| Measure Information | 2023 Performance Period |
|---|---|
| CMS eCQM ID | CMS146v11 |
| 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 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 |
| Initial Population |
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 |
| 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, 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. |
| 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. 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. |
| Telehealth Eligible | Yes |
| Next Version | |
| Previous Version |
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
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Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
-
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
-
Updated the initial population language to align with the logic and the current value sets.
Measure Section: Initial Population
Source of Change: Measure Lead
-
Revised the description, guidance, and initial population to use 'order' instead of 'dispense' to align with the measure logic.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Updated the description and guidance to clarify the strep test timing requirements.
Measure Section: Multiple Sections
Source of Change: ONC Project Tracking System (JIRA): CQM-4726
-
Updated grammar and punctuation to improve readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Logic
-
Updated the timing precision in definitions from datetime to date by adding the 'day of' operator to align with measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
-
Revised the logic to exclude patients with an antibiotic that is active before the encounter but is still active the same day of the encounter date.
Measure Section: Definitions
Source of Change: ONC Project Tracking System (JIRA): CQM-4749
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Added QDM datatypes Encounter, Performed and Assessment, Performed and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.
Measure Section: Definitions
Source of Change: Measure Lead
-
Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429).
Measure Section: Definitions
Source of Change: Measure Lead
-
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
-
Updated the version number of the Hospice Library to v4.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
-
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Revised the timing requirements for the strep test to occur in the interval between the 3 days before through the 3 days after the encounter.
Measure Section: Multiple Sections
Source of Change: ONC Project Tracking System (JIRA): CQM-4726
-
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/Technical 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.
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Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
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): Added 136 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 55 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 ICD-10-CM code (A04.7) based on validity of code during timing of look back period.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added 8 SNOMED CT codes (1092771000119104, 1144499001, 1149259003, 1153413001, 1153415008, 15984271000119108, 16016231000119109, 16016311000119107) based on review by technical experts, SMEs, and/or public feedback. Deleted 9 SNOMED CT codes (266355005, 77690003, 34320001, 186231006, 203271005, 25042006, 418750009, 59190009, 724502006) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 11 RxNorm codes (1291986, 1650198, 1809083, 2099768, 2122343, 309042, 351121, 757968, 758019, 853019, 861416) based on review by technical experts, SMEs, and/or public feedback. Deleted 94 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set (2.16.840.1.113883.3.464.1003.101.12.1026): Renamed to Preventive Care Services Individual Counseling based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
-
Value set (2.16.840.1.113883.3.464.1003.101.12.1023): Renamed to Preventive Care Services Initial Office Visit, 18 and Up based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
-
Value set (2.16.840.1.113883.3.464.1003.101.12.1002): Renamed to Initial Hospital Observation Care based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
-
Value set (2.16.840.1.113883.3.464.1003.101.12.1025): Renamed to Preventive Care Services Established Office Visit, 18 and Up based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
-
Replaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
-
Value set (2.16.840.1.113883.3.464.1003.101.12.1027): Renamed to Preventive Care Services Group Counseling based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
-
Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead