2021-10-14 Risk Adjustment Use Case Meeting

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. 

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

Project Tracking - Phase One

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

• 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. 

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