Chair:  Viet NguyenYan Heras

Scribe: Vanessa Candelora 
 

Minutes Approved as Presented 


This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."

Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy






Announcement

Da Vinci Testing Event- October 26-27th, 2021

  • Click here for event details- No formal link for registration, please add your name under the track below and/or reach out directly to the Track lead(s). 

Reviewed. 


January 2022 Ballot  

Notice of Intent to Ballot (NIB) was approved by CQI WG on 10/8 and submitted 

Project Tracking - Phase One

Reviewed - note newly added deadline for Oct 31. 
October Testing Event

Planning

  • Testing partners
  • Reference Implementation
  • Test plan and test data
  • Touchstone test scripts



Discussions


Review IG: https://build.fhir.org/ig/HL7/davinci-ra/index.html

  • Review the updates made to the Risk Adjustment MeasureReport profile extension data element: hiearchicalStatus (updates based on last week's discussions)

Discussion topics:

  • Should MeasureReport.group.ra-historicDiagnosis element be removed? 
    • ra-historicDiagnosis can be included as part of the evalautedResource and make this element seems to be redundant 
    • A potential use case of keeping ra-historicDiagnosis: a condition does not yet have a HCC code that can be rolled up to.
  • Clinical evaluation period passed in the $report periodStart and periodEnd parameters and the returned MeasureReport.period value
    • Example: the server has three MeasureReports for a patient: 2021-01-01 to 2021-06-30, 2021-07-01 to 2021-9-30, and 2020-01-01 to 2020-12-31. The $report operation is run for this patient with a periodStart of 2021-01-01 and periodEnd of 2021-12-31
  • Considering of adding slices to the evaluatedResource for commonly used types of supporting evidence, e.g., encounter, condition, procedure, etc.
  • Need to profile Bundle for the return parameter of $report operation

Topic to discuss with CQI:

  • How do we handle these scenarios in $report operation for the returns?
    • patient not found
    • group not found
    • no MeasureReport for the patient
    • two RA models but patient only falls under one
  • Reference Implementation is currently implemented as:
    • patient not found: returns a Parameters resource but no parameter element inside
    • group not found: if the Group is not found, it is not following the expected operation (because no patients are found for the group), so this returns a OperationOutcome with an error message saying that the Resource Group cannot be found
    • no MeasureReport for the patient: returns a Parameters resource but no parameter element inside. 
    •  two RA models but patient only falls under one: returns a Parameters resource with one parameter (with one Bundle)
  • The parameter element is one to one to patient. It will always return one Parameters regardless of a single patient or a group of patients. If a group has 10 patients, then a Parameters will contain 10 parameter elements

  • Reviewed the updates made to the Risk Adjustment MeasureReport profile extension data element: hiearchicalStatus (updates based on last week's discussions) - no objections. 



  • Should MeasureReport.group.ra-historicDiagnosis element be removed? 
    • ra-historicDiagnosis can be included as part of the evalautedResource and make this element seems to be redundant 
    • A potential use case of keeping ra-historicDiagnosis: a condition does not yet have a HCC code that can be rolled up to.
  • Seems redundant and not necessary. 
    • If there is no HCC code, then you don't need to report it.  If you need to send it, send it as condition.  
    • in VS, HCC wasn't originally suspected, but this other thing going on is not risk adjusted.  In the future, then the status of the HCC would be indicated as invalid and then the diagnosis that is found would be worked out... We don't really know how we are going to model this yet so doesn't really fit here. 
    • Next Step: Record this as a use case for future consideration.
    • The new extension would allow 0..* if the resource was an encounter, you could have many HCCs supported above. 
    • This is where we support the specific ID to tie back:



  • Clinical evaluation period passed in the $report periodStart and periodEnd parameters and the returned MeasureReport.period value
    • Example: the server has three MeasureReports for a patient: 2021-01-01 to 2021-06-30, 2021-07-01 to 2021-9-30, and 2020-01-01 to 2020-12-31. The $report operation is run for this patient with a periodStart of 2021-01-01 and periodEnd of 2021-12-31
  • Expectation settings:
    • You'd get 3 reports. 
  • Linda M. walked through another example. 
  • Running reports in January, you have two gaps for two different years.
    • If you run it on Jan 5th, 2022 you might get gaps for 1 year - 2021 (waiting to get analytics back)
    • If you run it on Jan 20th, 2022 you might get gaps for 2 years - 2021 and 2022. 
    • or- the back end system would create empties for future years. 
  • Takeaway: Need the date for when the report was run. 

Is it possible that you could create a report in 2022 for a measure who's period in 2021?

  • Date is in 2022
  • Period is 1/1/2021 - 12/31/2021
  • $report parameters for 2021 should get the 2021 report. 

Agreed on expectation. 

Does it need to start within the period or end within the period?

  • If you start June 2021 and end June 2022, you will get 2 reports.
  • overlap not containds. 
  • Next Step: Rob Reynolds  to update this to Overlap. Right now it's contained.

 







Madhurima Dhar (COZEVA) to Everyone

One question: can the coding system "http://cms.gov/cms-hcc/" be used to create a Resource Condition; basically want to understand can Condition resource will be valid with a CMS-HCC# as code instead of "http://snomed.info/sct" which is for SNOMED-CT


3:23 PM
Madhurima Dhar (COZEVA) to Everyone

Or "http://cms.gov/cms-hcc/" can only be used for Measure Report? Where to find the documentation on this?


3:39 PM
Brent Zenobia to Everyone

The Medicare Advantage models are here: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors


Next Step: Yan to follow-up with Rob McClure on this. 


Where do you put HCC in a resource?  

ask in community: without it being in a measure resource, but another resource for sharing HCCs that can travel with the patient. Condition?  It's different that applying it here which is not all confirmed HCCs. 

  • ICD, SNOMED, or another instance of coding with the diagnosis. e.g. when you're doing your porblme list, you can pick a SNOMED code, but for billing you want the ICD-10, so in the EHR, you'd select the SNOMED code that had an ICD-10 and HCC attached with it.  (not FHIR, in the clinical record) 
  • Codeable concept 2.24.0.5
  • Could have 8 Diagnosis that roll into one HCC. 
  • Don't want to overload other areas. 










more chat

Brent Zenobia to Everyone

The ACA (HHS-HCC) model is located here: https://www.cms.gov/files/document/updated-2022-benefit-year-final-hhs-risk-adjustment-model-coefficients-clean-version-508.pdf <https://r20.rs6.net/tn.jsp?f=001IcU5d3nGd0G4Q58i3IGI_S73HOkO-1CIWmIcnvUT_ChTwWmqNi0hGQgblr06kyEFRXId77Tw2wIV4YWIRHQBWqWnXrFX5e-ekqFcNOPybhMwVqqvbMmOrWaNXB04j0I7yq7BSiYabvMQIjeBw712rnmgoaj5OTtRL8sjXGwKA_aCMagMVmoyt4vMMZrm6qPh1eOHHkvYIuT0jHa76ABspSJjaDB5CaToj3_lqbtdx-mKb7oj5W9W8SPuy9x_wC71r4E01r70WFVDSw5wDo7IjrgkQRWTOZC2&c=ASevCXIA1Ta73BOn5zvDb-EmgGeC9f4Z9YR8D3Cwz1TRk8Q8vvCkwA==&ch=j3ruWVXld9VHaU5AtBU5iFV_vibkGOVOEpUv9I3nU7PfGoUT_XmV1A==>


3:59 PM
Linda Michaelsen (Optum) to Everyone

Additional Codes

More than one code may be used in CodeableConcept. The concept may be coded multiple times in different code systems (or even multiple times in the same code systems, where multiple forms are possible, such as with SNOMED CT). Each coding (also referred to as a 'translation') is a representation of the concept as described above and may have slightly different granularity due to the differences in the definitions of the underlying codes. There is no meaning associated with the ordering of coding within a CodeableConcept. A typical use of CodeableConcept is to send the local code that the concept was coded with, and also one or more translations to publicly defined code systems such as LOINC or SNOMED CT. Sending local codes is useful and important for the purposes of debugging and integrity auditing.


3:59 PM
Linda Michaelsen (Optum) to Everyone

definition of CodeableConcep






ManagementNext Agenda



Adjournment
adjourned at 4:00PM ET

Attendees  11

Present

Name

Affiliation


PresentNameAffiliation
PresentNameAffiliation
PresentNameAffiliation
  •  
Stratametrics
  •  
Dale Davidson

  •  
Rachel Foerster

  •  
Kimberly Bradbury
  •  


  •  
Karl EverittEpic
  •  
Tim McNeil

  •  
Steve Gasiorek
  •  
BCBS Alabama
  •  
Thomson Kuhn

  •  
Leah Hannum

  •  
Daniel Tam
  •  
Providence St. Joseph
  •  
Patty CraigTJC
  •  
Dave Foster

  •  
Steven Porteus
  •  

Peter Muir



  •  
Nick Radov

  •  
Bryan Briegel

  •  
Chris Johnson
  •  
Optum
  •  
William Harty

  •  
Preston Lee

  •  
Slater Ong
  •  

Brian Murta

Centene
  •  
Deidre Sacra

  •  
Gary Dickinson

  •  
Mary Ann BoyleHL7
  •  


  •  
Jay BakerEdifecs
  •  
Rob Reynolds

  •  
Jim Taylor 
  •  
POCP
  •  
Joseph QuinnHSX
  •  
Shawn Smith

  •  
Teresa Younkin
  •  
Phranil MethaHealow
  •  
Cigna Evernorth
  •  
Donielle Williams

  •  
Yanyan HuTJC
  •  
MultiCare
  •  
Mariel Brechner

  •  


  •  

Albert Tecson


  •  
BCBST
  •  
Christopher Marchand

  •  
Pranathi K

  •  
Bill LancelleEpic
  •  


  •  
Madhurima DharCozeva
  •  
Vijay Sravani Thotakura

  •  
Joe QuinnSmile CDR
  •  
Availity
  •  
Kira Whitworth

  •  
Angie Finley

  •  
Rachel Foerster
  •  
Brent Zenobia Novillus
  •  
Travis Hendrix

  •  
Eric Liu

  •  
Karen iapoce
  •  
Optum
  •  
Zahid Butt

  •  
Kim Faison




  •  
Frank

  •  
Khushwinder Singh

  •  
Tushar Shah





Action items

  •  Add to Phase 2 - Ability to remove and provide a reason for status change. e.g. the patient no longer has the condition.

Create Decision from template