[CQM-5432]  Provider encounters in CMS 155 quality measure pull more than stated PCP/OB/GYN visits Created: 07/12/22  Updated: 02/28/24  Resolved: 07/28/22

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

Type: HQMF Standards Priority: Moderate
Reporter: Patti Gilpin (Inactive) Assignee: Mathematica EC eCQM Team (Inactive)
Resolution: Answered Votes: 0
Labels: None

Contact Name: Patti Gilpin
Contact Email: patti.gilpin@nortonhealthcare.org
Contact Phone: 1-502-423-2449
Institution/Name: Norton Healthcare
Solution: Thank you for your inquiry for CMS155. Since no measure version or performance period is specified, this response is provided in the context of CMS155v11 (2023 Performance Period). Correct, the denominator encounter logic/codes are not provider specific. The measure developer will consider your request during a future revision of the measure.
Solution Posted On:
2023 Performance Period EC eCQMs:
CMS0155v11
2021 Performance Period EC eCQMs:
CMS155v9/NQFna
Impact: This measure is not applicable to specialty providers and the numbers increase our denominator and negatively affect our quality scores

 Description   

For the CMS 155 quality (and MIPS) measure of Weight Assessment and Counseling for Physical Activity and Nutrition for Adolescents, the definition states children aged 3-17 with an outpatient visit with a primary care provider (PCP) or OB/GYN within the measurement period. The CPT encounter codes are not specific to PCPs or OB/GYN providers. The reports run by our EHR (Epic) produce visits from every specialty provider the patient has seen during the measurement period (examples: orthopedics, neurology, pulmonology, cardiology, etc). This can equate approximately 30,000 visits. These numbers increase our denominator and negatively affect our quality measure scores.



 Comments   
Comment by Mathematica EC eCQM Team (Inactive) [ 07/25/22 ]

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) [ 07/18/22 ]

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

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