| Measure Information | 2021 Performance Period |
|---|---|
| CMS eCQM ID | CMS146v9 |
| NQF Number | Not Applicable |
| MIPS Quality ID | 066 |
| Description |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test |
| Initial Population |
Outpatient, telephone, online assessment, observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event among patients 3 years or older |
| Numerator |
A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date |
| Numerator Exclusions |
Not Applicable |
| Denominator |
Equals Initial Population |
| Denominator Exclusions |
Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care overlapping with the measurement period. Exclude episodes where the patient had a competing diagnosis within three days after the episode date. |
| Denominator Exceptions |
None |
| Steward | National Committee for Quality Assurance |
| Measure Scoring | Proportion measure |
| Measure Type | Process measure |
| Improvement Notation |
Higher score indicates better quality |
| Guidance |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is an episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
| Telehealth Eligible | Yes |
| Next Version | |
| Previous Version | No Version Available |
Compare eCQM Versions
The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.
Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.
| Measure Information | 2021 Performance Period | 2022 Performance Period | 2023 Performance Period | 2024 Performance Period |
|---|---|---|---|---|
| Title | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis |
| CMS eCQM ID | CMS146v9 | CMS146v10 | CMS146v11 | CMS146v12 |
| NQF Number | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| Description |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date |
| Initial Population |
Outpatient, telephone, online assessment, observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event among patients 3 years or older |
Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event on or within 3 days after the episode date among patients 3 years or older |
Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis and an antibiotic order on or within 3 days after the episode date among patients 3 years or older |
Outpatient, telephone, online assessment (i.e., e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions | Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care overlapping with the measurement period. Exclude episodes where the patient had a competing diagnosis within three days after the episode date. | Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date. Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care for any part of the measurement period. Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. | Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date. Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude episodes when the patient had hospice care for any part of the measurement period. Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. | Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period. Exclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date. |
| Numerator |
A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date |
A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date |
A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date |
A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
None |
None |
None |
None |
| Measure Steward | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process measure | Process measure | Process measure | Process measure |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Guidance |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is an episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. The intent is to determine whether antibiotics are being dispensed appropriately. Antibiotics should only be dispensed if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be dispensed for viral infections. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event during the measurement period. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on the episode date through 3 days after the episode date. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This is an episode of care measure that examines all eligible episodes for the patient. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on or three days after the episode date. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order from January 1 to December 28 of the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| MIPS Quality ID | 066 | 066 | 066 | 066 |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | CMS146v10 | CMS146v11 | CMS146v12 | No Version Available |
| Previous Version | No Version Available |
Data Element Repository
Header
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: eCQM Title
Source of Change: Measure Lead
-
Updated eCQM Version Number.
Measure Section: eCQM Version Number
Source of Change: Standards Update
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: Description
Source of Change: Measure Lead
-
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
-
Updated the rationale to remove outdated references and content and to update references.
Measure Section: Rationale
Source of Change: Measure Lead
-
Updated references.
Measure Section: Reference
Source of Change: Standards Update
-
Added more guidance about which eligible episode to include in the measure.
Measure Section: Guidance
Source of Change: Measure Lead
-
Added text to identify the Quality Data Model (QDM) version used in the measure specification.
Measure Section: Guidance
Source of Change: Standards Update
-
Added text to indicate whether the measure is patient-based or episode-based.
Measure Section: Guidance
Source of Change: Standards Update
-
Revised wording of the initial population statement to reflect measure is episode based for consistency with the measure intent.
Measure Section: Initial Population
Source of Change: Measure Lead
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: Initial Population
Source of Change: Measure Lead
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: Denominator
Source of Change: Measure Lead
-
Updated denominator exclusions to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
-
Revised the numerator statement by clarifying that the test should be within 3 days of the episode date to align with the measure logic.
Measure Section: Numerator
Source of Change: Measure Lead
Logic
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: Initial Population
Source of Change: Measure Lead
-
Updated the age ranges to 3 years and older, to address the increasing alarm of antibiotic overuse.
Measure Section: Denominator
Source of Change: Measure Lead
-
Updated denominator exclusions to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
-
Updated timing logic for the follow-up assessment to use 'in Interval' to simplify logic and promote harmonization between measures.
Measure Section: Definitions
Source of Change: Measure Lead
-
Clinical Quality Language (CQL) Library version update: Updated version number of the Hospice Library (Hospice-2.2.000).
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.
Measure Section: Multiple Sections
Source of Change: Standards Update
-
Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).
Measure Section: Multiple Sections
Source of Change: Standards Update
-
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards Update
-
Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.
Measure Section: Multiple Sections
Source of Change: Standards Update
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
-
Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 9 RxNorm codes (1148107, 199497, 199620, 199710, 199802, 245240, 245837, 245838, 761979) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
-
Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 SNOMED CT code (17436001) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
-
Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added Comorbid Conditions for Respiratory Conditions based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080): Added Telephone Visits based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Deleted 29 SNOMED CT codes based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
-
Replaced Value set Discharge Services Observation Care (2.16.840.1.113883.3.464.1003.101.12.1039) with direct reference code CPT Code (99217) to align with best practices for replacing single code value sets with direct reference codes.
Measure Section: Terminology
Source of Change: Annual Update