[CQM-6998] ECQI Measures Question (001 Diabetes and 236 Controlling high blood pressure) VBLTC ACO (A5330) Created: 05/28/24 Updated: 06/11/24 Resolved: 06/11/24 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Moderate |
| Reporter: | Byron Branning (Inactive) | Assignee: | Mathematica EC eCQM Team (Inactive) |
| Resolution: | Answered | Votes: | 0 |
| Labels: | None | ||
| Contact Name: | Byron Branning |
| Contact Email: | bbranning@health.saisystems.com |
| Contact Phone: | 2032606267 |
| Institution/Name: | VBLTC ACO A5330 |
| Solution: | Thank you for your inquiry about the ’Advanced Illness and Frailty Exclusion’ criteria for CMS122v12 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%), and CMS165v12 Controlling High Blood Pressure.
Please note that the criteria for those patients who are living long term in a nursing home, any time on or before the end of the measurement period, is an independent exclusion criteria that can be met separately from the advanced illness and frailty criteria. The intent of the exclusion for those patients living long term in a nursing home is to identify individuals who are likely to be living in a nursing home, any time on or before the end of the measurement period and are receiving institutionalized long-term care services. The intent is to capture those patients who live in facility long term, and not those who are only in the facility for short term. The exclusion criteria "Is Age 66 or Older Living Long Term in a Nursing Home" The measure logic defines patients 66 years or older (at the end of the measurement period) where the last housing status assessment performed meets the value (LOINC code 71802-3) or has a result of "lives in a nursing home (finding)" (SNOMED code 160734000). For a patient aged 66-80 years to meet the entire "advanced illness and frailty" exclusion, they would also need to meet the advanced illness criteria, in addition to the frailty criteria. The combination of age, frailty and advanced illness qualifies them for the denominator exclusion. The exception is patients aged 81 and older in CMS165 where they can meet exclusion with only one indication of frailty. The measures will exclude the patient if one of any denominator exclusions is met. |
| Solution Posted On: | |
| 2024 Performance Period EC eCQMs: |
CMS0122v12, CMS0165v12
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| Impact: | eCQI measures calculation - determining the correct denominator |
| Description |
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We reviewed the following ACO(ECQI measures , and we need to clarify the following Denominator Exclusions. As per the QPP website, they have this denominator exclusion for Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) (001), and Controlling High Blood Pressure(236). We would like to get more clarity on this denominator exclusion as our ACO customers are servicing their patients in long-term care nursing homes aged more than 66. We would like to understand how this exclusion is determined. For example, is this determined by the Place of Service for the patient (Nursing Facility (32) vs Skilled Nursing Facility (31))? Perhaps the measure is based on a timeframe the patient in in the Nursing Home, 180+ days. Denominator Exclusion: Exclude patients 66 and older by the end of the measurement period who are living long-term in a nursing home at any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. |
| Comments |
| Comment by Mathematica EC eCQM Team (Inactive) [ 06/05/24 ] |
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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) [ 06/03/24 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |
| Comment by Cathy Maffry [ 06/02/24 ] |
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Reassignment needed for correct measure steward. Thank you. |
| Comment by Byron Branning (Inactive) [ 05/30/24 ] |
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Hi Cathy - this is the first time I'm using this site to try to get clarification on quality measures so I dont know if commenting here is appropriate or can help get to an answer. However, if you need any additional information from me please let me know and I can work to collect it for you. thanks Byron |