[CQM-5463] CMS e154v11Appropriate Treatment for Upper Respiratory Infection (URI) Discrepency between gray matter and logic on timing Created: 07/25/22  Updated: 10/12/22  Resolved: 08/03/22

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

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

Attachments: PNG File image-2022-07-25-16-48-10-986.png    
Contact Name: Jennifer Distefano
Contact Email: Jennifer.distefano@allscripts.com
Solution: ​Thank you for your question on CMS154v11.

The language in the header specifying the denominator exclusion for an active prescription of antibiotics reads the following: "Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter."

This is looking for an active prescription of antibiotics 30 days prior to the episode date, which is correctly specified in the logic. The second half of that exclusion criteria is still relevant because if that specified active prescription continues to be active through the date of the encounter, it still counts as an exclusion. In the logic, we meet this timing criteria using the overlaps operator.

We will consider providing further clarifications in a future version of the measure.
Solution Posted On:
Measure Type: EP
2023 Performance Period EC eCQMs:
CMS0154v11
Impact: Reporting discrepency: Denominator Exclusion gray matter is different than what is stated in the logic.
Last Commented Date:

 Description   

The description for Denominator Exclusion and the CQL logic for the Denom Exclusion appear to read different.  

Gray matter description:  reads to include the first day of the encounter 

  • Encounter with Upper Respiratory Infection and Antibiotics Active 30 Days Prior Or The First Day of the Encounter"

CQL Logic - does not appear to include the first day of the encounter

  1. Encounter with Upper Respiratory Infection" EncounterWithURI
      with ["Medication, Active": "Antibiotic Medications for Pharyngitis"] ActiveAntibiotic
        such that ( Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[start of EncounterWithURI.relevantPeriod - 30 days, {*}start of EncounterWithURI.relevantPeriod - 1 day]{*})

 

 Comments   
Comment by Mathematica EC eCQM Team [ 10/12/22 ]

Thank you for your follow up comment. Please note that this depends on if the active medication period "overlaps" the 30-day period prior to the episode date, per logic specification. For example, an active medication starting any time prior to the episode date and continues through the episode date would meet denominator exclusion criteria, but an active medication starting on the day of the episode date and continues after the episode date would NOT. For example, EncounterWithURI with date of 12/31/2012 and ActiveAntibiotic with interval of 9/30/2012-1/31/2013 would meet denominator exclusion criteria, but EncounterWithURI with date of 12/31/2012 and ActiveAntibiotic with interval of 12/31/2012-3/31/2013 would NOT because the interval does not overlap the 30-day period prior to the episode date though active on the episode date.

Comment by Mathematica EC eCQM Team [ 08/24/22 ]

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

Comment by Jennifer Distefano (Inactive) [ 08/22/22 ]

I would just like to clarify that we are looking for an active medication on the day of the encounter based on your response. 

The logic below appears to us to read an overlap in the start of the encounter - 30 days and the start of the encounter -1 day.  In this case it would be 30 days before the start of the encounter to the day before the start of the encounter.     

....  such that ( Global."NormalizeInterval" ( ActiveAntibiotic.relevantDatetime, ActiveAntibiotic.relevantPeriod ) overlaps day of Interval[start of EncounterWithURI.relevantPeriod - 30 days, \{*}start of EncounterWithURI.relevantPeriod - 1 day]{*})

 

Comment by Mathematica EC eCQM Team [ 08/02/22 ]

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 [ 07/26/22 ]

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

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