[CQM-7168] Statin Therapy for the Prevention & Tx CV Dx CMS347 [clarify active diagnosis DM at any time during measurement period] Created: 08/13/24 Updated: 08/22/24 Resolved: 08/20/24 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Moderate |
| Reporter: | Stacey R Arens-Wilson (Inactive) | Assignee: | Mathematica EC eCQM Team |
| Resolution: | Answered | Votes: | 0 |
| Labels: | None | ||
| Contact Name: | Stacey Arens-Wilson |
| Contact Email: | arenss@health.missouri.edu |
| Contact Phone: | 573-882-2908 |
| Institution/Name: | MUHC |
| Solution: | Thank you for your question regarding 347v7, Statin Therapy for the Prevention and Treatment of Cardiovascular Disease.
The measure logic references the Diabetes value set (OID 2.16.840.1.113883.3.464.1003.103.12.1001), to establish an ‘Initial Population’ for CMS347v7. If a code within the value set is found within the patients’ medical record, they would meet the ‘risk category’ for ‘Population 3’. In regard to timing, the measure logic requires the documentation of a new or existing diagnosis of Type 1 or Type 2 diabetes; AND that the patient is between 40 and 75 years of age during the measurement period, AND they did not meet the ‘Denominator Exclusion’ or ‘Denominator Exception’ criteria. If these exclusion criteria are not met, the patient would be included in the ‘Population 3’ initial population. Specific to your example, if a patient has an active diagnosis of E11.9 (Type 2 diabetes mellitus without complications), AND was between 40 and 75 years of age, during the measurement period, the patient would qualify for the ‘Population 3’ ‘risk category’ for the ‘Initial Population’ for the 2024 calendar year reporting. We hope this helps. |
| Solution Posted On: | |
| 2025 Performance Period EC eCQMs: |
CMS0347v8
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| 2024 Performance Period EC eCQMs: |
CMS0347v7
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| Impact: | this may inflate Population 3 denominator if interpreted incorrectly. |
| Last Commented Date: |
| Description |
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Regarding: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Collection Type – 2024 eCQMs https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS347v7.html Population 3: Patients aged 40 to 75 years of age at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.
[1] Please clarify definition of “active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.” [2] Will a patient with a diagnosis prior to the measurement period [for example diagnosis of E11.9 associated to an encounter or submitted on claim DOS 6/25/2019] qualify for Population 3 denominator for 2024 calendar year reporting? |
| Comments |
| Comment by Stacey R Arens-Wilson (Inactive) [ 08/22/24 ] |
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Thank you for your response. Your definitions of active, inactive or resolved do not answer my question. Regarding my example of E11.9 on a claim. A diagnosis on a claim is NEVER updated by a provider to state Inactive or Resolved as you stated in your response.... "For a diagnosis to be marked as 'Resolved' or 'Inactive' requires explicit action by the provider to change the diagnoses status." We received this definition regarding Active Diagnosis from CMS when reporting PREV-12 Preventative Care & Screening for Depression and Follow up CMS Web Interface. We believe this to be the definition of Active Diagnosis. The term “active diagnosis” is defined as a diagnosis that is either on the patient’s problem list, a diagnosis code description listed on the encounter, or is documented in a progress note indicating that the patient is being treated or managed for the disease or condition during the measurement period |
| Comment by Mathematica EH eCQM Team [ 08/22/24 ] |
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Thank you for the follow-up question regarding 347v7, Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. Quality measures include different criteria for diagnoses that are ‘Active’, ‘Inactive’, or ‘Resolved’. An ‘Active’ diagnosis is one currently present in the patient (e.g. current pneumonia). An ‘Inactive’ diagnosis is one that is currently dormant in the patient but not resolved (e.g. lupus during a remission,). A ‘Resolved’ diagnosis is one that is no longer present in the patient (e.g. pneumonia in the past that has been cured). There is no implied state transition from active to inactive or resolved. For a diagnosis to be marked as 'Resolved' or 'Inactive' requires explicit action by the provider to change the diagnoses status. The Diagnosis Active template requires a start (effectiveTime/low) and stop (effectiveTime/high) time. If the condition is still active, the effectiveTime/high would be NULL. Given the example you provided, if the diagnosis is showing up in the patient record as 'active' - i.e., a provider has not marked the diagnosis indicating a ‘Resolved’ or ‘Inactive’ diagnosis - and the other conditions are met (as described in our previous response), then that patient would qualify for Population 3. |
| Comment by Stacey R Arens-Wilson (Inactive) [ 08/21/24 ] |
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Please define “active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.” This was in our original request and was not answered above. Thanks Stacey |
| Comment by Mathematica EC eCQM Team [ 08/20/24 ] |
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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 [ 08/13/24 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |