When reviewing Patient Outliers available in EQuIPP, pharmacies may note patients that are now deceased. Here are some considerations for pharmacies given this situation:
1. According to CMS’ measurement specifications for members that may become deceased, they will evaluate those patients through the member’s exact death date (if available) or the end of their enrollment.
- PQS receives monthly eligibility files from participating health plans and reconciles member eligibility with the measure calculation.
- Based upon when the health plan records are updated with this information it may not be immediately reflected for the patient in the dashboard. The data will be reconciled with the reporting on the date the patient passed once the records have been updated.
2. These examples serve as an important reminder as to why pharmacies should proactively be addressing quality measures such as adherence. If and when a patient becomes deceased, they are no longer evaluated for that measure from that point moving forward. However, the pharmacy and health plan would still be evaluated for the time period in which the patient is alive. Therefore, a pharmacy simply relying on patient outliers may be limiting their capabilities to improve quality measure scores.
Below is language from the Final Call Letter for 2016:
CMS will use the exact death date (when available in the Common Medicare Environment enrollment table) to determine the beneficiary’s disenrollment date instead of the CME disenrollment date as the end of the beneficiary’s measurement period
Bottom line, it takes time for the patient to fall out of the measure,
Do not rely simply on outliers, be proacticve.