate
Reporter: Cory Rintoul Assignee: Mathematica EC eCQM Team (Inactive)
Resolution: Answered Votes: 0
Labels: None

Attachments: JPEG File SS1.jpg     JPEG File SS2.jpg    
Solution: Thank you for your question about the HbA1c Laboratory Test for CMS122v10 "Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)."

In response to your first question, the measure uses LOINC codes to look at the hbA1c test which do not specify a min or max value. The applicable value set is HbA1c Laboratory Test (2.16.840.1.113883.3.464.1003.198.12.1013) and is accessible at https://vsac.nlm.nih.gov/ . The current logic does not look for a minimum value for the HbA1c laboratory test. Per the logic below, the logic looks for the HbA1c laboratory test result to be > 9%:

Has Most Recent Elevated HbA1c: "Most Recent HbA1c"result > 9 '%'

Could you please describe where you see the min and max values in the VSAC? If possible, please provide a screenshot.

In response to your second question, the most recent A1c result on 12/1 is less than 9% and therefore does not qualify for the numerator.

In response to your third question, the measure will use the most recent A1c results on 12/1 of 25.1% which is greater than 9% and therefore will qualify for the numerator. Invalid values should be corrected in your EHR to prevent them from feeding the measures.




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Solution Posted On:
2022 Performance Period EC eCQMs:
CMS0122v10
Last Commented Date:

 Description   

In the VSAC value set max and min values are given for the HbA1c Laboratory Test LOINCs.

Values given are - Min Value: 1.0 , Max Value: 25.0

Question 1: Is it expected that the values are enforced at the time of measure calculation or are these simply given as guidance in the value set document? No range restrictions are given in the functions of the measure specifications.

If these values need to be enforced, requesting on guidance on how these values should be handled in determining whether a patient is numerator compliant or not. (If these values do not need to be enforced, please ignore questions 2 and 3.)

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Question 2: Given Scenario: Patient has 2 labs performed during the measurement period. 

Lab 1- Performed 1/1/2022 - Result 8.2%

Lab 2- Performed 12/1/2022 - Result  0.1%

 

Should patient be considered only in denominator based on Lab 1 as Lab 2 should be ignored due to invalid result values.

OR

Considered only in denominator because result of Lab 2 is <9%,

OR

Considered numerator compliant as most recent lab has invalid value.

-----------------------------------------------------------

Question 3: Given Scenario: Patient has 2 labs performed during the measurement period. 

Lab 1- Performed 1/1/2022 - Result 8.2%

Lab 2- Performed 12/1/2022 - Result  25.1%

Should patient be considered only in denominator based on Lab 1 as Lab 2 should be ignored due to invalid result values.

OR

Considered numerator compliant as most recent lab is >9%,

OR

Considered numerator compliant as most recent lab has invalid value.

 

 Comments   
Comment by Mathematica EC eCQM Team (Inactive) [ 07/09/21 ]

Thank you for identifying the location of the min/max codes for the HbA1c LOINC codes. We followed up with the NLM who noted the min/max values were supplied by CMS some years ago, and they do not pertain to how the measure logic is calculated.

Comment by Mathematica EC eCQM Team (Inactive) [ 07/06/21 ]

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

Comment by Cory Rintoul [ 06/30/21 ]

Thank you for your response. We only see these values on the document when you download by QDM category 

They are in the last columns of this document and values are only present for select items, not all Labs and DI. That is why we were seeking clarification on the intent of that information(ie values need to be enforced during measure calculation or they are purely informational).

Comment by Mathematica EC eCQM Team (Inactive) [ 06/24/21 ]

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Comment by Mathematica EC eCQM Team (Inactive) [ 06/17/21 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

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