Severe Obstetric Complications

Measure Information	2023 Reporting Period	2024 Reporting Period	2025 Reporting Period	2026 Reporting Period
Title	Severe Obstetric Complications	Severe Obstetric Complications	Severe Obstetric Complications	Severe Obstetric Complications
CMS eCQM ID	CMS1028v1	CMS1028v2	CMS1028v3	CMS1028v4
Short Name	PC-07	PC-07	PC-07	PC-07
CBE ID*	Not Applicable	Not Applicable	Not Applicable	Not Applicable
Measure Steward	The Joint Commission	The Joint Commission	The Joint Commission	The Joint Commission
Description	Patients with severe obstetric complications which occur during the inpatient delivery hospitalization.	Patients with severe obstetric complications which occur during the inpatient delivery hospitalization	Patients with severe obstetric complications that occur during the inpatient delivery hospitalization	Patients with severe obstetric complications that occur during the inpatient delivery hospitalization
Measure Scoring	Proportion	Proportion	Proportion	Proportion
Measure Type	Outcome	Outcome	Outcome	Outcome
Stratification	*See CMS1028v1.html	Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. Additionally, this measure will be stratified by race and ethnicity after measure submission.	This measure will be stratified by race/ethnicity and payer after measure submission	None
Risk Adjustment	*See CMS1028v1.html	The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. - Anemia - Asthma - Autoimmune Disease - Bariatric Surgery - Bleeding disorder - Cardiac Disease - Gastrointestinal Disease - Gestational Diabetes - HIV - Housing Instability - Hypertension - Maternal Age (derived from birthdate) - Mental Health Disorder - Morbid Obesity - Multiple Pregnancy - Neuromuscular Disease - Other Pre-eclampsia - Placenta Previa - Placental Abruption - Placental Accreta Spectrum - Pre-existing Diabetes - Preterm Birth - Previous Cesarean - Pulmonary Hypertension - Renal Disease - Severe Pre-eclampsia - Substance Abuse - Thyrotoxicosis - Long-term Anticoagulant Use - Obstetric VTE Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - White blood cell count: 10*3/uL - Hematocrit: % Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files.	The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard, Kennedy, Carmichael, Lyell, & Main, 2020; Main, Leonard, & Menard, 2020). - Anemia (includes sickle cell disease) - Asthma - Autoimmune Disease - Bariatric Surgery - Bleeding Disorder - Cardiac Disease - Economic Housing Instability - Gastrointestinal Disease - Gestational Diabetes - HIV - Hypertension - Long-term Anticoagulant Use - Maternal Age (derived from birthdate) - Mental Health Disorder - Morbid Obesity - Multiple Pregnancy - Neuromuscular Disease - Obstetric VTE - Other Pre-eclampsia - Placenta Previa - Placental Abruption - Placental Accreta Spectrum - Pre-existing Diabetes - Preterm Birth - Previous Cesarean - Pulmonary Hypertension - Renal Disease - Severe Pre-eclampsia - Substance Abuse - Thyrotoxicosis Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - Hematocrit: % - White blood cell count: 10*3/uL Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files.	The Severe Obstetric Complications Risk Adjustment Methodology Report is available on this eCQI Resource Center. Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard, Kennedy, Carmichael, Lyell, & Main, 2020; Main, Leonard, & Menard, 2020). - Anemia (includes sickle cell disease) - Asthma - Autoimmune Disease - Bariatric Surgery - Bleeding Disorder - Cardiac Disease - Economic Housing Instability - Gastrointestinal Disease - Gestational Diabetes - HIV - Hypertension - Long-term Anticoagulant Use - Maternal Age (derived from birthdate) - Mental Health Disorder - Morbid Obesity - Multiple Pregnancy - Neuromuscular Disease - Obstetric VTE - Other Pre-eclampsia - Placenta Previa - Placental Abruption - Placental Accreta Spectrum - Pre-existing Diabetes - Preterm Birth - Previous Cesarean - Pulmonary Hypertension - Renal Disease - Severe Pre-eclampsia - Substance Abuse - Thyrotoxicosis Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - Hematocrit: % - White blood cell count: 10*3/uL Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA I file. Specific risk variable templates are not needed in the QRDA I files.
Rationale	*See CMS1028v1.html	The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health. There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.	The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, 2021). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012). There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.	The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. The Centers for Disease Control and Prevention (CDC) (2021) report that these rates have continued to trend upward in recent decades. Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2020). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012). There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.
Clinical Recommendation Statement	*See CMS1028v1.html	Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care.	Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.). The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, & Ecker, 2016).	Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.). The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, & Ecker, 2016).
Improvement Notation	Improvement noted as a decrease in the rate.	Improvement noted as a decrease in the rate	Improvement noted as a decrease in the rate	Decreased score indicates improvement
Definition	*See CMS1028v1.html	For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).	For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).	For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).
Guidance	In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 2 approaches to determine estimated gestational age (EGA) in the following order of precedence: 1. The EGA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The EGA is obtained from a discrete field in the electronic health record. This option is only used when the calculated EGA is not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. *ACOG ReVITALize Guidelines for Calculating Gestational Age: Gestational Age = (280-(EDD minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (eg, assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends 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.	In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. *ACOG ReVITALize Guidelines for Calculating Gestational Age: Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends 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.	In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery. *ACOG ReVITALize Guidelines for Calculating Gestational Age (ACOG, 2014): Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded down to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends 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.	Note: This measure will be stratified by race/ethnicity and payer after measure submission. In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. When the calculated GA is not available, the GA is obtained from a discrete field in the electronic health record. The intent is to capture the last estimated GA in the interval starting 24 hours or less prior to delivery and ending before midnight on the same day of delivery. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. *ACOG ReVITALize Guidelines for Calculating Gestational Age (ACOG, 2014): Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number, and gestational age should be rounded down to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends 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.
Initial Population	Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period	Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period	Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period	Population Criteria 1, Initial Population: Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period Population Criteria 2, Initial Population: Same initial population as Population Criteria 1.
Denominator	Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed	Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed	Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed	Population Criteria 1, Denominator: Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed Population Criteria 2, Denominator: Same denominator population as Population Criteria 1.
Denominator Exclusions	Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure	Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure	Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure during the encounter	None
Numerator	Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation	Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation	Two numerator populations are defined for this measure: 1. All Severe Obstetric Complications (SOC). 2. SOC excluding encounters where transfusion was the only SOC. Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation	Population Criteria 1, Numerator: All Severe Obstetric Complications (SOC). Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation Population Criteria 2, Numerator: Delivery encounters with SOC excluding encounters where transfusion was the only SOC. Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation
Numerator Exclusions	Not applicable	Not applicable	Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications.	Population Criteria 1, Numerator Exclusion: Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications Population Criteria 2, Numerator Exclusion: Inpatient hospitalizations with SOC excluding encounters where transfusion was the only SOC, with a hysterectomy or blood transfusion with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications
Denominator Exceptions	None	None	None	None
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Measure Information

2023 Reporting Period

2024 Reporting Period

2025 Reporting Period

2026 Reporting Period

Title

Severe Obstetric Complications

CMS eCQM ID

CMS1028v1

CMS1028v2

CMS1028v3

CMS1028v4

Short Name

PC-07

CBE ID*

Not Applicable

Measure Steward

The Joint Commission

Description

Patients with severe obstetric complications which occur during the inpatient delivery hospitalization.

Patients with severe obstetric complications which occur during the inpatient delivery hospitalization

Patients with severe obstetric complications that occur during the inpatient delivery hospitalization

Measure Scoring

Proportion

Measure Type

Outcome

Stratification

*See CMS1028v1.html

Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication.

Additionally, this measure will be stratified by race and ethnicity after measure submission.

This measure will be stratified by race/ethnicity and payer after measure submission

None

Risk Adjustment

*See CMS1028v1.html

The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov).

Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data.

- Anemia

- Asthma

- Autoimmune Disease

- Bariatric Surgery

- Bleeding disorder

- Cardiac Disease

- Gastrointestinal Disease

- Gestational Diabetes

- HIV

- Housing Instability

- Hypertension

- Maternal Age (derived from birthdate)

- Mental Health Disorder

- Morbid Obesity

- Multiple Pregnancy

- Neuromuscular Disease

- Other Pre-eclampsia

- Placenta Previa

- Placental Abruption

- Placental Accreta Spectrum

- Pre-existing Diabetes

- Preterm Birth

- Previous Cesarean

- Pulmonary Hypertension

- Renal Disease

- Severe Pre-eclampsia

- Substance Abuse

- Thyrotoxicosis

- Long-term Anticoagulant Use

- Obstetric VTE

Lab and Physical Exam Results:

Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:

- Heart rate: {beats}/min

- Systolic blood pressure: mm[Hg]

- White blood cell count: 10*3/uL

- Hematocrit: %

Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files.

The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov).

Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard, Kennedy, Carmichael, Lyell, & Main, 2020; Main, Leonard, & Menard, 2020).

- Anemia (includes sickle cell disease)

- Asthma

- Autoimmune Disease

- Bariatric Surgery

- Bleeding Disorder

- Cardiac Disease

- Economic Housing Instability

- Gastrointestinal Disease

- Gestational Diabetes

- HIV

- Hypertension

- Long-term Anticoagulant Use

- Maternal Age (derived from birthdate)

- Mental Health Disorder

- Morbid Obesity

- Multiple Pregnancy

- Neuromuscular Disease

- Obstetric VTE

- Other Pre-eclampsia

- Placenta Previa

- Placental Abruption

- Placental Accreta Spectrum

- Pre-existing Diabetes

- Preterm Birth

- Previous Cesarean

- Pulmonary Hypertension

- Renal Disease

- Severe Pre-eclampsia

- Substance Abuse

- Thyrotoxicosis

Lab and Physical Exam Results:

Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:

- Heart rate: {beats}/min

- Systolic blood pressure: mm[Hg]

- Hematocrit: %

- White blood cell count: 10*3/uL

The Severe Obstetric Complications Risk Adjustment Methodology Report is available on this eCQI Resource Center.

- Anemia (includes sickle cell disease)

- Asthma

- Autoimmune Disease

- Bariatric Surgery

- Bleeding Disorder

- Cardiac Disease

- Economic Housing Instability

- Gastrointestinal Disease

- Gestational Diabetes

- HIV

- Hypertension

- Long-term Anticoagulant Use

- Maternal Age (derived from birthdate)

- Mental Health Disorder

- Morbid Obesity

- Multiple Pregnancy

- Neuromuscular Disease

- Obstetric VTE

- Other Pre-eclampsia

- Placenta Previa

- Placental Abruption

- Placental Accreta Spectrum

- Pre-existing Diabetes

- Preterm Birth

- Previous Cesarean

- Pulmonary Hypertension

- Renal Disease

- Severe Pre-eclampsia

- Substance Abuse

- Thyrotoxicosis

Lab and Physical Exam Results:

Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:

- Heart rate: {beats}/min

- Systolic blood pressure: mm[Hg]

- Hematocrit: %

- White blood cell count: 10*3/uL

Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA I file. Specific risk variable templates are not needed in the QRDA I files.

Rationale

*See CMS1028v1.html

The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health.

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, 2021). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012).

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. The Centers for Disease Control and Prevention (CDC) (2021) report that these rates have continued to trend upward in recent decades. Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2020). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012).

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

Clinical Recommendation Statement

*See CMS1028v1.html

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations

The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care.

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.).

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, & Ecker, 2016).

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.).

Improvement Notation

Improvement noted as a decrease in the rate.

Improvement noted as a decrease in the rate

Decreased score indicates improvement

Definition

*See CMS1028v1.html

For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).

Guidance

In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter.

This measure allows for 2 approaches to determine estimated gestational age (EGA) in the following order of precedence:

1. The EGA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*

2. The EGA is obtained from a discrete field in the electronic health record. This option is only used when the calculated EGA is not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.

*ACOG ReVITALize Guidelines for Calculating Gestational Age:

Gestational Age = (280-(EDD minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (eg, assisted reproductive technology)

--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.

Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends 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.

In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter.

This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:

1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*

2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available.

3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.

*ACOG ReVITALize Guidelines for Calculating Gestational Age:

Gestational Age = (280-(Estimated Due Date minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology)