Meaningful Use Stage 2 Exception vs. Exclusion Logic Explained

Introduced in Meaningful Use Stage 2 was the notion of both exception logic and exclusion logic with the Proportion-Based CQMs.  Based on numerous conversations over the past several months, there appears to be ongoing confusion in logical implementation of exception and exclusion logic for these CQMs as part of the Meaningful Use program.

The authoritative resource for this explanation is the Clinical Quality eMeasure Logic and Implementation Guidance Document that is publicly available on the CMS site.  The details for proportion-based CQM that I have paraphrased follows below:

• Initial Patient Population: The set of patients (or episodes of care) to be evaluated by the measure.
• Denominator Population: A subset of the Initial Patient Population.
• Exclusion Population: The members of the Denominator that should not be considered for inclusion in the Numerator.
• Numerator Population: A subset of the Denominator.  The numerator criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator.
• Exception Population: These are the members of the Denominator that were considered for membership in the Numerator, but were rejected, and meet the logic required for the exception criteria.

I have included an illustration that attempts to capture this updated logic for Meaningful Use Stage 2.

Meaningful Use Stage 2 Proportion-Based CQM Logic

These final population counts are then used to calculate the performance rate of any CQM against a population of patients via the following formula:

Performance Rate = Numerator Count / (Denominator Count – Exclusion Count – Exception Count)


This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. © Rob McCready, 2013.