There is some confusion about the terms "Consecutively Completed" and "Skipped" patients especially in terms of meeting the 2017 reporting threshold of 248 consecutive patients.
According to the CMS GPRO Support Call documentation:
“Consecutively” means that: – Data has been entered for patients, in order, by rank
“Completed” means that you have:
– Found the Medical Record; and
– Confirmed the patient’s eligibility for the sample; and
– Confirmed the patient’s eligibility for the module/measure in which they are ranked; and
– Provided all the information required in the GPRO Web Interface.
"Skipping" If you skip a patient for any of the following reasons: a) the medical record was not found; b) the patient is not eligible for the sample for one of the following reasons: – Patient died, is in hospice, a non-US resident, or HMO-enrolled; c) the patient is not eligible for the measure/module in which they are ranked then an additional patient, on a one to one basis, must be completed.
"Incomplete" then means that you have not answered one or more of the questions for a patient for one or more measures. For example, if the patient is ranked for CAD-7 and the answer for CAD Confirmed is Yes but the answer for Has Diabetes for LVSD is blank (neither Yes or No was selected), then the data is incomplete and the patient is Incomplete for that measure.
Note: When the data in the Clinigence Registry has not been Approved, the patient will show as Incomplete in the CMS GPRO Web Interface reports.
So when you are trying to determine if you have met the 2016 requirement of 248 "consecutively completed" patients, you do not count the skipped patients as completed. Any skipped patients must be replaced by the next ranked patient. Meaning, you cannot have incomplete patients included in the list of consecutively ranked completed and skipped patients.
For example, if you have a set of patients for a measure like this:
|Patient Rank||MRF and Eligibility Confirmed||All Required Data Complete?||Counts Toward Threshold?||Comments|
|1-10||Yes||Yes||Yes||Patients are "completed"|
|11||No - MRF Not Found||Yes||No||Patient is "skipped"|
|12||No - Denominator Exclusion||Yes||No||Patient is "skipped"
|13-240||Yes||Yes||Yes||Patients are "completed"
|241||No - Not Eligible for Sample||Yes||No||Patient is "skipped"|
|242-248||Yes||Yes||Yes||Patients are "completed"
|249||Yes||Yes||Yes||Patient replaces rank #11|
|250||No||No||No||This incomplete patient means the count of "consecutive completed" patients is 247 -- you are 2 patients short of the required 248.|
|251||Yes||Yes||Yes||Patient becomes the new first patient in the count towards 248 "consecutive completed patients."|
You cannot have any patients that are incomplete between rank #1 and the ultimate ranking that gets you to the threshold of 248 completed patients.
What If I Can't Reach 248 Consecutive Completed Patients?
In cases where you have a smaller sample size or a large number of skipped patients, it may not be possible to reach the 248 consecutive completed patients threshold. In that case, you must answer the questions (complete or skip) for 100% of the patients in the CMS Sample Patient file for that measure.
Example 1: Your sample size for CAD-7 is only 288 patients and you have more than 40 patients with a valid skip reason, you will need to answer all appropriate questions for all 288 patients (100%) in the sample -- no incomplete patients are allowed.
Example 2: Your sample size for PREV-11 is 616 patients and you have 345 patients with a valid skip reason (denominator exclusions, for example). You will need to answer all appropriate questions for all 616 patients (100%) in the sample -- no incomplete patients are allowed.