Submitting Patient Data

Overview

For a given organization a patient sample consists of about 2000 patients. Each patient can be ranked in up to 10 quality measures. Detailed information on each measure can be found here. For the purposes of reporting and reporting completion the top 248 patient in each measure must be completed. A patient measure is considered complete when data for all of the required questions has been sucessfully submitted to the WI API. Metadata on all measures can be found here.

While there are a number of endpoints available on the WI API for the purposes of obtaining patients and submitting data there are two that are of particular note:

Examples

For the purposes of this example we will examine submission data for the PREV-5 measure, how it relates to the measures metadata, how to complete a measure, how to skip a measure, and how to skip a patient and all of their measures.

To boil it down to the simplest example possible let’s imagine this organization has one patient ranked in one measure.

In this case calling the GET /beneficiaries/organization/{id} endpoint will return this:

{
	"apiVersion": 1,
	"data": {
		"kind": "Beneficiary",
		"totalItems": 1,
		"currentItemCount": 1,
		"itemsPerPage": 1,
		"startIndex": 0,
		"items": [{
			"id": 1,
			"medicareId": "999999999",
			"firstName": "Tony",
			"lastName": "Stark",
			"gender": "MALE",
			"dateOfBirth": "1965-03-03",
			"mrn": "99999999",
			"otherId": "",
			"comments": "",
			"skippedReason": null,
			"medicalRecordFound": null,
			"medicalNotQualifiedReason": null,
			"medicalNotQualifiedDate": null,
			"status": "INCOMPLETE",
			"organizationId": 1,
			"clinicId": 12345,
			"requiredMeasuresCount": 1,
			"optionalMeasuresCount": 0,
			"requiredMeasuresComplete": 0,
			"optionalMeasuresComplete": 0,
			"skippedMeasuresCount": 0,
			"qualificationComments": null,
			"isMBI": false,
			"created_at": "2018-08-16T14:55:33.000Z",
			"updated_at": "2018-08-16T14:55:34.000Z",
			"measures": [{
				"status": "INCOMPLETE",
				"id": 1,
				"name": "PREV-5",
				"rank": 1,
				"skippedReason": null,
				"comments": "",
				"beneficiaryId": 1,
				"includedInNumerator": false,
				"includedInDenominator": false,
				"denominatorException": false,
				"submissions": []
			}]
		}]
  }
}

Completing a Measure

Data will be submitted for an array of patients using the PATCH /beneficiaries/organization/{id} endpoint.

To complete the submission for this patient and the PREV-5 measure here are the important properties to consider:

{
	"medicalRecordFound": null,
	"measures": [{
		"name": "PREV-5",
		"submissions": []
	}]
}

Required Data

This is the minimum information that is required to complete a patients measure for PREV-5. A completed reporting submission for this patient measure would look like this (NOTE: Refer to the interactive swagger documentation for more details):

{
    "id": 1,
    "medicalRecordFound": "YES",
    "measures": [{
        "name": "PREV-5",
        "submissions": [{
                "attribute": "confirmed",
                "value": "Y"
            },
            {
                "attribute": "screening-performed",
                "value": "Y"
            }
        ]
    }]
}

Skipping a measure

Measures can be SKIPPED for various reasons (i.e. NCD Not Confirmed - Diagnosis, or NOCAR No - Other CMS Approved Reason). To skip a measure the measures "attribute": "confirmed" value would get one of the skipped confirmation answers. In this example the patients PREV-5 measure would be SKIPPED:

NOTE: After submitting “NOCAR” through the API, you will need to submit the skip request manually through the CMS Web Interface and describe why the patient is not qualified for this measure.

{
	"medicalRecordFound": "YES",
	"measures": [{
		"name": "PREV-5",
		"submissions": [{
			"attribute": "confirmed",
			"value": "NOCAR"
		}]
	}]
}

Skipping a Patient

A patient (and subsequently all of their measures) can be SKIPPED if the patient’s medical record cannot be found or they are for some other reason not qualified for the sample. To skip a patient and their measures for medical record not found set beneficiary.medicalRecordFound = 'NO'.

{
	"medicalRecordFound": "NO"
}

If the patient is not qualified for the sample you MUST provide a medicalNotQualifiedReason and a medicalNotQualifiedDate. Valid medicalNotQualifiedReason values are IN_HOSPICE,MOVED_OUT_OF_COUNTRY,DECEASED,NON_FFS_MEDICARE,

{
	"medicalRecordFound": "NOT_QUALIFIED_FOR_SAMPLE",
	"medicalNotQualifiedReason": "NON_FFS_MEDICARE",
	"medicalNotQualifiedDate": "2018-02-02"
}

Checking for measure completion

A measure is complete when you have either submitted data and completed the top 248 ranked patients in the measure, or you have completed or skipped all measures if the sample contains less than 248 patients. If measures are SKIPPED they do not count towards the minimum reporting requirements for that measure. For example, if you skip the measure ranked 1 you will then need to complete measures 2 thru 249 (if available). In our example we only have one patient ranked in the PREV-5 measure so if we complete or skip that measure it will be consider complete.

This is not immediately apparent when submitting data on the PATCH endpoint. In order to check completion of your measures you will use the GET /organizations/{id}/measure/stats endpoint. This will return all measure statistics including completion.

CMS WI API Documentation

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