Chris,
The test data has been updated and every episode of care is now evaluated against the logic for inclusion in the IPP, Denominator, and Numerator.
Thanks for your feedback!
Sharon

Chris ,

Thanks for pointing this out. We were not informed that this measure had changed from patient based to episode based. I suspect that they had intended the first version to be episode based as well but the guidance never made it in. We'll look to getting this taken care of. In the mean time if this is preventing you from certifying please have the ATL you are using contact us if they have any questions about it and we'll bring this up with ONC the next time we meet.

That may be the case for the v1 HQMF document, however, I believe the most current version for this measure is v2 (per the CQM Updated Release Notes from 6/14/13). In those updated release notes, there is a note that the Guidance section was updated.

Looking at the CMS146v2 HQMF document, the Guidance section reads "This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure."

The determination as to whether a measure is episode or patient based is given in the Guidance section of the HQMF documents. If the measure is to be calculated as an episode based measure then specific guidance to that fact will be given in that Guidance section. For CMS146 there is no such guidance therefore it is a patient based reporting measure.

I cannot seem to find a way to attach files to this so I'll just post it here. Taken from the CMS146v1 HQMF document.

Definition None
Guidance None
Transmission Format TBD
Initial Patient Population Children 2-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit
Denominator Equals Initial Patient Population
Denominator Exclusions Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis
Numerator Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis
Numerator Exclusions Not Applicable
Denominator Exceptions None
Measure Population Not Applicable
Measure Observations Not Applicable
Supplemental Data Elements For every patient evaluated by this measure also identify payer, race, ethnicity and sex.