Blood pressure control, sixteen members
Roster generated from a seeded stream (seed 2104) and placed by an oracle implementation of synthetic measure QM-CBP (src/tasks/pop.ts). Every member carries at least one boundary — age, enrolment, event window, exclusion, or numerator window — drawn from the same traps the single-member family uses.
Field mean
90.5
across 28 models
Models scoring 100
24
of 28
Models scoring 0
1
of 28
What the model was given
MEASURE QM-CBP — BLOOD PRESSURE CONTROL IN HYPERTENSION
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION (denominator)
Age: 18 through 85 years as of 2026-12-31.
Event: at least one outpatient encounter with a hypertension diagnosis (I10)
on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does
not establish the event.
Continuous enrolment: enrolled for the full measurement year with no more than
one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of
any length, removes the member from the denominator.
NUMERATOR
The most recent outpatient blood pressure reading taken on or after the date of
the qualifying hypertension encounter and on or before 2026-12-31 is below
140 systolic AND below 90 diastolic. Both components must be below the
threshold. A reading taken in an emergency department or on an inpatient
admission does not count and is skipped when identifying the most recent
reading. If no qualifying reading exists, the member is in the denominator and
not in the numerator.
REQUIRED EXCLUSIONS (remove from the denominator before scoring)
E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any
time on or before 2026-12-31.
E2. Pregnancy (any O00-O9A code) during the measurement year.
E3. Enrolled in hospice or receiving palliative care at any time during the
measurement year.
E4. Died during the measurement year.ROSTER — 16 members
MEMBER 71041. Date of birth 1941-07-25, so 85 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-02-18 Office visit, diagnosis I10. BP 150/72.
2026-05-18 Inpatient admission, diagnosis R07.9. BP 159/81.
No hospice. Member alive at year end.
MEMBER 71042. Date of birth 1940-06-12, so 86 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-03-27; 2026-04-12 through 2026-06-29; 2026-07-12 through 2026-12-31. Gaps of 15 and 12 days.
Encounters and results:
2026-04-05 Office visit, diagnosis I10. BP 146/88.
2026-04-11 Office visit, diagnosis I10. BP 139/82.
2026-05-01 Office visit, diagnosis E78.5. BP 167/83.
No hospice. Member alive at year end.
MEMBER 71043. Date of birth 1991-01-17, so 35 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-02-12 Office visit, diagnosis I10. BP 126/73.
2026-03-21 Office visit, diagnosis I10. BP 135/73.
2026-05-22 Office visit, diagnosis E78.5. BP 119/102.
2026-10-02 Office visit, diagnosis E78.5. BP 136/103.
No hospice. Member alive at year end.
MEMBER 71044. Date of birth 1956-05-26, so 70 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-04-23 Office visit, diagnosis I10. BP 152/76.
Other history:
2024-06-20 Diagnosis N18.6, end stage renal disease.
No hospice. Member alive at year end.
MEMBER 71045. Date of birth 1982-06-22, so 44 years old on 2026-12-31. Female.
Enrolment: 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05.
Encounters and results:
2026-05-23 Office visit, diagnosis I10. BP 150/72.
No hospice. Member alive at year end.
MEMBER 71046. Date of birth 1991-10-18, so 35 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days.
Encounters and results:
2026-03-08 Office visit, diagnosis I10. BP 137/82.
2026-05-11 Office visit, diagnosis I10. BP 119/85.
2026-08-20 Office visit, diagnosis J06.9. BP 138/68.
2026-09-18 Emergency department visit, diagnosis S52.501A. BP 130/69.
No hospice. Member alive at year end.
MEMBER 71047. Date of birth 2008-04-06, so 18 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-06-17 Office visit, diagnosis I10. BP 138/76.
2026-07-25 Office visit, diagnosis I10. BP 137/73.
2026-11-21 Inpatient admission, diagnosis I10. BP 118/88.
No hospice. Member alive at year end.
MEMBER 71048. Date of birth 1991-04-26, so 35 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-05-15 Office visit, diagnosis I10. BP 134/93.
No hospice. Member alive at year end.
MEMBER 71049. Date of birth 1965-05-12, so 61 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days.
Encounters and results:
2026-08-25 Office visit, diagnosis I10. BP 116/86.
2026-11-28 Emergency department visit, diagnosis R07.9. BP 124/82.
2026-12-25 Office visit, diagnosis I10. BP 138/87.
No hospice. Member alive at year end.
MEMBER 71050. Date of birth 1942-01-04, so 84 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-06-23 Office visit, diagnosis I10. BP 122/84.
2026-09-08 Office visit, diagnosis J06.9. BP 129/71.
No hospice. Member alive at year end.
MEMBER 71051. Date of birth 1991-04-19, so 35 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days.
Encounters and results:
2026-03-21 Office visit, diagnosis I10. BP 135/94.
2026-04-06 Office visit, diagnosis I10. BP 144/93.
2026-10-07 Emergency department visit, diagnosis S52.501A. BP 154/95.
Other history:
2026-10-27 Hospice election.
Member alive at year end.
MEMBER 71052. Date of birth 1991-11-27, so 35 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days.
Encounters and results:
2026-04-08 Office visit, diagnosis I10. BP 121/76.
2026-06-04 Office visit, diagnosis I10. BP 149/73.
2026-07-13 Office visit, diagnosis I10. BP 127/73.
2026-07-16 Emergency department visit, diagnosis S52.501A. BP 119/89.
No hospice. Member alive at year end.
MEMBER 71053. Date of birth 1942-08-07, so 84 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days.
Encounters and results:
2026-05-22 Office visit, diagnosis I10. BP 146/72.
2026-06-26 Office visit, diagnosis I10. BP 133/95.
2026-08-24 Inpatient admission, diagnosis R07.9. BP 112/84.
No hospice. Member alive at year end.
MEMBER 71054. Date of birth 1942-12-16, so 84 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days.
Encounters and results:
2026-03-21 Office visit, diagnosis I10. BP 137/92.
2026-05-06 Office visit, diagnosis I10. BP 138/85.
2026-06-05 Inpatient admission, diagnosis S52.501A. BP 132/76.
2026-10-28 Office visit, diagnosis E78.5. BP 132/95.
No hospice. Member alive at year end.
MEMBER 71055. Date of birth 1940-08-21, so 86 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-02-18 Office visit, diagnosis I10. BP 144/79.
2026-09-16 Office visit, diagnosis J06.9. BP 112/64.
No hospice. Member alive at year end.
MEMBER 71056. Date of birth 1942-01-17, so 84 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Encounters and results:
2026-01-19 Office visit, diagnosis I10. BP 125/88.
2026-03-20 Office visit, diagnosis I10. BP 153/86.
No hospice. Member alive at year end.json{
"kind": "fields",
"fields": {
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
}Every model's answer
Sorted by score. Open a row for the response and, where the vendor exposes it, the reasoning behind it.
100Claude Fable 5.1 · Anthropic12.0s · 1,042 out | 16.7s · 1,165 out | 13.6s · 1,018 out
Reasoning · 867 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 990 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 843 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.7 Flash · Google21.6s · 3,939 out | 26.1s · 3,570 out | 34.2s · 4,546 out
Reasoning · 3,694 tokens
**Evaluating QM-CBP Measure**
I'm currently reviewing the QM-CBP measure specifications. My focus is on the defined measurement year (2026) and the age range for members (18-85). This information is crucial for accurately evaluating the 16 members and generating the JSON output.
**Clarifying Numerator Logic**
I'm refining the logic for the numerator. Specifically, I'm ensuring the qualifying blood pressure reading must be taken *after* the initial hypertension diagnosis encounter, within the specified measurement year, and excluding inpatient/ED visits.
**Processing Member Data**
I've analyzed several members' data, focusing on eligibility criteria and numerator logic. Specifically, I've determined one member is non-compliant due to elevated blood pressure after diagnosis, another is not eligible due to age and enrollment gaps, and a third is non-compliant based on their most recent outpatient reading.
**Analyzing Member Exclusions**
I've identified several members now with definitive statuses. Member 71045 and 71046 were excluded due to enrollment gaps exceeding the allowed threshold. Member 71047 meets compliance criteria with a 137/73 reading. Member 71048 is non-compliant due to a 134/93 reading.
**Determining Member Compliance**
I've finalized the compliance status for additional members. Member 71050 is compliant, with their latest outpatient reading meeting the criteria. Member 71051 is not eligible due to enrollment gaps. Member 71052 has been determined compliant based on their most recent outpatient reading after their qualifying event.
**Finalizing Member Statuses**
I've determined Member 71053 is non-compliant due to a high diastolic reading and Member 71054 is also non-compliant for the same reason. Member 71055 has been identified as not eligible due to age. Member 71056's compliance is still under evaluation.
**Completing Member Review**
I have now finalized the compliance status for all 16 members. My final evaluations confirm eleven members are non-compliant, three are compliant, and two are not eligible based on the established criteria.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,325 tokens
**Reviewing eligibility criteria**
I'm currently processing the specifications, focusing on defining the eligible population for the QM-CBP measure. My attention is specifically on establishing the age range, 18 to 85, for the measurement year of 2026.
**Evaluating member exclusions**
I'm now applying the exclusion criteria to the eligible population. For Member 71041, after confirming their age and enrollment, I've assessed the encounter and noted no exclusions based on ESRD, pregnancy, hospice, or death within the measurement year.
**Assessing individual compliance**
I'm now processing individual member data. Member 71043 is non-compliant due to elevated diastolic pressure. Member 71044 is excluded due to ESRD. Member 71045 is not eligible due to enrollment gaps.
**Processing member exclusions**
I have continued processing exclusions, and Member 71046 is not eligible due to enrollment gaps. Member 71047 is compliant, while Member 71048 is non-compliant due to high diastolic pressure. Member 71049 is excluded for lacking an early measurement.
**Determining member compliance**
I'm continuing to assess individual member data. Member 71050 has been confirmed as compliant. Member 71051 is not eligible due to enrollment gaps and hospice election. Member 71052 remains under review for numerator data.
**Processing additional members**
I'm continuing to assess new member data. Member 71053 is non-compliant due to elevated diastolic pressure. Member 71054 is also non-compliant for the same reason. Member 71055 is not eligible based on age, and Member 71056 is still under review for other criteria.
**Finalizing member status**
I have completed the review of all 16 members, categorizing them into compliant, non-compliant, excluded, or not eligible. The final counts have been tallied and sum checked, allowing for the calculation of the denominator and numerator.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,301 tokens
**Evaluating QM-CBP Performance**
I am currently analyzing the 16 members against the QM-CBP measure specification for the 2026 measurement year. My focus is on meticulously reviewing each member's data to ensure accurate evaluation against the defined criteria.
**Validating Member Eligibility**
I'm now focusing on the specific criteria for member eligibility, particularly age and continuous enrollment throughout the measurement year. My next step is to meticulously check for any disqualifying events.
**Assessing Specific Cases**
I'm currently working through individual member assessments. For 02-18, the systolic reading met the threshold but diastolic did not. Member 71042 is ineligible due to age. Member 71043 also failed to meet diastolic criteria. Member 71044 has an exclusion based on diagnosis N1.
**Reviewing Recent Cases**
My analysis continues with member 71047, who is eligible and compliant with readings of 137/73. Member 71048 is eligible but non-compliant due to a diastolic reading of 93. Member 8.6 is excluded due to ESRD. Members 71045 and 71046 are not eligible due to enrollment gaps exceeding 45 days.
**Processing New Cases**
I've determined member 08-25 is not eligible due to no qualifying encounter. Member 71050 is compliant with their qualifying encounter. Member 71051 is ineligible due to enrollment gaps. Member 71052 is eligible, with their qualifying encounter on 2026-04-08.
**Completing Member Assessments**
I’ve finished evaluating member 71053, who is eligible but non-compliant due to a high diastolic reading. Member 71054 is also eligible, and their most recent outpatient reading is currently under review. I am proceeding with further case analysis.
**Finalizing Member Status**
I have concluded the assessment for member 06, who is non-compliant due to elevated diastolic readings. Additionally, member 71055 has been marked as ineligible due to age. Member 71056 is also non-compliant due to high systolic pressure. I am now compiling final counts for each category.
**Recalculating Rate**
I'm re-evaluating the QM-CBP rate after identifying a discrepancy. My current calculations indicate 3 compliant, 6 non-compliant, 1 excluded, and 6 not eligible members, resulting in a 33.3% rate. I am performing a thorough review of all 16 members to ensure accuracy.
**Updating Member Status**
I've determined member 71049 is not eligible due to lacking a qualifying encounter in the first half of the year, and 71050 and 71052 are compliant. Member 71051 is not eligible due to enrollment gaps.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.5 · OpenAI14.4s · 1,355 out | 16.0s · 1,468 out | 20.9s · 1,791 out
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,298 tokens
**Evaluating outpatient readings**
I need to identify the most recent outpatient reading taken on or after the qualifying encounter, possibly on April 8. The available readings are from April 8, June 4, and July 13, with the last relevant one being from July 13, which shows compliance. The enrollment periods and encounters during gaps also require attention; the event on May 22 falls within the gap. The prompt mentions that encounters outside enrollment aren’t ignored. Overall, it's complex, but I think the latest eligible reading is from June 26.
**Analyzing outpatient compliance**
If May 22 is the earliest date for the qualifying encounter, the most recent outpatient reading still stands at June 26, which indicates a high blood pressure. This suggests non-compliance in managing the condition. I need to ensure that I accurately reflect this situation in my conclusions, considering the importance of monitoring and compliance for effective patient care.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,621 tokens
**Clarifying eligibility criteria**
I’m analyzing if an event qualifies if it happens during a coverage gap. For example, someone has an office visit on April 5 during a gap, but they weren’t enrolled either then or after. There’s another gap I’m considering too, where qualifying events might land outside typical enrollment periods. It seems that encounters might still count even during gaps, and it’s essential to focus on listed events regardless of enrollment status, as long as they're eligible.
**Evaluating event eligibility**
I’m looking at event 71053 on May 22. If that counts, then it’s eligible. The last outpatient blood pressure reading after that is June 26, which shows noncompliance since there was an inpatient skip. If May 22 doesn't count because of a gap, I need to check June 26's timing—ah, it’s actually within the enrollment period by June 30. For 71042, age disqualifies the person regardless of gaps. So, overall, not eligible.
**Calculating rates for eligibility**
I’m calculating the rate by multiplying 3/9 by 100 to get 33.333, and rounding it to one decimal gives me 33.3. I want to ensure that 71044 is included as eligible before any exclusions. I’m also considering 71042, but since it's age 86 with two gaps, it’s not eligible. If age 86 means not eligible, that’s good to know. Now, I need to make sure to output the data in exactly fenced JSON format.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Sol · OpenAI6.5s · 545 out | 7.4s · 533 out | 7.2s · 565 out
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.6 · xAI55.0s · 3,816 out | 55.6s · 3,813 out | 61.6s · 4,324 out
Reasoning · 3,675 tokens
The user wants me to analyze a measure population for QM-CBP blood pressure control. I need to place every member against the specification and output JSON only.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,672 tokens
The user wants me to evaluate members against a measure specification and output JSON.
{
"71041": {
"eligibility": "eligible",
"numerator": "not_met",
"reason": "No qualifying BP reading on or after the qualifying encounter (2026-02-18) and on or before 2026-12-31"
},
" 71042": {
"eligibility": "not_eligible",
"reason": "Age 86 (exceeds 85)"
},
"71043": {
"eligibility": "eligible",
"numerator": "not_met",
"reason": "No qualifying BP reading on 2026-10-02 (136/103) meets criteria"
},
"71044": {
"eligibility": "excluded",
"reason": "ESRD (N18.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,183 tokens
The user wants me to evaluate a measure population for QM-CBP - Blood Pressure Control in Hypertension. I need to place every member against the specification and output JSON.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.5 · xAI38.1s · 2,774 out | 28.7s · 2,400 out | 44.7s · 3,205 out
Reasoning · 2,633 tokens
The task requires me to analyze each member against the QM-CBP measure specification and categorize them.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,259 tokens
The task requires me to analyze each member against the measure specification and categorize them.
{
"denominator": 15,
"numerator": 0,
"excluded": 0,
"not_eligible": 1,
"rate": 0,
"compliant_members": [],
"non_compliant_members": [
"71041",
"710 43",
"71045",
"71046",
"71048",
"71049",
"71050",
"71051",
"71052",
"71053",
"71054",
"71055",
"71056"
],
"excluded_members": 0,
"not_eligible_members": [
"71042"
]
} Wait, I think I messed up the categorization. Let me re-evaluate each member carefully against the measure specification.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,064 tokens
The task requires me to evaluate 16 members against the QM-CBP measure specification and report the population in a specific JSON format.
{
"measure": "QM-CBP",
"year": 2026,
"eligible_population": 14,
"numerator": 0,
"denominator": 14,
"compliance_rate": 0.0,
"members": [
{
"member_id 71041": {
"age": 85,
"enrollment": "continuous",
"qualifying_encounter": "2026-02-18",
"most_recent_bp": "150/72",
"compliant": false,
"reason": "BP 150/72 >= 140 systolic"
}
},
{
"member_id 71042": {
"age": 86,
"reason": "age > 85"
}
},
{
"member_id 71043": {
"age": 35,
"enrollment": " continuous",
"qualifying_encounter": "2026-02-12",
"most_recent_bp": "136/103",
"compliant": false,
"reason": "BP 103 >= 90 diastolic"
}
},
{
"member_id 71044": {
"age": 70,
"reason": "ESRD (N18.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.1 Pro · Google51.7s · 7,166 out | 53.9s · 7,596 out | 55.2s · 7,684 out
Reasoning · 6,921 tokens
**Analysis of Hypertension Quality Measure (QM-CBP) for 16 Members**
My objective here is to meticulously evaluate 16 members against the QM-CBP, a quality measure designed to assess hypertension control, and then to consolidate these findings into a JSON output. This requires a systematic application of the measure's denominator, numerator, and exclusion criteria.
First, I'll establish the criteria for the **Denominator**, which defines the eligible population. A member must meet all of the following:
1. **Age:** Be between 18 and 85 years old inclusive, as of December 31, 2026. This translates to a Date of Birth (DOB) on or after January 1, 1941, and on or before December 31, 2008.
2. **Event:** Have at least one outpatient encounter for hypertension (ICD-10 code I10) occurring between January 1, 2026, and June 30, 2026.
3. **Continuous Enrollment:** Be continuously enrolled throughout the entire measurement year, 2026, with a maximum of one gap in enrollment not exceeding 45 days. More than one gap, or any gap exceeding 45 days, renders the member ineligible.
Next, I'll consider the **Numerator**, which identifies compliant members within the eligible denominator population. To be compliant, a member must have:
* Their most recent outpatient blood pressure (BP) reading recorded on or after the date of their qualifying hypertension encounter and no later than December 31, 2026.
* This BP reading must be less than 140 systolic AND less than 90 diastolic.
* Crucially, BP readings taken during Emergency Department (ED) visits or inpatient admissions are explicitly excluded and must be skipped. If no qualifying BP reading exists, the member is deemed non-compliant.
Finally, I must apply the **Exclusions**. These are specific conditions that, if present and met on or before December 31, 2026 (or during the measurement year, as applicable), will exclude a member from the denominator, even if they otherwise meet the age, event, and enrollment criteria. The exclusions are:
* **E1:** End-Stage Renal Disease (ESRD, N18.6) or dependence on renal dialysis (Z99.2).
* **E2:** Pregnancy (codes O00-O9A).
* **E3:** Enrollment in hospice or palliative care.
* **E4:** Death during the measurement year.
Now, let's walk through each member:
**MEMBER 71041:**
* **Age:** 85 (DOB 1941-07-25) - Eligible for age.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-02-18 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-02-18 (150/72). The systolic reading (150) is >= 140. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
**MEMBER 71042:**
* **Age:** 86. This is greater than 85. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71043:**
* **Age:** 35 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-02-12 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-10-02 (136/103). The diastolic reading (103) is >= 90. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
**MEMBER 71044:**
* **Age:** 70 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-04-23 Outpatient I10 - Eligible.
* **Exclusions:** Identified ESRD (N18.6) on 2024-06-20. This member is excluded.
* **Result:** `excluded_members`.
**MEMBER 71045:**
* **Enrollment:** Enrolled from 2026-04-05 to 2026-12-31. This implies a gap from 2026-01-01 to 2026-04-04, which is 94 days. This gap is greater than 45 days. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71046:**
* **Enrollment:** Has a gap of 58 days. This gap is greater than 45 days. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71047:**
* **Age:** 18 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-06-17 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-07-25 (137/73). Systolic (137) < 140 and diastolic (73) < 90. Compliant.
* **Result:** `compliant_members`.
**MEMBER 71048:**
* **Age:** 35 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-05-15 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-05-15 (134/93). The diastolic reading (93) is >= 90. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
**MEMBER 71049:**
* **Event:** I reviewed the encounters. There are no outpatient encounters with an I10 diagnosis between 2026-01-01 and 2026-06-30. The earliest qualifying encounter (I10) is 2026-08-25, which is outside the required window. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71050:**
* **Age:** 84 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-06-23 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-09-08 (129/71). Systolic (129) < 140 and diastolic (71) < 90. Compliant.
* **Result:** `compliant_members`.
**MEMBER 71051:**
* **Enrollment:** Has two gaps: one of 26 days and another of 14 days. Having two gaps means they are not continuously enrolled as required. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71052:**
* **Age:** 35 - Eligible.
* **Enrollment:** Has one gap of 45 days, which is within the allowed limit. Eligible.
* **Event:** 2026-04-08 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-07-13 (127/73). Systolic (127) < 140 and diastolic (73) < 90. Compliant.
* **Result:** `compliant_members`.
**MEMBER 71053:**
* **Age:** 84 - Eligible.
* **Enrollment:** Has a gap of 22 days, which is allowed. Eligible.
* **Event:** I re-checked encounters and found one on 2026-06-26 (Office visit, I10), which falls within the Jan-Jun window. Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-06-26 (133/95). The diastolic reading (95) is >= 90. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
**MEMBER 71054:**
* **Age:** 84 - Eligible.
* **Enrollment:** Has a gap of 42 days, which is allowed. Eligible.
* **Event:** 2026-03-21 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-10-28 (132/95). The diastolic reading (95) is >= 90. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
**MEMBER 71055:**
* **Age:** 86. This is greater than 85. Not eligible.
* **Result:** `not_eligible_members`.
**MEMBER 71056:**
* **Age:** 84 - Eligible.
* **Enrollment:** Continuous, no gaps - Eligible.
* **Event:** 2026-01-19 Outpatient I10 - Eligible.
* **Exclusions:** None identified.
* **Numerator:** The most recent valid outpatient BP reading was on 2026-03-20 (153/86). The systolic reading (153) is >= 140. Therefore, non-compliant.
* **Result:** `non_compliant_members`.
After reviewing all members and their data against the measure criteria, I can consolidate the results:
* **Compliant Members (Numerator):** 3 members were found to be compliant: "71047", "71050", "71052".
* **Non-Compliant Members:** 6 members met the denominator criteria but did not meet the numerator criteria: "71041", "71043", "71048", "71053", "71054", "71056".
* **Excluded Members:** 1 member was excluded due to specific conditions: "71044".
* **Not Eligible Members:** 6 members did not meet the initial denominator criteria (age, enrollment, or event): "71042", "71045", "71046", "71049", "71051", "71055".
This gives me a total of 9 members in the denominator (3 compliant + 6 non-compliant).
The total number of members evaluated is 16 (9 in denominator + 1 excluded + 6 not eligible).
The calculated rate is (Numerator / Denominator) \* 100 = (3 / 9) \* 100 = 33.3%.
My final output, reflecting these findings, will be in the specified JSON format.
```json
{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
```
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,351 tokens
**Analysis of QM-CBP Measure Performance for 16 Members**
My task was to evaluate 16 members against the QM-CBP measure for the 2026 measurement year, focusing on hypertension control. I needed to meticulously apply the measure's specifications to determine who met the criteria for the denominator, who was compliant (met the numerator criteria), who was excluded due to specific conditions, and who was not eligible in the first place.
Here’s a breakdown of my thought process for each member and the subsequent aggregation:
First, I familiarized myself with the core criteria:
* **Measurement Year:** January 1, 2026, to December 31, 2026.
* **Eligible Population (Denominator):** Members aged 18-85 by Dec 31, 2026, with at least one outpatient encounter for hypertension (ICD-10 code I10) between January 1 and June 30, 2026, and continuous enrollment for the full year, allowing for no more than one gap of up to 45 days.
* **Numerator:** The most recent outpatient blood pressure (BP) reading on or after the qualifying hypertension encounter and on or before Dec 31, 2026, must be less than 140 systolic AND less than 90 diastolic. Emergency department (ED) and inpatient readings were explicitly excluded from this numerator assessment. If no qualifying reading was available, the member would be in the denominator but not the numerator (non-compliant).
* **Exclusions:** Members in the denominator could be excluded if they had ESRD (N18.6) or dialysis (Z99.2), were pregnant (O00-O9A), were on hospice or palliative care, or died during the measurement year. These exclusions are evaluated *before* the numerator assessment.
I then proceeded to evaluate each of the 16 members systematically:
1. **MEMBER 71041:**
* Age 85 on Dec 31, 2026 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on Feb 18, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: Feb 18, 2026 (150/72). Systolic 150 is not less than 140. **Non-compliant.**
2. **MEMBER 71042:**
* Age 86 on Dec 31, 2026. This exceeds the 85-year-old limit. **Not eligible.**
3. **MEMBER 71043:**
* Age 35 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on Feb 12, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: Oct 2, 2026 (136/103). Diastolic 103 is not less than 90. **Non-compliant.**
4. **MEMBER 71044:**
* Age 70 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on Apr 23, 2026 (Eligible).
* **Eligible for denominator.**
* However, had ESRD diagnosis (N18.6) on June 20, 2024, which is on or before Dec 31, 2026. This is **Exclusion E1**. **Excluded.**
5. **MEMBER 71045:**
* Age 44 (Eligible).
* Enrolled from April 5, 2026, through Dec 31, 2026. This means they were not enrolled from Jan 1 to Apr 4, creating a gap of 94 days. This exceeds the allowed maximum of 45 days for one gap. **Not eligible.**
6. **MEMBER 71046:**
* Age 35 (Eligible).
* Enrolled with a gap from April 27 to June 23, 2026. Calculating the days: April (30-27+1=4 days) + May (31 days) + June (23 days) = 58 days. This gap exceeds the allowed 45 days. **Not eligible.**
7. **MEMBER 71047:**
* Age 18 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on June 17, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: July 25, 2026 (137/73). Both systolic <140 and diastolic <90. **Compliant.**
8. **MEMBER 71048:**
* Age 35 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on May 15, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: May 15, 2026 (134/93). Diastolic 93 is not less than 90. **Non-compliant.**
9. **MEMBER 71049:**
* Age 61 (Eligible).
* Enrolled Jan 1-June 26 and July 30-Dec 31. The gap between June 27 and July 29 is 33 days (<=45 days, 1 gap). So, enrollment is valid.
* Hypertension encounter on Aug 25, 2026. This encounter falls *after* June 30, 2026. The qualifying event requires an encounter *on or between* Jan 1 and June 30, 2026. Since there's no encounter within this specific period, the member does not meet the event criteria. **Not eligible.**
10. **MEMBER 71050:**
* Age 84 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on June 23, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: Sept 8, 2026 (129/71). Both systolic <140 and diastolic <90. **Compliant.**
11. **MEMBER 71051:**
* Age 35 (Eligible).
* Had two enrollment gaps: April 9 to May 4 (26 days) and August 8 to August 21 (14 days). The measure states that two or more gaps of any length make a member ineligible. **Not eligible.** (Even though there was a hospice exclusion documented, the enrollment criteria failure takes precedence).
12. **MEMBER 71052:**
* Age 35 (Eligible).
* Enrolled with a gap from April 9 to May 23, 2026. Calculating days: April (30-9+1 = 22 days) + May (23 days) = 45 days. This is exactly the maximum allowed for one gap, so enrollment is valid.
* Hypertension encounter on April 8, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: July 13, 2026 (127/73). Both systolic <140 and diastolic <90. **Compliant.**
13. **MEMBER 71053:**
* Age 84 (Eligible).
* Enrolled Jan 1-May 15 and June 7-Dec 31. The gap from May 16 to June 6 is 22 days (<=45 days, 1 gap). Enrollment is valid.
* Hypertension encounter on May 22, 2026. Although the encounter is during a gap, the member also had an encounter on June 26, 2026, which falls within the required Jan 1 - June 30 period and the member was enrolled at that time. So the event criteria are met.
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the qualifying encounter period (using the June 26 encounter as the reference point for subsequent readings): June 26, 2026 (133/95). Diastolic 95 is not less than 90. **Non-compliant.**
14. **MEMBER 71054:**
* Age 84 (Eligible).
* Enrolled with a gap from May 7 to June 17, 2026. Calculating days: May (31-7+1 = 25 days) + June (17 days) = 42 days. This is within the allowed 45 days for one gap. Enrollment is valid.
* Hypertension encounter on March 21, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: Oct 28, 2026 (132/95). Diastolic 95 is not less than 90. **Non-compliant.**
15. **MEMBER 71055:**
* Age 86 on Dec 31, 2026. This exceeds the 85-year-old limit. **Not eligible.**
16. **MEMBER 71056:**
* Age 84 (Eligible).
* Continuous enrollment (Eligible).
* Hypertension encounter on Jan 19, 2026 (Eligible).
* **In denominator.**
* No documented exclusions.
* Most recent outpatient BP reading after the encounter: March 20, 2026 (153/86). Systolic 153 is not less than 140. **Non-compliant.**
Following this detailed review, I compiled the results:
* **Total Members Evaluated:** 16
* **Not Eligible Members (6):**
* 71042 (Age > 85)
* 71045 (Enrollment gap > 45 days)
* 71046 (Enrollment gap > 45 days)
* 71049 (No qualifying hypertension event in H1)
* 71051 (Two enrollment gaps)
* 71055 (Age > 85)
* **Excluded Members (1):**
* 71044 (ESRD)
* **Compliant Members (Numerator) (3):**
* 71047
* 71050
* 71052
* **Non-Compliant Members (Denominator, not Numerator) (6):**
* 71041
* 71043
* 71048
* 71053
* 71054
* 71056
The denominator consists of compliant and non-compliant members, totaling 3 + 6 = 9 members.
The numerator consists of the compliant members, totaling 3 members.
Therefore, the rate for the QM-CBP measure is calculated as (Numerator / Denominator) \* 100:
(3 / 9) \* 100 = 33.333...%
Rounding to one decimal place, the performance rate is **33.3%**. My process ensured adherence to each specific criterion for eligibility, exclusion, and numerator attainment, systematically working through the logic for each individual.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,439 tokens
**My Thought Process for Evaluating Blood Pressure Control Quality Measure (QM-CBP) for 16 Members**
Okay, my task is to evaluate 16 members against a specific quality measure for blood pressure control (QM-CBP) for the measurement year 2026. I need to determine who is compliant, non-compliant, excluded, or not eligible based on a set of detailed criteria, and then output this information in a JSON format. This requires a meticulous, step-by-step assessment of each individual.
First, I need to firmly grasp the core definitions:
* **Measurement Year:** 2026-01-01 to 2026-12-31. This is my timeframe for most conditions.
* **Eligible Population (Denominator):** To even be considered for the measure's numerator, a member must first meet the denominator criteria.
* **Age:** They must be between 18 and 85 years old, inclusive, as of the end of the measurement year (2026-12-31).
* **Qualifying Event:** They need at least one outpatient encounter with a hypertension diagnosis (ICD-10 code I10) that occurred specifically between January 1, 2026, and June 30, 2026. This is a critical window for establishing their hypertension diagnosis for the measure.
* **Continuous Enrollment:** They must have been continuously enrolled throughout the entire measurement year, with a very specific allowance for enrollment gaps: no more than one gap, and that gap cannot exceed 45 days. Two gaps of any length, or a single gap longer than 45 days, disqualifies them from eligibility.
* **Numerator:** If a member qualifies for the denominator, I then check if they meet the numerator criteria for *compliant* status.
* **BP Reading:** I need to find their most recent outpatient blood pressure reading. This reading must have occurred on or after their qualifying hypertension encounter date and on or before the end of the measurement year (2026-12-31).
* **Control Threshold:** Crucially, this most recent reading must show systolic pressure **less than 140 mmHg AND diastolic pressure less than 90 mmHg**.
* **Exclusion of Certain Readings:** When I'm searching for that "most recent outpatient reading," I must explicitly ignore any readings taken in an Emergency Department (ED) or during an inpatient admission. These do not count for the numerator.
* **Required Exclusions:** Even if a member meets the denominator criteria (age, event, enrollment), certain conditions will cause them to be marked as "excluded" rather than "compliant" or "non-compliant." These are checked *after* determining denominator eligibility.
* **E1: ESRD/Dialysis:** If they had End-Stage Renal Disease (N18.6) or were dependent on dialysis (Z99.2) at any point on or before 2026-12-31.
* **E2: Pregnancy:** If they were pregnant during the measurement year.
* **E3: Hospice/Palliative Care:** If they received hospice or palliative care during the measurement year.
* **E4: Death:** If they died during the measurement year.
It's important to remember the order: If a member fails any of the *eligibility* criteria (age, event, continuous enrollment), they are immediately classified as "not\_eligible" and I don't even proceed to check exclusions or numerator conditions for them. Exclusions only apply to those who *are* eligible for the denominator.
Now, let's systematically go through each of the 16 members:
**MEMBER 71041:**
* **Age:** 85 on 2026-12-31. Passes.
* **Enrollment:** Continuous, no gaps. Passes.
* **Event:** 2026-02-18 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, they are eligible for the denominator.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-02-18: 2026-02-18 Office visit BP 150/72; 2026-05-18 Inpatient BP 159/81.
* The inpatient reading is skipped. The most recent *outpatient* reading is 2026-02-18: 150/72.
* Systolic is 150, which is NOT < 140.
* **Status:** Non\_compliant.
**MEMBER 71042:**
* **Age:** 86 on 2026-12-31. Fails age criterion.
* **Status:** Not\_eligible. (No need to check further).
**MEMBER 71043:**
* **Age:** 35. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-02-12 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-02-12: 2026-02-12 (126/73), 2026-03-21 (135/73), 2026-05-22 (119/102), 2026-10-02 (136/103 Office visit).
* Most recent outpatient BP is 2026-10-02: 136/103.
* Diastolic is 103, which is NOT < 90.
* **Status:** Non\_compliant.
**MEMBER 71044:**
* **Age:** 70. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-04-23 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** N18.6 (ESRD) was documented on 2024-06-20. This falls under E1 exclusion criteria (on or before 2026-12-31).
* **Status:** Excluded.
**MEMBER 71045:**
* **Age:** 44. Passes.
* **Enrollment:** Not enrolled before 2026-04-05. This means there's a gap from January 1 to April 4, which is 94 days. This is > 45 days. Fails continuous enrollment.
* **Status:** Not\_eligible.
**MEMBER 71046:**
* **Age:** 35. Passes.
* **Enrollment:** One gap from 2026-04-27 to 2026-06-23. This gap is 58 days (4 in Apr + 31 in May + 23 in Jun). This is > 45 days. Fails continuous enrollment.
* **Status:** Not\_eligible.
**MEMBER 71047:**
* **Age:** 18. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-06-17 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-06-17: 2026-06-17 (138/76), 2026-07-25 (137/73), 2026-11-21 (Inpatient).
* The inpatient reading is skipped. The most recent outpatient BP is 2026-07-25: 137/73.
* Systolic < 140 (137) AND Diastolic < 90 (73). Both conditions pass.
* **Status:** Compliant.
**MEMBER 71048:**
* **Age:** 35. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-05-15 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Most recent outpatient BP on or after 2026-05-15: 2026-05-15 (134/93 Office visit).
* Diastolic is 93, which is NOT < 90.
* **Status:** Non\_compliant.
**MEMBER 71049:**
* **Age:** 61. Passes.
* **Enrollment:** Has one gap of 33 days. Passes.
* **Event:** Their first I10 diagnosis is on 2026-08-25. This is *after* the required window of 2026-01-01 to 2026-06-30. They do not have a qualifying event.
* **Status:** Not\_eligible.
**MEMBER 71050:**
* **Age:** 84. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-06-23 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-06-23: 2026-06-23 (122/84), 2026-09-08 (129/71 Office visit).
* Most recent outpatient BP is 2026-09-08: 129/71.
* Systolic < 140 (129) AND Diastolic < 90 (71). Both pass.
* **Status:** Compliant.
**MEMBER 71051:**
* **Age:** 35. Passes.
* **Enrollment:** Has two gaps: one of 26 days and another of 14 days. Fails continuous enrollment (more than one gap).
* **Status:** Not\_eligible. (Even though they also have hospice, the 'not\_eligible' status takes precedence).
**MEMBER 71052:**
* **Age:** 35. Passes.
* **Enrollment:** One gap of exactly 45 days (April 9 to May 23). This is allowed ("up to 45 days"). Passes.
* **Event:** 2026-04-08 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-04-08: 2026-04-08 (121/76), 2026-06-04 (149/73), 2026-07-13 (127/73 Office visit), 2026-07-16 (ED).
* The ED reading is skipped. The most recent outpatient BP is 2026-07-13: 127/73.
* Systolic < 140 (127) AND Diastolic < 90 (73). Both pass.
* **Status:** Compliant.
**MEMBER 71053:**
* **Age:** 84. Passes.
* **Enrollment:** One gap of 22 days. Passes.
* **Event:** Has an event on 2026-05-22 (I10). Also has an event on 2026-06-26 (I10, Office visit), which also falls within the qualifying window. So, eligible.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after the *earliest* qualifying event (2026-05-22): 2026-05-22 (146/72), 2026-06-26 (133/95 Office visit), 2026-08-24 (Inpatient).
* The inpatient reading is skipped. The most recent outpatient BP is 2026-06-26: 133/95.
* Diastolic is 95, which is NOT < 90.
* **Status:** Non\_compliant.
**MEMBER 71054:**
* **Age:** 84. Passes.
* **Enrollment:** One gap of 42 days (May 7 to June 17). This is allowed (<= 45 days). Passes.
* **Event:** 2026-03-21 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-03-21: 2026-03-21 (137/92), 2026-05-06 (138/85), 2026-06-05 (Inpatient), 2026-10-28 (132/95 Office visit).
* The inpatient reading is skipped. The most recent outpatient BP is 2026-10-28: 132/95.
* Diastolic is 95, which is NOT < 90.
* **Status:** Non\_compliant.
**MEMBER 71055:**
* **Age:** 86 on 2026-12-31. Fails age criterion.
* **Status:** Not\_eligible.
**MEMBER 71056:**
* **Age:** 84. Passes.
* **Enrollment:** Continuous. Passes.
* **Event:** 2026-01-19 Office visit with I10 dx. Passes.
* **Eligibility:** Yes, eligible.
* **Exclusions:** None noted.
* **Numerator Check:**
* Readings on or after 2026-01-19: 2026-01-19 (125/88), 2026-03-20 (153/86 Office visit).
* Most recent outpatient BP is 2026-03-20: 153/86.
* Systolic is 153, which is NOT < 140.
* **Status:** Non\_compliant.
**Final Tally and Rate Calculation:**
After going through each member individually, I can now compile the totals:
* **Compliant Members:** 71047, 71050, 71052 (3 members)
* **Non-Compliant Members:** 71041, 71043, 71048, 71053, 71054, 71056 (6 members)
* **Excluded Members:** 71044 (1 member)
* **Not Eligible Members:** 71042, 71045, 71046, 71049, 71051, 71055 (6 members)
Total members = 3 + 6 + 1 + 6 = 16. This confirms I've accounted for everyone.
Now, to calculate the rate:
* **Denominator:** This is the total number of eligible members who either met the numerator criteria (compliant) or did not (non-compliant). So, Denominator = Compliant + Non-Compliant = 3 + 6 = 9 members.
* **Numerator:** This is the number of compliant members. Numerator = 3 members.
* **Excluded:** 1 member.
* **Not Eligible:** 6 members.
The quality measure rate is calculated as (Numerator / Denominator) * 100.
Rate = (3 / 9) * 100 = 33.333...%, which rounds to **33.3%**.
And finally, I'll format this into the required JSON structure. This whole process ensures that each member is assessed against the precise rules, and the final output reflects a clear, data-driven evaluation.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Opus 5 · Anthropic18.4s · 1,292 out | 16.1s · 1,320 out | 16.3s · 1,273 out
Reasoning · 1,117 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,145 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
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{
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"present": true
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{
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{
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{
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"ok": true,
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"fabricated": false,
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}Reasoning · 1,098 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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"want": 9,
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{
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}100Gemini 3 Flash · Google80.1s · 13,244 out | 81.1s · 13,519 out | 31.3s · 5,310 out
Reasoning · 12,999 tokens
**Understanding the Blood Pressure Control Measure (QM-CBP) for 2026**
Okay, let's break down how I'm approaching this Blood Pressure Control in Hypertension measure for the 2026 measurement year. My goal is to determine patient eligibility, identify those meeting the criteria for compliance, and ultimately calculate the performance rate.
First, I'm establishing the core parameters of the measure:
* **Measure:** Blood Pressure Control in Hypertension (QM-CBP)
* **Measurement Period:** January 1, 2026, through December 31, 2026.
Next, I'm defining the **Denominator**, which represents the eligible population. To be included, a patient must meet these criteria by December 31, 2026:
* **Age:** Be between 18 and 85 years old.
* **Hypertension Event:** Have at least one outpatient encounter with a hypertension diagnosis (ICD-10 code I10) between January 1, 2026, and June 30, 2026. This is the qualifying event that brings them into the measure.
* **Continuous Enrollment:** Be continuously enrolled for the entire measurement year, with a maximum of one gap in enrollment lasting no more than 45 days. Two or more gaps, or a single gap exceeding 45 days, disqualifies them from the denominator.
Then, I'm defining the **Numerator**. To be considered compliant, a patient in the denominator must have their most recent outpatient blood pressure reading (taken on or after their qualifying hypertension encounter and on or before December 31, 2026) meet *both* of these conditions:
* Systolic blood pressure is *less than* 140 mmHg.
* Diastolic blood pressure is *less than* 90 mmHg.
Crucially, I'm told to *exclude* blood pressure readings taken in the Emergency Department (ED) or during inpatient stays.
Finally, I have a list of **Exclusions** that remove a patient from the denominator *even if they meet all other criteria*:
* **E1:** End-Stage Renal Disease (ESRD) diagnosis (N18.6) or dialysis (Z99.2) at any point on or before December 31, 2026.
* **E2:** Pregnancy (ICD-10 codes O00-O9A) during 2026.
* **E3:** Enrollment in hospice or palliative care during 2026.
* **E4:** Death during 2026.
Now, I'm applying these rules to individual members:
* **MEMBER 71041:** This individual is 85, continuously enrolled, and had an I10 encounter on February 18, 2026. No exclusions apply. Their most recent outpatient BP reading after the qualifying encounter was on February 18, 2026, at 150/72. Since 150 is not less than 140, they are **non-compliant**.
* **MEMBER 71042:** This person is 86 years old on December 31, 2026, so they are **not eligible** due to age.
* **MEMBER 71043:** This individual is 35, continuously enrolled, and had an I10 encounter on February 12, 2026. No exclusions apply. Their most recent outpatient BP reading was on October 2, 2026, at 136/103. Since 103 is not less than 90, they are **non-compliant**.
* **MEMBER 71044:** This individual is 70, continuously enrolled, and had an I10 encounter on April 23, 2026. However, they have an ESRD diagnosis (N18.6) from 2024. This triggers exclusion **E1**, so they are **excluded**.
* **MEMBER 71045:** This person's enrollment only started on April 5, 2026. They were not continuously enrolled for the full measurement year, so they are **not eligible**.
* **MEMBER 71046:** This individual had an enrollment gap from April 26 to June 24, totaling 58 days. This exceeds the maximum allowed 45-day gap, making them **not eligible**.
* **MEMBER 71047:** This individual is 18, continuously enrolled, and had an I10 encounter on June 17, 2026. No exclusions apply. Their most recent outpatient BP reading was on July 25, 2026, at 137/73. Both 137 < 140 and 73 < 90, so they are **compliant**.
* **MEMBER 71048:** This individual is 35, continuously enrolled, and had an I10 encounter on May 15, 2026. No exclusions apply. Their most recent outpatient BP reading was on May 15, 2026, at 134/93. Since 93 is not less than 90, they are **non-compliant**.
* **MEMBER 71049:** This member had continuous enrollment with a single gap of 33 days, which is acceptable. However, their first outpatient I10 encounter was on August 25, 2026. This is *after* the required date range of January 1, 2026, to June 30, 2026, for the qualifying hypertension event. Therefore, they do not meet the event criteria and are **not eligible**.
* **MEMBER 71050:** This individual is 84, continuously enrolled, and had an I10 encounter on June 23, 2026. No exclusions apply. Their most recent outpatient BP reading was on September 8, 2026, at 129/71. Both 129 < 140 and 71 < 90, so they are **compliant**.
* **MEMBER 71051:** This person has two separate enrollment gaps (26 days and 14 days). The measure specifies "no more than one gap." Therefore, they are **not eligible**. (Even if they had hospice care, the enrollment issue takes precedence for eligibility).
* **MEMBER 71052:** This individual is 35, enrolled with one gap of 45 days (which is acceptable), and had an I10 encounter on April 8, 2026. No exclusions apply. Their most recent outpatient BP reading was on July 13, 2026, at 127/73. Both 127 < 140 and 73 < 90, so they are **compliant**.
* **MEMBER 71053:** This individual is 84, enrolled with one gap of 22 days (acceptable), and had an I10 encounter on May 22, 2026. No exclusions apply. Their most recent outpatient BP reading was on June 26, 2026, at 133/95. Since 95 is not less than 90, they are **non-compliant**.
* **MEMBER 71054:** This individual is 84, enrolled with one gap of 42 days (acceptable), and had an I10 encounter on March 21, 2026. No exclusions apply. Their most recent outpatient BP reading was on October 28, 2026, at 132/95. Since 95 is not less than 90, they are **non-compliant**.
* **MEMBER 71055:** This person is 86 years old on December 31, 2026, making them **not eligible** due to age.
* **MEMBER 71056:** This individual is 84, continuously enrolled, and had an I10 encounter on January 19, 2026. No exclusions apply. Their most recent outpatient BP reading was on March 20, 2026, at 153/86. Since 153 is not less than 140, they are **non-compliant**.
Based on this analysis:
* **Eligible Population (Denominator Pool):** I identified 10 members who met the age, event, and enrollment criteria: 71041, 71043, 71044, 71047, 71048, 71050, 71052, 71053, 71054, and 71056.
* **Exclusions:** Member 71044 was excluded due to ESRD.
* **Final Denominator:** This leaves 9 members (10 eligible - 1 excluded).
* **Numerator (Compliant Patients):** I found 3 members who met the numerator criteria: 71047, 71050, and 71052.
* **Non-Compliant Patients:** There are 6 members who met the denominator criteria but not the numerator: 71041, 71043, 71048, 71053, 71054, and 71056.
* **Not Eligible Patients:** There are 6 members who did not meet the initial denominator criteria: 71042, 71045, 71046, 71049, 71051, and 71055.
Therefore, the calculated rate for Blood Pressure Control in Hypertension for this cohort is **33.3%** (3 compliant / 9 in the denominator).
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
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],
"non_compliant_members": [
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"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
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{
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}Reasoning · 13,275 tokens
### My Thought Process for Member Eligibility and Compliance
As I sifted through the data to determine member compliance with the hypertension measure for the 2026 measurement year, my primary focus was on systematically applying the defined criteria for each individual.
First, I established the baseline criteria:
* **Measurement Year:** January 1, 2026, to December 31, 2026.
* **Age:** Members had to be between 18 and 85 years old inclusive, as of December 31, 2026. This meant I needed to cross-reference birth dates with the end of the measurement year. For example, Member 71041, born in July 1941, turned 85 in 2026 and was within the age range. Conversely, Member 71042, born in June 1940, turned 86 in 2026, thus failing the age criterion and being marked as `not_eligible`.
* **Qualifying Event:** A member needed at least one outpatient encounter with an **I10 (Hypertension) diagnosis** between January 1, 2026, and June 30, 2026. This first trigger was crucial. For Member 71049, I meticulously checked their encounters; unfortunately, their first I10 diagnosis occurred on August 25, 2026, which fell outside this initial qualifying window, leading to their `not_eligible` status.
* **Continuous Enrollment:** The member had to be continuously enrolled for the entire measurement year, with the allowance of **no more than one gap of up to 45 days**. This rule required careful examination of enrollment dates. For Member 71046, I identified a gap from April 27th to June 23rd, which totaled 58 days. Since this exceeded the 45-day limit, they were `not_eligible`. Similarly, Member 71051 had two distinct gaps in their enrollment (one of 26 days and another of 14 days). As the rule specifies "two or more gaps of *any* length," this immediately disqualified them as `not_eligible`, even before considering other potential exclusions. Member 71052, on the other hand, had a gap of exactly 45 days, which was permissible, allowing me to proceed with further evaluation.
* **Exclusions:** Several specific conditions would lead to a member being `excluded` from the denominator, even if they met the initial eligibility criteria. These included:
* **E1: ESRD (N18.6) or dialysis (Z99.2)** on or before December 31, 2026. Member 71044, with an ESRD diagnosis in 2024, met this exclusion criterion.
* **E2: Pregnancy** during the measurement year.
* **E3: Hospice or Palliative Care** during the measurement year.
* **E4: Death** during the measurement year.
It was important to note that exclusions only applied to members who were otherwise eligible. If a member was already `not_eligible` due to age, event, or enrollment, any exclusion documentation wouldn't change their status; they would remain `not_eligible`.
Once a member passed these initial eligibility and exclusion checks, I moved to the **Numerator criteria**:
* **Blood Pressure Reading:** I needed to find the **most recent outpatient blood pressure reading** (excluding ED and inpatient readings).
* **Timing of Reading:** This reading had to be taken **on or after the date of the qualifying hypertension encounter** (the first I10 diagnosis between Jan-Jun) and **on or before December 31, 2026**.
* **Compliance Threshold:** The reading had to be **less than 140 systolic AND less than 90 diastolic**. Both conditions needed to be met.
Let me walk through a few examples of how I applied these numerator rules:
* **Member 71041:** They were eligible. Their qualifying I10 encounter was on February 18, 2026. The most recent *outpatient* BP reading on or after that date was also on February 18, 2026, recorded as 150/72. Since 150 is not less than 140, they were `non_compliant`.
* **Member 71047:** Eligible. Their qualifying I10 encounter was June 17, 2026. They had subsequent outpatient readings, with the most recent being 137/73 on July 25, 2026. Both 137 (systolic) and 73 (diastolic) are below the thresholds (<140 and <90), thus they were `compliant`.
* **Member 71043:** Eligible. They had qualifying I10 encounters on February 12 and March 21, 2026. The most recent outpatient BP reading overall was on October 2, 2026, at 136/103. While 136 is less than 140, 103 is not less than 90. This failure in the diastolic reading made them `non_compliant`.
* **Member 71048:** Eligible. Their qualifying I10 encounter was May 15, 2026, with a BP reading of 134/93. This was their most recent outpatient reading. Since 93 is not less than 90, they were `non_compliant`.
* **Member 71050:** Eligible. Their qualifying I10 encounter was June 23, 2026. The most recent outpatient BP reading was 129/71 on September 8, 2026. Both values were below the targets (<140 and <90), making them `compliant`.
* **Member 71052:** Eligible and had a permissible enrollment gap. Their qualifying I10 encounter was April 8, 2026. They had several subsequent outpatient readings, the most recent being 127/73 on July 13, 2026. Both 127 and 73 were below the required thresholds, so they were `compliant`.
* **Member 71053:** Eligible. They had qualifying I10 encounters on May 22 and June 26. The most recent outpatient BP reading was 133/95 on June 26. As 95 is not less than 90, they were `non_compliant`.
* **Member 71054:** Eligible. Their qualifying I10 encounter was March 21, 2026. The most recent outpatient BP reading was 132/95 on October 28, 2026. The diastolic reading of 95 failed the <90 criterion, making them `non_compliant`.
* **Member 71056:** Eligible. Their qualifying I10 encounter was January 19, 2026. The most recent outpatient BP reading was 153/86 on March 20, 2026. The systolic reading of 153 failed the <140 criterion, making them `non_compliant`.
After this detailed assessment of all 16 members, I compiled the results:
* **Compliant Members (Numerator):** 3 (71047, 71050, 71052)
* **Non-Compliant Members:** 6 (71041, 71043, 71048, 71053, 71054, 71056)
* **Excluded Members:** 1 (71044)
* **Not Eligible Members:** 6 (71042, 71045, 71046, 71049, 71051, 71055)
The **denominator** for the measure includes all members who are compliant and non-compliant, totaling 3 + 6 = 9 members.
The **numerator** is the count of compliant members, which is 3.
Therefore, the **rate** for this cohort is calculated as (Numerator / Denominator) * 100, which is (3 / 9) * 100 = **33.3%**.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
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"want": [
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{
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"want": [
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],
"fabricated": false,
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}Reasoning · 5,065 tokens
**My Thought Process for Evaluating the QM-CBP Measure**
I've just been going through the specifics of the QM-CBP measure for Blood Pressure Control in Hypertension, aiming to understand how to assess compliance for individual members. The measurement year is clear: January 1, 2026, through December 31, 2026.
My first step in assessing any patient is to determine if they fall into the eligible population. This involves a few key criteria:
* **Age:** They need to be between 18 and 85 years old by the end of the measurement year (December 31, 2026).
* **Qualifying Event:** They must have had at least one outpatient encounter where hypertension (diagnosis code I10) was recorded between January 1, 2026, and June 30, 2026. This is crucial – it's the trigger for them to be considered for this measure.
* **Continuous Enrollment:** They need to have been continuously enrolled for the entire measurement year. I'm allowing for a single, short gap of no more than 45 days, but anything more than that or multiple gaps makes them ineligible.
Once a member meets these denominator criteria, I then need to assess if they achieved the numerator, which means their blood pressure was controlled. This requires looking at their *most recent outpatient blood pressure reading* taken on or after their qualifying hypertension encounter and on or before December 31, 2026. The target is a reading *below* 140 systolic AND *below* 90 diastolic. I need to be careful to exclude any BP readings taken during an Emergency Department (ED) visit or an Inpatient (IP) admission. If they meet the denominator criteria but don't have a qualifying BP reading, they are still considered denominator-compliant but numerator-non-compliant.
There are also specific exclusions I need to apply:
* **E1:** End-Stage Renal Disease (ESRD) (N18.6) or dialysis (Z99.2) on or before December 31, 2026.
* **E2:** Pregnancy (codes O00-O9A) at any point during 2026.
* **E3:** Receiving hospice or palliative care during 2026.
* **E4:** Death occurring during 2026.
Now, let's walk through how I applied these rules to the provided examples:
* **Member 71041:** This individual was 85, had a qualifying office visit on February 18, 2026, and was continuously enrolled. Their most recent outpatient BP reading was from that same qualifying event: 150/72. Since 150 is not less than 140, they are **Non-compliant**. I double-checked – the inpatient BP reading later in the year was correctly ignored as it wasn't the *most recent outpatient* reading after the qualifying event.
* **Member 71042:** This person was 86 years old on December 31, 2026. The maximum age for eligibility is 85, so they are **Not eligible**.
* **Member 71043:** This member, age 35, had a qualifying office visit on February 12, 2026, and was continuously enrolled. Their most recent outpatient BP reading was 136/103 on October 2, 2026. While 136 is < 140, 103 is not < 90. Thus, they are **Non-compliant**.
* **Member 71044:** This 70-year-old had a qualifying event and was continuously enrolled. However, they had a history of ESRD (N18.6) in 2024. This falls under Exclusion E1, making them **Excluded** from the measure.
* **Member 71045:** At 44 years old, they meet the age criteria. However, their enrolment only started on April 5, 2026. The rule requires *full* measurement year enrolment (or a specific gap), so starting mid-year means they are **Not eligible**.
* **Member 71046:** This 35-year-old had a qualifying event and meets age and initial enrolment criteria. However, their enrolment had a gap of 58 days, which exceeds the maximum allowed 45-day gap. Therefore, they are **Not eligible**.
* **Member 71047:** This 18-year-old was eligible by age, had a qualifying event on June 17, 2026, and was continuously enrolled. Their most recent outpatient BP reading was 137/73 on July 25, 2026. Both 137 < 140 and 73 < 90. This member is **Compliant**. I correctly ignored the inpatient BP reading.
* **Member 71048:** This 35-year-old met age, enrolment, and qualifying event criteria. Their most recent outpatient BP reading was 134/93 on May 15, 2026. While 134 is < 140, 93 is not < 90. This makes them **Non-compliant**.
* **Member 71049:** At 61, this individual meets the age criteria. However, I found no outpatient encounters with a diagnosis of hypertension (I10) between January 1 and June 30, 2026. Their first relevant encounters (August 25 and December 25) were after the qualifying period. Therefore, they are **Not eligible**.
* **Member 71050:** This 84-year-old was eligible, had a qualifying event on April 23, 2026, and was continuously enrolled. Their most recent outpatient BP reading was 129/71 on September 8, 2026. Both 129 < 140 and 71 < 90. This member is **Compliant**.
* **Member 71051:** This 35-year-old had a qualifying event. While they met age and initial enrolment criteria, their enrolment record showed two separate gaps (26 days and 14 days). The rule allows for *at most one* gap of up to 45 days. Having two gaps disqualifies them, so they are **Not eligible**. I noted they also had a hospice exclusion, which would have made them excluded anyway, but the enrolment issue is the primary reason for ineligibility.
* **Member 71052:** This 44-year-old was eligible by age and had a qualifying event on April 8, 2026. Their enrolment had a single gap of 45 days, which is precisely the maximum allowed. Their most recent outpatient BP reading was 127/73 on July 13, 2026. Both 127 < 140 and 73 < 90. This member is **Compliant**. I correctly excluded the ED visit BP.
* **Member 71053:** This 84-year-old met age, enrolment (a 22-day gap is fine), and qualifying event criteria. Their most recent outpatient BP reading was 133/95 on June 26, 2026. While 133 is < 140, 95 is not < 90. Therefore, they are **Non-compliant**.
* **Member 71054:** This 84-year-old also met age, enrolment (a 42-day gap is fine), and qualifying event criteria. Their most recent outpatient BP reading was 132/95 on October 28, 2026. Although 132 is < 140, 95 is not < 90. This makes them **Non-compliant**. I confirmed the earlier office visit BP was correctly disregarded as it wasn't the most recent.
* **Member 71055:** Like 71042, this individual was 86 years old on December 31, 2026, making them **Not eligible** due to age.
* **Member 71056:** This 84-year-old was eligible by age, had a qualifying event on January 19, 2026, and was continuously enrolled. Their most recent outpatient BP reading was 153/86 on March 20, 2026. Since 153 is not < 140, they are **Non-compliant**.
After going through each member, I consolidated the results:
* **Compliant Members (Numerator):** 71047, 71050, 71052 (Total: 3)
* **Non-Compliant Members:** 71041, 71043, 71048, 71053, 71054, 71056 (Total: 6)
* **Denominator:** Compliant + Non-Compliant = 3 + 6 = 9 members.
* **Excluded Members:** 71044 (Total: 1)
* **Not Eligible Members:** 71042, 71045, 71046, 71049, 71051, 71055 (Total: 6)
* **Total Members on Roster:** 9 (Denominator) + 1 (Excluded) + 6 (Not Eligible) = 16 members. This matches the count of individuals I processed.
Finally, I calculated the performance rate:
* Numerator: 3
* Denominator: 9
* Rate: (3 / 9) * 100 = 33.333...%
* **Rounded Rate:** 33.3%
I then performed a self-correction and double-check on a few edge cases and specific readings to ensure my interpretation of the rules, especially regarding the "most recent outpatient BP" and the gap durations, was accurate. For example, I re-verified the age cutoffs and the exact wording of the enrolment gap rule. My re-checks confirmed the initial classifications and the final rate calculation.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K3 · Moonshot52.3s · 1,864 out | 67.1s · 3,610 out | 108.9s · 3,467 out
Reasoning · 1,741 tokens
Let me work through each member carefully against the measure specification.
Measure QM-CBP: Blood Pressure Control in Hypertension. Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
- Age 18–85 as of 2026-12-31.
- Event: outpatient encounter with I10 between 2026-01-01 and 2026-06-30.
- Continuous enrolment: full MY, at most one gap up to 45 days. Gap >45 days, or 2+ gaps of any length → removes.
Exclusions (only if eligible):
- E1: N18.6 or Z99.2 on or before 2026-12-31.
- E2: Pregnancy O00–O9A during MY.
- E3: Hospice/palliative during MY.
- E4: Death during MY.
Numerator: most recent outpatient BP reading taken on/after the qualifying I10 encounter date and on/before 2026-12-31 is <140 systolic AND <90 diastolic. ED or inpatient readings skipped. If no qualifying reading, in denominator, not numerator.
Go member by member:
**71041**: Age 85 (eligible). Enrolled continuous, no gaps. Encounters: 2026-02-18 office I10 (qualifying). BP readings: 150/72 (office, 02-18) → ≥140 systolic, not compliant. Inpatient 05-18 BP 159/81 skipped (inpatient). Most recent outpatient reading = 150/72 → non_compliant. Denominator.
**71042**: Age 86 → not_eligible (age fails). Also enrolment has two gaps (15 and 12 days) → two gaps removes. Either way, not eligible. not_eligible.
**71043**: Age 35. Continuous. I10 encounters 02-12, 03-21 (qualifying). Readings after qualifying date: 03-21 135/73 (office), 05-22 119/102 (office, diastolic ≥90), 10-02 136/103 (diastolic ≥90). Most recent outpatient reading = 10-02 136/103: diastolic 103 ≥90 → not compliant. non_compliant.
**71044**: Age 70. Continuous. I10 encounter 04-23 (qualifying). N18.6 from 2024-06-20 → on or before 2026-12-31 → E1 exclusion. excluded.
**71045**: Age 44. Enrolled only 04-05 through 12-31 → not full MY → not_eligible (enrolment fails). Event 05-23 I10 exists but enrolment fails. not_eligible.
**71046**: Age 35. One gap 58 days (>45) → not_eligible. Even though I10 events. not_eligible.
**71047**: Age 18 (eligible, 18 through 85). Continuous. I10 encounters: 06-17 (qualifying, within first half). 07-25 I10 (also outpatient). Readings after qualifying date (06-17): 06-17 138/76, 07-25 137/73, 11-21 inpatient 118/88 (skipped). Most recent outpatient reading = 07-25 137/73 → <140 and <90 → compliant.
**71048**: Age 35. Continuous. I10 05-15 (qualifying). Reading 134/93: diastolic 93 ≥90 → non_compliant.
**71049**: Age 61. One gap 33 days (≤45, one gap) → eligible. I10 encounters: 08-25 (qualifying? it's after 06-30... wait, qualifying event must be between 01-01 and 06-30). 08-25 is after 06-30. 12-25 also after 06-30. No I10 encounter on or before 06-30 → event fails → not_eligible. The ED visit 11-28 R07.9 doesn't count. So 71049 is not_eligible.
**71050**: Age 84. Continuous. I10 06-23 (qualifying). Readings after: 06-23 122/84, 09-08 J06.9 129/71 (office). Most recent outpatient = 09-08 129/71 → compliant.
**71051**: Age 35. Enrolment: two gaps (26 and 14 days) → two gaps removes → not_eigible? Wait — exclusions evaluated only for members in eligible population. Enrolment fails (two gaps), so not_eligible even though hospice documented. Yes: not_eligible.
**71052**: Age 35. One gap 45 days (allowed: "up to 45 days"). Eligible. I10 encounters: 04-08 (qualifying). Readings after 04-08: 04-08 121/76, 06-04 149/73, 07-13 127/73, 07-16 ED 119/89 (skipped). Most recent outpatient = 07-13 127/73 → compliant.
**71053**: Age 84. One gap 22 days → eligible. I10 05-22 (qualifying). Readings after: 05-22 146/72, 06-26 133/95, 08-24 inpatient 112/84 (skipped). Most recent outpatient = 06-26 133/95: diastolic 95 ≥90 → non_compliant.
**71054**: Age 84. One gap 42 days → eligible. I10 encounters 03-21, 05-06 (qualifying). Readings after 03-21 (or after 05-06? The qualifying encounter date — the most recent qualifying I10 encounter? Let me consider. Numerator: most recent outpatient BP taken on or after the date of the qualifying hypertension encounter. Multiple qualifying encounters exist; the reading just needs to be on/after a qualifying encounter date. Most recent outpatient reading overall after 03-21: 10-28 E78.5 132/95 (office). Inpatient 06-05 skipped. So most recent outpatient = 10-28 132/95 → diastolic 95 ≥90 → non_compliant.
**71055**: Age 86 → not_eligible.
**71056**: Age 84. Continuous. I10 encounters 01-19, 03-20 (qualifying). Readings: 01-19 125/88, 03-20 153/86. Most recent outpatient = 03-20 153/86 → systolic ≥140 → non_compliant.
Tally:
- Compliant: 71047, 71050, 71052 → 3
- Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
- Excluded: 71044 → 1
- Not eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Denominator = 3 + 6 = 9. Numerator = 3. Rate = 3/9 × 100 = 33.333... → 33.3.
Double-check 71049: encounters are 08-25 I10, 11-28 ED R07.9, 12-25 I10. All I10 encounters after 06-30 → no qualifying event → not eligible. Correct.
Double-check 71051: two gaps 26 and 14 days → two gaps of any length removes → not eligible. Hospice is irrelevant since enrolment fails first. Correct.
Double-check 71042: age 86 fails; also two gaps. Not eligible. 71055: age 86. Not eligible.
Rate: 3/9 = 0.3333 → 33.3.
JSON output.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,766 tokens
Let me work through each member carefully.
Measure QM-CBP: Blood Pressure Control in Hypertension.
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION:
- Age 18 through 85 as of 2026-12-31.
- At least one outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30.
- Continuous enrolment: full measurement year, no more than one gap of up to 45 days. A gap >45 days, or two or more gaps of any length, removes from denominator.
NUMERATOR: most recent outpatient BP reading on or after the qualifying HTN encounter date and on or before 2026-12-31 is <140 systolic AND <90 diastolic. ED or inpatient readings don't count and are skipped. If no qualifying reading, member is in denominator, not numerator.
EXCLUSIONS (before numerator, only for eligible population):
E1: ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31.
E2: Pregnancy during MY.
E3: Hospice or palliative care during MY.
E4: Died during MY.
Note the exclusions are only evaluated for members who are in the eligible population. A member who fails age/event/enrolment is not_eligible even if exclusion documented.
Let me go member by member.
MEMBER 71041: DOB 1941-07-25, 85 on 2026-12-31. Age OK (85 included, "18 through 85").
Enrolment: full year, no gaps. OK.
Event: 2026-02-18 office visit I10. Qualifying encounter (outpatient, in window Jan1–Jun30). OK.
Exclusions: none (no N18.6, no pregnancy, no hospice, alive). Not excluded.
Numerator: readings on/after 2026-02-18, outpatient: 2026-02-18 BP 150/72. 2026-05-18 is inpatient (R07.9) — skipped. Most recent qualifying outpatient reading: 2026-02-18 150/72. Systolic 150 ≥140, not controlled. Non-compliant.
→ non_compliant.
MEMBER 71042: DOB 1940-06-12, 86 on 2026-12-31. Age 86 > 85 → not eligible.
Also enrolment has two gaps (15 and 12 days) → also fails enrolment. Also, encounters: 2026-04-05 I10 — but wait, enrolment gap 2026-03-27 to 2026-04-12, so 2026-04-05 visit during gap? Doesn't matter. Not eligible due to age (and enrolment). → not_eligible.
MEMBER 71043: 35, female. Enrolment full year. Event: 2026-02-12 I10 outpatient. Eligible.
Exclusions: none.
Numerator: outpatient readings on/after 2026-02-12: 2026-02-12 126/73; 2026-03-21 135/73; 2026-05-22 119/102; 2026-10-02 136/103. Most recent = 2026-10-02 136/103. Systolic 136 <140 yes; diastolic 103 ≥90 no. Not controlled → non_compliant.
MEMBER 71044: 70, male. Enrolment full. Event: 2026-04-23 I10. Eligible.
Exclusions: N18.6 diagnosed 2024-06-20 — "any time on or before 2026-12-31" → E1 applies. Excluded.
→ excluded.
MEMBER 71045: 44, female. Enrolment: 2026-04-05 through 2026-12-31; not enrolled before. Not enrolled full measurement year — gap from 2026-01-01 to 2026-04-05 is more than 45 days (and it's not a "gap" so much as late enrolment, but the requirement is enrolled for the full measurement year with no more than one gap up to 45 days). Not enrolled Jan 1 – Apr 4 = ~94 days > 45. → not_eligible.
Event 2026-05-23 I10 would qualify but enrolment fails. → not_eligible.
MEMBER 71046: 35, male. Enrolment: 2026-01-01–2026-04-26; 2026-06-24–2026-12-31. One gap of 58 days > 45 → not_eligible.
(Encounters include I10 but enrolment fails.) → not_eligible.
MEMBER 71047: 18, male. Enrolment full. Event: 2026-06-17 I10 (within Jan1–Jun30). Eligible.
Exclusions: none.
Numerator: outpatient readings on/after 2026-06-17: 2026-06-17 138/76; 2026-07-25 137/73; 2026-11-21 inpatient — skipped. Most recent qualifying = 2026-07-25 137/73. Both below thresholds → compliant.
MEMBER 71048: 35, female. Enrolment full. Event: 2026-05-15 I10. Eligible.
Numerator: readings on/after 2026-05-15: 2026-05-15 134/93. Systolic OK, diastolic 93 ≥90 → not controlled → non_compliant.
MEMBER 71049: 61, male. Enrolment: 2026-01-01–2026-06-26; 2026-07-30–2026-12-31. One gap 33 days ≤45 → OK.
Event: needs outpatient I10 on/between 2026-01-01 and 2026-06-30. Encounters: 2026-08-25 I10 (after Jun 30 — doesn't establish event); 2026-11-28 ED R07.9; 2026-12-25 I10 (after Jun 30). No I10 encounter in window → not eligible (no qualifying event). → not_eligible.
Wait — check: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." 71049's first I10 is 2026-08-25. So not eligible. → not_eligible.
MEMBER 71050: 84, male. Enrolment full. Event: 2026-06-23 I10 (in window). Eligible.
Numerator: readings on/after 2026-06-23: 2026-06-23 122/84; 2026-09-08 129/71. Most recent 2026-09-08 129/71 → controlled → compliant.
MEMBER 71051: 35, female. Enrolment: three segments, gaps of 26 and 14 days → two gaps → fails continuous enrolment → not_eligible. Also hospice 2026-10-27 (E3), but exclusions only apply to eligible population; enrolment fails first → not_eligible.
→ not_eligible.
MEMBER 71052: 35, male. Enrolment: 2026-01-01–2026-04-08; 2026-05-24–2026-12-31. One gap of 45 days — "up to 45 days" allowed → OK (45 ≤ 45).
Event: 2026-04-08 I10 (in window, outpatient). Eligible.
Numerator: outpatient readings on/after 2026-04-08: 2026-04-08 121/76; 2026-06-04 149/73; 2026-07-13 127/73; 2026-07-16 ED — skipped. Most recent qualifying = 2026-07-13 127/73 → controlled → compliant.
MEMBER 71053: 84, female. Enrolment: 2026-01-01–2026-05-15; 2026-06-07–2026-12-31. One gap 22 days → OK.
Event: 2026-05-22 I10 — wait, enrolment gap is 2026-05-15 to 2026-06-07; the encounter 2026-05-22 falls during the gap. Hmm. Does the encounter need to occur while enrolled? The spec says "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." It doesn't explicitly require enrolment on the encounter date. The roster gives us the encounter, so presumably it counts. The continuous enrolment requirement is separate and satisfied (one gap of 22 days). I'll treat the event as satisfied by 2026-05-22 I10 (also 2026-06-26 I10 is in window and after gap). Either way, event satisfied.
Eligible.
Exclusions: none.
Numerator: outpatient readings on/after qualifying encounter date. Qualifying encounter: the first I10 in window = 2026-05-22. Readings on/after 2026-05-22: 2026-05-22 146/72; 2026-06-26 133/95; 2026-08-24 inpatient — skipped. Most recent qualifying = 2026-06-26 133/95. Diastolic 95 ≥90 → not controlled → non_compliant.
MEMBER 71054: 84, male. Enrolment: 2026-01-01–2026-05-06; 2026-06-18–2026-12-31. One gap 42 days ≤45 → OK.
Event: 2026-03-21 I10 (in window). Eligible.
Numerator: readings on/after 2026-03-21 (outpatient): 2026-03-21 137/92; 2026-05-06 138/85; 2026-06-05 inpatient — skipped; 2026-10-28 132/95. Most recent qualifying = 2026-10-28 132/95. Diastolic 95 → not controlled → non_compliant.
MEMBER 71055: 86 on 2026-12-31 → age >85 → not_eligible. (Despite good BP.) → not_eligible.
MEMBER 71056: 84, male. Enrolment full. Event: 2026-01-19 I10 (in window). Eligible.
Numerator: readings on/after 2026-01-19: 2026-01-19 125/88; 2026-03-20 153/86. Most recent = 2026-03-20 153/86. Systolic 153 ≥140 → not controlled → non_compliant.
Now tally:
Compliant: 71047, 71050, 71052 → 3
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
Excluded: 71044 → 1
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Total: 3+6+1+6 = 16. ✓
Denominator = compliant + non_compliant = 9.
Numerator = 3.
Rate = 3/9 × 100 = 33.333... → 33.3 (rounded half up to one decimal).
Let me double-check a few tricky ones.
71042: gaps of 15 and 12 days → two gaps → fails enrolment anyway; also age 86. Not eligible. ✓
71045: Enrolment starts 2026-04-05. The requirement: "enrolled for the full measurement year with no more than one gap of up to 45 days." Not enrolled from 2026-01-01 to 2026-04-04 — that's a gap of ~94 days at the start. Actually, is a late enrolment a "gap"? Typically in HEDIS, continuous enrolment means enrolled throughout the period with allowable gaps. A member not enrolled at start and enrolling in April fails "enrolled for the full measurement year." So not eligible. ✓
71046: one gap 58 days > 45 → not eligible. ✓
71049: event fails (no I10 in Jan1–Jun30 window) → not eligible. ✓ Note enrolment OK (one gap 33 days). But no qualifying event. ✓
71051: two gaps → not eligible even though hospice exclusion exists. Per rules: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." ✓
71052: gap of exactly 45 days — "no more than one gap of up to 45 days" → allowed. ✓ Most recent outpatient reading after qualifying encounter: qualifying encounter date — first I10 in window is 2026-04-08. Readings on/after that: 04-08 (121/76), 06-04 (149/73), 07-13 (127/73); ED 07-16 skipped. Most recent = 07-13 127/73 → compliant. ✓
71053: qualifying encounter 2026-05-22 (during enrolment gap). Hmm, should I worry? The spec doesn't require the encounter to be during enrolment; the encounter exists in the record. Also 2026-06-26 I10 is in window too and is after the gap. So even if 05-22 didn't count, 06-26 establishes the event. Then numerator readings on/after qualifying encounter date — which qualifying encounter? "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter." If qualifying encounter is 2026-05-22, readings after: 05-22 (146/72), 06-26 (133/95); most recent 06-26 → not controlled. If qualifying encounter were 06-26, readings: 06-26 (133/95) → same result. Non-compliant either way. ✓
71054: gap 42 days OK. Qualifying encounter 2026-03-21. Most recent outpatient reading: 2026-10-28 132/95 → diastolic fails → non_compliant. ✓
71056: most recent 2026-03-20 153/86 → non_compliant. ✓
71041: most recent outpatient = 2026-02-18 150/72 (inpatient 05-18 skipped) → non_compliant. ✓
71043: most recent 2026-10-02 136/103 → non_compliant. ✓
71047: most recent qualifying outpatient = 2026-07-25 137/73 (inpatient 11-21 skipped) → compliant. ✓
71048: only reading 2026-05-15 134/93 → non_compliant. ✓
71050: most recent 2026-09-08 129/71 → compliant. ✓
71044: eligible but E1 (N18.6 in 2024, "any time on or before 2026-12-31") → excluded. ✓
Rate = 3/9 = 33.3333 → 33.3.
Final JSON.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,365 tokens
Let me work through each member systematically against the measure specification.
Measure QM-CBP — Blood Pressure Control in Hypertension
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION:
- Age: 18 through 85 as of 2026-12-31.
- Event: at least one outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30.
- Continuous enrolment: enrolled full measurement year with no more than one gap of up to 45 days. A gap >45 days, OR two or more gaps of any length, removes member.
NUMERATOR:
- Most recent outpatient BP reading on or after qualifying hypertension encounter date and on/before 2026-12-31 must be <140 systolic AND <90 diastolic. ED or inpatient readings skipped when identifying most recent reading. If no qualifying reading → denominator, not numerator.
EXCLUSIONS (before numerator, only if eligible):
- E1: N18.6 or Z99.2 anytime on or before 2026-12-31.
- E2: pregnancy O00-O9A during measurement year.
- E3: hospice or palliative care during measurement year.
- E4: died during measurement year.
Now go member by member.
MEMBER 71041: DOB 1941-07-25 → 85 years old on 2026-12-31 (2026-1941 = 85; born July, so on Dec 31 still 85). Age OK (18-85 inclusive).
Enrolment: full year, no gaps. OK.
Event: 2026-02-18 office visit I10 → qualifies (outpatient, before 2026-06-30). OK.
Exclusions: none. So in denominator.
Numerator: qualifying encounter 2026-02-18, BP 150/72 is an outpatient reading on/after qualifying date. Most recent outpatient reading on/after the qualifying encounter: readings are 2026-02-18 (outpatient) 150/72 and 2026-05-18 inpatient (skipped). So most recent outpatient = 150/72. Systolic 150 not <140 → non-compliant.
71041 → non_compliant.
MEMBER 71042: DOB 1940-06-12 → 86 on 2026-12-31. Age >85 → not eligible. Also enrolment has two gaps (15 and 12 days) → two gaps also removes. Either way not_eligible. Per spec: a member who fails age, event, or enrolment is not_eligible even if an exclusion is documented. Age fails → not_eligible.
71042 → not_eligible.
MEMBER 71043: DOB 1991-01-17 → 35. Age OK.
Enrolment: continuous. OK.
Event: 2026-02-12 office I10 → qualifies.
Exclusions: none.
Numerator: most recent outpatient reading on/after 2026-02-12. Readings: 02-12 126/73, 03-21 135/73, 05-22 119/102, 10-02 136/103. Most recent = 2026-10-02: 136/103. Systolic 136 <140 yes, diastolic 103 <90 no → non-compliant.
71043 → non_compliant.
MEMBER 71044: DOB 1956-05-26 → 70. Age OK.
Enrolment: continuous. OK.
Event: 2026-04-23 office I10 → qualifies.
Exclusions: N18.6 on 2024-06-20 → E1 (any time on or before 2026-12-31, so 2024 counts). Excluded.
71044 → excluded.
MEMBER 71045: DOB 1982-06-22 → 44. Age OK.
Enrolment: 2026-04-05 through 2026-12-31; not enrolled before 2026-04-05. So not enrolled for full measurement year → fails continuous enrolment → not_eligible.
Wait: enrolled from 2026-04-05. The period 2026-01-01 to 2026-04-05 is a gap of ~94 days, and gaps are within enrolment... The continuous enrolment requirement says "enrolled for the full measurement year with no more than one gap of up to 45 days." Not enrolled before 2026-04-05 means not enrolled for the full year → not eligible. This is a gap far longer than 45 days (Jan 1 to Apr 4 = 93 days). → not_eligible.
71045 → not_eligible.
MEMBER 71046: DOB 1991-10-18 → 35. Age OK.
Enrolment: one gap of 58 days → gap longer than 45 days → removes from denominator → not_eligible.
71046 → not_eligible.
MEMBER 71047: DOB 2008-04-06 → 18 as of 2026-12-31 (2026-2008=18, born April so 18 by Dec 31). Age OK (18 through 85 inclusive).
Enrolment: continuous. OK.
Event: 2026-06-17 office I10 → within Jan 1–Jun 30 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-06-17: 2026-06-17 (outpatient) 138/76; 2026-07-25 (outpatient) 137/73; 2026-11-21 inpatient (skipped). Most recent outpatient = 2026-07-25: 137/73. Both below 140/90 → compliant.
71047 → compliant.
MEMBER 71048: DOB 1991-04-26 → 35. Age OK.
Enrolment: continuous. OK.
Event: 2026-05-15 office I10 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-05-15: only 2026-05-15: 134/93. Systolic OK, diastolic 93 ≥90 → non-compliant.
71048 → non_compliant.
MEMBER 71049: DOB 1965-05-12 → 61. Age OK.
Enrolment: one gap of 33 days → allowed (one gap ≤45). OK.
Event: encounters: 2026-08-25 office I10. That's after 2026-06-30 → does not establish event. 2026-12-25 office I10 also after. So no qualifying event in window → not_eligible.
71049 → not_eligible.
MEMBER 71050: DOB 1942-01-04 → 84. Age OK.
Enrolment: continuous. OK.
Event: 2026-06-23 office I10 → qualifies (by 06-30).
Exclusions: none.
Numerator: readings on/after 2026-06-23: 2026-06-23 122/84 (outpatient); 2026-09-08 129/71 (outpatient). Most recent = 2026-09-08: 129/71. Both below → compliant.
71050 → compliant.
MEMBER 71051: DOB 1991-04-19 → 35. Age OK.
Enrolment: gaps of 26 and 14 days → two gaps → two or more gaps of any length removes from denominator → not_eligible.
Also hospice election 2026-10-27 → E3 exclusion, but not eligible takes precedence per "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
71051 → not_eligible.
MEMBER 71052: DOB 1991-11-27 → 35. Age OK.
Enrolment: one gap of 45 days → "no more than one gap of up to 45 days" → 45 days is allowed ("up to 45"). OK.
Event: 2026-04-08 office I10 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-04-08: 2026-04-08 121/76; 2026-06-04 149/73; 2026-07-13 127/73; 2026-07-16 ED (skipped). Most recent outpatient = 2026-07-13: 127/73. Both below → compliant.
71052 → compliant.
MEMBER 71053: DOB 1942-08-07 → 84. Age OK.
Enrolment: one gap of 22 days → OK.
Event: 2026-05-22 office I10 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-05-22: 2026-05-22 146/72; 2026-06-26 133/95; 2026-08-24 inpatient (skipped). Most recent outpatient = 2026-06-26: 133/95. Diastolic 95 ≥90 → non-compliant.
71053 → non_compliant.
MEMBER 71054: DOB 1942-12-16 → 84. Age OK.
Enrolment: one gap of 42 days → OK.
Event: 2026-03-21 office I10 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-03-21: 2026-03-21 (outpatient) 137/92; 2026-05-06 (outpatient) 138/85; 2026-06-05 inpatient (skipped); 2026-10-28 (outpatient) 132/95. Most recent outpatient = 2026-10-28: 132/95. Diastolic 95 ≥90 → non-compliant.
71054 → non_compliant.
MEMBER 71055: DOB 1940-08-21 → 86 on 2026-12-31. Age >85 → not_eligible.
71055 → not_eligible.
MEMBER 71056: DOB 1942-01-17 → 84. Age OK.
Enrolment: continuous. OK.
Event: 2026-01-19 office I10 → qualifies.
Exclusions: none.
Numerator: readings on/after 2026-01-19: 2026-01-19 125/88; 2026-03-20 153/86. Most recent = 2026-03-20: 153/86. Systolic 153 ≥140 → non-compliant.
71056 → non_compliant.
Summary:
- compliant: 71047, 71050, 71052 → 3 members
- non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6 members
- excluded: 71044 → 1 member
- not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6 members
Total = 3+6+1+6 = 16 ✓
Denominator = compliant + non_compliant = 3 + 6 = 9 (after exclusions removed — excluded member not in denominator).
Numerator = 3.
Excluded = 1.
Not eligible = 6.
Rate = 3/9 × 100 = 33.333... → rounded half up to one decimal = 33.3.
Check alternative denominator interpretation: "denominator — members in the eligible population after exclusions are removed (compliant + non_compliant)". Yes, 9.
Rate: 3/9 = 0.33333... × 100 = 33.333... → 33.3.
Let me double-check some edge cases:
71042: age 86 → not eligible regardless. Confirmed. Also two gaps. Not eligible either way.
71045: enrolment starts 2026-04-05. "Enrolled for the full measurement year" — fails. not_eligible. Even though the encounter 2026-05-23 is within window while enrolled, enrolment requirement fails → not eligible.
71046: one gap of 58 days. Wait — let me verify: enrolled 2026-01-01 through 2026-04-26; then 2026-06-24 through 2026-12-31. Gap from 04-27 to 06-23 = April 27-30 (4 days) + May (31) + June 1-23 (23) = 58 days. Yes >45 → not eligible. The record says one gap of 58 days, take as given.
71049: qualifying event must be I10 outpatient on/between 01-01 and 06-30. Member's encounters: 08-25 (I10), 11-28 ED, 12-25 (I10). None in window → not eligible. Confirmed.
71051: two gaps (26, 14) → not eligible even though hospice exclusion would apply. Confirmed per spec.
71052: one gap 45 days → "up to 45 days" allowed. Eligible. Most recent outpatient reading: skip the ED visit 07-16; most recent is 07-13 127/73 → compliant. Confirmed.
71053: skip inpatient 08-24 reading; most recent outpatient is 06-26 133/95 → diastolic fails → non-compliant. Confirmed.
71054: 10-28 132/95 → diastolic fails → non-compliant.
71041: most recent outpatient reading on/after qualifying encounter... 02-18 BP 150/72 taken same day as qualifying encounter — "on or after the date of the qualifying hypertension encounter" — includes same day. 150/72 fails systolic → non-compliant. The reading on the qualifying encounter date counts.
Hmm, is there a nuance? The qualifying encounter is identified by diagnosis I10; the BP reading requirement is separate — any outpatient BP reading on/after that date. 02-18 reading counts. 150 ≥140 → non-compliant. Confirmed.
71047: 18 years old — "18 through 85" inclusive. OK. Inpatient reading 11-21 118/88 skipped; most recent outpatient = 07-25 137/73 → compliant. Note: even if the inpatient reading counted, 118/88 <140/90 both — would still be compliant. Either way compliant.
Denominator = 9, numerator = 3, rate = 33.3.
Output format: required keys exactly:
"denominator": 9
"numerator": 3
"excluded": 1
"not_eligible": 6
"rate": 33.3
"compliant_members": ["71047", "71050", "71052"]
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"]
"excluded_members": ["71044"]
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
Rate as number 33.3.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 2.5 Pro · Google50.1s · 6,458 out | 51.6s · 6,119 out | 52.5s · 5,707 out
Reasoning · 6,213 tokens
Okay, I've meticulously reviewed the QM-CBP quality measure specification and applied it to the roster of 16 members. My thought process involved breaking down the criteria step-by-step for each individual, ensuring I correctly categorized them into one of the four statuses: compliant, non_compliant, excluded, or not_eligible.
First, I internalized the core requirements for the **measurement year (2026)**. Then, I delved into the **eligible population (denominator)**, focusing on the age range (18-85 by year-end 2026), the requirement for at least one outpatient encounter with a hypertension diagnosis (ICD-10 code I10) specifically between January 1, 2026, and June 30, 2026, and the crucial **continuous enrollment** rule: no more than one gap of up to 45 days. Any more than that, or longer single gaps, immediately render a member ineligible.
Next, I thoroughly understood the **required exclusions**: End-Stage Renal Disease (ESRD) or dialysis (N18.6, Z99.2) before year-end 2026, pregnancy (O00-O9A) during the year, hospice or palliative care, and death within the measurement year. These are absolute disqualifiers for inclusion in the denominator, even if other criteria are met.
The **numerator** requirement was also clear: the most recent *outpatient* blood pressure reading, taken on or after the qualifying hypertension encounter and by year-end 2026, must be below 140 systolic AND below 90 diastolic. Importantly, ED and inpatient readings are explicitly excluded from this calculation. If no qualifying reading exists, the member is considered non-compliant.
With these parameters firmly in mind, I systematically went through each member's data:
* **MEMBER 71041**: Age was fine, continuous enrollment was good, and they had a qualifying I10 encounter in February. No exclusions applied. So, they entered the denominator. However, their most recent outpatient BP reading after the encounter was 150/72. Since 150 is not < 140, they failed the numerator. Thus, **non_compliant**.
* **MEMBER 71042**: Their date of birth (1940-06-12) meant they would be 86 on 2026-12-31, exceeding the 85-year-old limit. This immediately made them **not_eligible**.
* **MEMBER 71043**: Met age, enrollment, and event criteria. No exclusions. In the denominator. For the numerator, I looked at their outpatient readings. The most recent one was 136/103. Since 103 is not < 90, they failed the numerator. Thus, **non_compliant**.
* **MEMBER 71044**: Met age and enrollment criteria. They had a qualifying I10 encounter. However, they had a recorded diagnosis of ESRD (N18.6) prior to the end of the measurement year, which is exclusion E1. Therefore, they are **excluded**.
* **MEMBER 71045**: Their enrollment period (2026-04-05 to 2026-12-31) meant they were not enrolled for the full measurement year. This disqualifies them, making them **not_eligible**.
* **MEMBER 71046**: I calculated their enrollment gap. It spanned from April 27th to June 23rd, totaling 58 days. This exceeds the 45-day limit for a single gap, rendering them **not_eligible**.
* **MEMBER 71047**: Satisfied age, enrollment, and had a qualifying I10 encounter in June. No exclusions. In the denominator. I checked their outpatient BPs, and the most recent qualifying one was 137/73. Both 137 < 140 and 73 < 90. They met the numerator criteria. Thus, **compliant**.
* **MEMBER 71048**: Met age, enrollment, and had a qualifying I10 encounter in May. No exclusions. In the denominator. Their most recent outpatient BP was 134/93. Since 93 is not < 90, they failed the numerator. Thus, **non_compliant**.
* **MEMBER 71049**: Their enrollment gap was 33 days, which is within the acceptable limit. However, their qualifying I10 encounter date was August 25, 2026. This is *after* the June 30th cutoff for establishing the event. Therefore, they never entered the eligible population and are **not_eligible**.
* **MEMBER 71050**: Met age, continuous enrollment, and had a qualifying I10 encounter in June. No exclusions. In the denominator. Their most recent outpatient BP was 129/71, which meets both numerator conditions. Thus, **compliant**.
* **MEMBER 71051**: This member had *two* gaps in their enrollment record. The specification states that "two or more gaps of any length" means they are removed from the denominator. Although they also had a hospice election (an exclusion), the failure to meet enrollment continuity took precedence. They are **not_eligible**.
* **MEMBER 71052**: Their enrollment gap was precisely 45 days, which is within the "up to 45 days" allowance. They met age and event criteria, with no exclusions. In the denominator. Their most recent outpatient BP reading was 127/73, satisfying both numerator conditions. Thus, **compliant**.
* **MEMBER 71053**: Had a 22-day enrollment gap (acceptable) and a qualifying I10 encounter in May. No exclusions. In the denominator. Their most recent outpatient BP was 133/95. Since 95 is not < 90, they failed the numerator. Thus, **non_compliant**.
* **MEMBER 71054**: Had a 42-day enrollment gap (acceptable) and a qualifying I10 encounter in March. No exclusions. In the denominator. Their most recent outpatient BP was 132/95. Since 95 is not < 90, they failed the numerator. Thus, **non_compliant**.
* **MEMBER 71055**: Their date of birth (1940-08-21) meant they would be 86 on 2026-12-31, exceeding the age limit. Thus, **not_eligible**.
* **MEMBER 71056**: Met age, continuous enrollment, and had a qualifying I10 encounter in January. No exclusions. In the denominator. Their most recent outpatient BP was 153/86. Since 153 is not < 140, they failed the numerator. Thus, **non_compliant**.
After this individual assessment, I tallied the results:
* **Compliant**: 3 members (71047, 71050, 71052)
* **Non-compliant**: 6 members (71041, 71043, 71048, 71053, 71054, 71056)
* **Excluded**: 1 member (71044)
* **Not Eligible**: 6 members (71042, 71045, 71046, 71049, 71051, 71055)
This totals 16 members, confirming my coverage. From these counts, I derived the final metrics:
* **Denominator**: 3 (compliant) + 6 (non_compliant) = 9
* **Numerator**: 3 (compliant)
* The **rate** is calculated as (3 / 9) * 100, which is 33.3%.
Finally, I compiled the lists of member IDs for each category and the summary counts as per the requirements. My analysis is thorough and directly reflects the QM-CBP specification.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,874 tokens
Here's a summary of my thought process as I evaluated each member against the Blood Pressure Control in Hypertension (QM-CBP) quality measure specification:
My primary objective was to meticulously assess each of the 16 members provided, categorizing them according to the defined criteria to ultimately calculate a quality rate. I needed to place each member into one of four distinct buckets: `compliant_members`, `non_compliant_members`, `excluded_members`, or `not_eligible_members`.
I first familiarized myself with the measure specification, paying close attention to the nuances of the **Eligible Population (Denominator)** and the **Required Exclusions**.
For the **Eligible Population**, I noted three key criteria:
1. **Age:** Must be between 18 and 85 years old as of December 31, 2026.
2. **Event:** At least one outpatient encounter with an I10 (hypertension) diagnosis between January 1, 2026, and June 30, 2026.
3. **Continuous Enrolment:** Enrolled for the entire measurement year (January 1, 2026, to December 31, 2026) with a maximum of one gap lasting up to 45 days. Any more than one gap, or a single gap exceeding 45 days, renders them ineligible.
Next, the **Required Exclusions** were critical for identifying members who, while meeting denominator criteria, should be removed from it:
* End-stage renal disease (ESRD) or dialysis dependence.
* Pregnancy.
* Hospice or palliative care.
* Death during the measurement year.
Finally, the **Numerator** criteria were clear: the most recent *outpatient* blood pressure reading, taken on or after the qualifying hypertension encounter and by the end of the measurement year, must be less than 140 systolic AND less than 90 diastolic. Importantly, any readings from emergency departments or inpatient admissions were to be disregarded. If no qualifying reading existed, the member would be considered non-compliant.
With the specifications firmly in mind, I proceeded to evaluate each member individually:
**Member 71041:**
* Age (85 on 12/31/2026) and enrolment were fine.
* Had an outpatient I10 encounter on 2026-02-18, meeting the event criteria.
* No exclusions applied.
* Therefore, they were in the denominator.
* For the numerator, the most recent *outpatient* reading on or after their qualifying encounter was 150/72 (from 2026-02-18). The systolic (150) was not less than 140.
* **Result:** `non_compliant`.
**Member 71042:**
* Born in 1940, they would be 86 on 12/31/2026, exceeding the age limit.
* **Result:** `not_eligible`.
**Member 71043:**
* Age (35), enrolment, and event (I10 on 2026-02-12) were all met.
* No exclusions applied.
* In the denominator.
* For the numerator, the most recent outpatient reading was 136/103 on 2026-10-02. The diastolic (103) was not less than 90.
* **Result:** `non_compliant`.
**Member 71044:**
* Age (70), enrolment, and event (I10 on 2023-04-23) were met.
* However, they had a diagnosis of N18.6 (ESRD) from 2024-06-20, which falls under exclusion E1.
* **Result:** `excluded`.
**Member 71045:**
* While age and event might have been met (assuming they were), their enrolment began on 2026-04-05, meaning they were not enrolled for the full measurement year.
* **Result:** `not_eligible`.
**Member 71046:**
* Age (35) and event were met.
* Their enrolment had a gap from 2026-04-27 to 2026-06-23, which is 58 days. This exceeds the 45-day limit for a single gap.
* **Result:** `not_eligible`.
**Member 71047:**
* Age (18), enrolment, and event (I10 on 2026-06-17) were all met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading on or after the qualifying encounter was 137/73 on 2026-07-25. Both systolic (<140) and diastolic (<90) were met.
* **Result:** `compliant`.
**Member 71048:**
* Age (35), enrolment, and event (I10 on 2026-05-15) were met.
* No exclusions.
* In the denominator.
* For the numerator, the only reading on or after the qualifying encounter was 134/93 on 2026-05-15. The diastolic (93) was not less than 90.
* **Result:** `non_compliant`.
**Member 71049:**
* Age (61) and enrolment (a 33-day gap, which is acceptable) were met.
* However, their first I10 diagnosis occurred on 2026-08-25, which is *after* the required 2026-06-30 deadline for the qualifying event.
* **Result:** `not_eligible`.
**Member 71050:**
* Age (84), enrolment, and event (I10 on 2026-06-23) were met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading was 129/71 on 2026-09-08. Both systolic (<140) and diastolic (<90) were met.
* **Result:** `compliant`.
**Member 71051:**
* Age (35) and event were met.
* However, their enrolment history showed two distinct gaps, making them ineligible regardless of other factors. Critically, I recognized that `not_eligible` (due to enrolment issues) takes precedence over `excluded` (due to hospice).
* **Result:** `not_eligible`.
**Member 71052:**
* Age (35), enrolment (a 45-day gap, which is acceptable as it's "up to 45 days"), and event (I10 on 2026-04-08) were met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading was 127/73 on 2026-07-13. Both systolic (<140) and diastolic (<90) were met. (The ED reading was correctly ignored.)
* **Result:** `compliant`.
**Member 71053:**
* Age (84), enrolment (a 22-day gap, acceptable), and event (I10 on 2026-05-22) were met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading was 133/95 on 2026-06-26. The diastolic (95) was not less than 90.
* **Result:** `non_compliant`.
**Member 71054:**
* Age (84), enrolment (a 42-day gap, acceptable), and event (I10 on 2026-03-21) were met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading was 132/95 on 2026-10-28. The diastolic (95) was not less than 90.
* **Result:** `non_compliant`.
**Member 71055:**
* Born in 1940, they would be 86 on 12/31/2026, exceeding the age limit.
* **Result:** `not_eligible`.
**Member 71056:**
* Age (84), enrolment, and event (I10 on 2026-01-19) were met.
* No exclusions.
* In the denominator.
* For the numerator, the most recent outpatient reading was 153/86 on 2026-03-20. The systolic (153) was not less than 140.
* **Result:** `non_compliant`.
After processing each member, I compiled the results:
* **Compliant Members:** 71047, 71050, 71052 (Total: 3)
* **Non-Compliant Members:** 71041, 71043, 71048, 71053, 71054, 71056 (Total: 6)
* **Excluded Members:** 71044 (Total: 1)
* **Not Eligible Members:** 71042, 71045, 71046, 71049, 71051, 71055 (Total: 6)
This gave me the following totals:
* **Denominator:** Compliant + Non-compliant = 3 + 6 = 9
* **Numerator:** Compliant = 3
* **Excluded:** 1
* **Not Eligible:** 6
I cross-referenced that the sum of all categories (3 + 6 + 1 + 6) equaled the total number of members (16), which confirmed my counts.
Finally, I calculated the quality rate:
* Rate = (Numerator / Denominator) \* 100
* Rate = (3 / 9) \* 100 = 33.333...%
* Rounded to one decimal place, this is **33.3%**.
This detailed, member-by-member analysis, combined with a clear understanding of the measure's intricacies, allowed me to confidently derive the final results.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,462 tokens
Alright, I'm tasked with evaluating a roster of 16 individuals against the QM-CBP measure specification for blood pressure control in hypertension during the 2026 measurement year. My primary goal is to determine which members fall into the denominator (eligible population) and then, for those in the denominator, whether they meet the numerator criteria for controlled blood pressure.
Here’s how I'm approaching this, member by member:
First, I need to establish who is even *eligible* for consideration. The measure specifies:
* **Age:** They must be between 18 and 85 years old as of December 31, 2026.
* **Hypertension Diagnosis:** They need at least one outpatient encounter with an ICD-10 code of I10 for hypertension between January 1, 2026, and June 30, 2026. This is the qualifying event.
* **Continuous Enrollment:** They must have been continuously enrolled for the entire measurement year (January 1 to December 31, 2026), with a maximum of one gap in enrollment lasting no more than 45 days.
Next, there are specific **exclusions** that, if met, remove a member from consideration, even if they otherwise meet the eligibility criteria. These are:
* End-Stage Renal Disease (ESRD) or dialysis on or before the end of the measurement year.
* Pregnancy during the measurement year.
* Receiving hospice or palliative care during the measurement year.
* Dying during the measurement year.
Once a member is deemed eligible (i.e., meets age, event, and enrollment criteria) and is not excluded, they are added to the **denominator**.
Then, for those in the denominator, I look at the **numerator**:
* I need to find the *most recent outpatient* blood pressure reading taken on or after their qualifying hypertension encounter, up to December 31, 2026.
* This reading must be strictly less than 140 systolic AND strictly less than 90 diastolic.
* Crucially, blood pressure readings from Emergency Department (ED) or inpatient visits are disregarded for this numerator calculation.
I'll walk through each member:
**Member 71041:**
* Age: 85. This is within the 18-85 range, so OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on February 18, 2026. This falls within the first half of the year. OK.
* Eligibility: Yes, they meet all the basic eligibility requirements.
* Exclusions: No ESRD, pregnancy, hospice, or death documented. Not excluded.
* Denominator: Yes, they are in the denominator.
* Numerator: The qualifying encounter was on February 18, 2026.
* A reading on the same day (February 18, office visit) was 150/72.
* An inpatient reading on May 18 was 159/81. This is ignored as it's an inpatient reading.
* The most recent *outpatient* reading available is 150/72 from February 18.
* Is 150 < 140? No. Is 72 < 90? Yes. Both conditions are NOT met.
* **Status: Non-compliant.**
**Member 71042:**
* Age: 86. This is outside the 18-85 range.
* **Status: Not_eligible (age).**
**Member 71043:**
* Age: 35. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on February 12, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter February 12, 2026.
* Outpatient readings after this date: 02/12 (126/73), 03/21 (135/73), 05/22 (119/102), 10/02 (136/103).
* The most recent outpatient reading is 136/103 on October 2.
* Is 136 < 140? Yes. Is 103 < 90? No. Both conditions are NOT met.
* **Status: Non-compliant.**
**Member 71044:**
* Age: 70. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on April 23, 2026. OK.
* Eligibility: Yes.
* Exclusions: E1 - Diagnosis N18.6 (ESRD) documented on June 20, 2024. This is on or before December 31, 2026. They are excluded.
* **Status: Excluded.**
**Member 71045:**
* Age: 44. OK.
* Enrolment: Started on April 5, 2026. They were not enrolled for the full measurement year. Fails continuous enrolment.
* **Status: Not_eligible (enrolment).**
**Member 71046:**
* Age: 35. OK.
* Enrolment: Had a gap from April 27 to June 23, 2026, which is 58 days. This is greater than the allowed 45 days. Fails continuous enrolment.
* **Status: Not_eligible (enrolment).**
**Member 71047:**
* Age: 18. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on June 17, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter June 17, 2026.
* Outpatient readings after: 06/17 (138/76), 07/25 (137/73).
* An inpatient reading on November 21 is ignored.
* The most recent outpatient reading is 137/73 on July 25.
* Is 137 < 140? Yes. Is 73 < 90? Yes. Both conditions ARE met.
* **Status: Compliant.**
**Member 71048:**
* Age: 35. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on May 15, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter May 15, 2026.
* The only outpatient reading available is 134/93 on May 15.
* Is 134 < 140? Yes. Is 93 < 90? No. Both conditions are NOT met.
* **Status: Non-compliant.**
**Member 71049:**
* Age: 61. OK.
* Enrolment: Had a gap of 33 days (June 27 to July 29, 2026). This is within the allowed 45 days. OK for enrolment.
* Event: Office visit with I10 on August 25, 2026. This is *after* the required cutoff of June 30, 2026, for the qualifying event. Fails event criteria.
* **Status: Not_eligible (event).**
**Member 71050:**
* Age: 84. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on June 23, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter June 23, 2026.
* Outpatient readings after: 06/23 (122/84), 09/08 (129/71).
* The most recent outpatient reading is 129/71 on September 8.
* Is 129 < 140? Yes. Is 71 < 90? Yes. Both conditions ARE met.
* **Status: Compliant.**
**Member 71051:**
* Age: 35. OK.
* Enrolment: Had two gaps: one of 26 days and another of 14 days. The measure states "two or more gaps of any length, removes the member from the denominator." Fails continuous enrolment.
* **Status: Not_eligible (enrolment).** (Note: Even if they had hospice, eligibility failure takes precedence.)
**Member 71052:**
* Age: 35. OK.
* Enrolment: Had one gap of 45 days (April 9 to May 23, 2026). This is within the allowed 45 days. OK for enrolment.
* Event: Office visit with I10 on April 8, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter April 8, 2026.
* Outpatient readings after: 04/08 (121/76), 06/04 (149/73), 07/13 (127/73).
* An ED visit on July 16 is ignored.
* The most recent outpatient reading is 127/73 on July 13.
* Is 127 < 140? Yes. Is 73 < 90? Yes. Both conditions ARE met.
* **Status: Compliant.**
**Member 71053:**
* Age: 84. OK.
* Enrolment: Had one gap of 22 days (May 16 to June 6, 2026). OK for enrolment.
* Event: Office visit with I10 on May 22, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter May 22, 2026.
* Outpatient readings after: 05/22 (146/72), 06/26 (133/95).
* An inpatient reading on August 24 is ignored.
* The most recent outpatient reading is 133/95 on June 26.
* Is 133 < 140? Yes. Is 95 < 90? No. Both conditions are NOT met.
* **Status: Non-compliant.**
**Member 71054:**
* Age: 84. OK.
* Enrolment: Had one gap of 42 days (May 7 to June 17, 2026). OK for enrolment.
* Event: Office visit with I10 on March 21, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter March 21, 2026.
* Outpatient readings after: 03/21 (137/92), 05/06 (138/85), 10/28 (132/95).
* An inpatient reading on June 5 is ignored.
* The most recent outpatient reading is 132/95 on October 28.
* Is 132 < 140? Yes. Is 95 < 90? No. Both conditions are NOT met.
* **Status: Non-compliant.**
**Member 71055:**
* Age: 86. This is outside the 18-85 range.
* **Status: Not_eligible (age).**
**Member 71056:**
* Age: 84. OK.
* Enrolment: Continuous, no gaps. OK.
* Event: Office visit with I10 on January 19, 2026. OK.
* Eligibility: Yes.
* Exclusions: None apply.
* Denominator: Yes.
* Numerator: Qualifying encounter January 19, 2026.
* Outpatient readings after: 01/19 (125/88), 03/20 (153/86).
* The most recent outpatient reading is 153/86 on March 20.
* Is 153 < 140? No. Is 86 < 90? Yes. Both conditions are NOT met.
* **Status: Non-compliant.**
After reviewing all 16 members:
* **Compliant:** 3 members (71047, 71050, 71052)
* **Non-compliant:** 6 members (71041, 71043, 71048, 71053, 71054, 71056)
* **Excluded:** 1 member (71044)
* **Not_eligible:** 6 members (71042, 71045, 71046, 71049, 71051, 71055)
This gives me a total denominator of 3 (compliant) + 6 (non-compliant) = 9 members.
The numerator is the number of compliant members, which is 3.
The excluded count is 1, and the not_eligible count is 6.
Therefore, the blood pressure control rate is (3 / 9) * 100 = 33.3%.
I've double-checked the individual assessments and the final counts to ensure accuracy.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.2 · Z.ai45.7s · 5,493 out | 113.5s · 6,291 out | 27.7s · 3,113 out
Reasoning · 5,249 tokens
Let me carefully work through each member against the measure specification.
First, let me understand the measure QM-CBP:
- Measurement year: 2026-01-01 through 2026-12-31
**ELIGIBLE POPULATION (denominator):**
- Age: 18 through 85 years as of 2026-12-31
- Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
- Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days
**NUMERATOR:**
- Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic
- ED or inpatient readings don't count (skipped)
- If no qualifying reading exists, member is in denominator but not numerator
**REQUIRED EXCLUSIONS (before scoring):**
- E1: ESRD (N18.6) or renal dialysis dependence (Z99.2) any time on or before 2026-12-31
- E2: Pregnancy (O00-O9A) during measurement year
- E3: Hospice or palliative care during measurement year
- E4: Died during measurement year
Now let me go through each member:
**MEMBER 71041**
- DOB: 1941-07-25, age 85 on 2026-12-31 → age 85, within range (18-85) ✓
- Enrolment: continuous, no gaps ✓
- Event: 2026-02-18 Office visit, I10 → within 2026-01-01 to 2026-06-30 ✓
- Exclusions: No ESRD, no pregnancy, no hospice, alive at year end → no exclusion
- Numerator: Most recent outpatient BP reading on or after 2026-02-18 and on or before 2026-12-31
- 2026-02-18 Office visit, BP 150/72 (outpatient) ✓
- 2026-05-18 Inpatient admission, BP 159/81 (inpatient - skipped)
- Most recent outpatient reading: 2026-02-18, BP 150/72 → 150 systolic ≥ 140 → NOT controlled
- Status: non_compliant
- Lists: denominator, non_compliant
**MEMBER 71042**
- DOB: 1940-06-12, age 86 on 2026-12-31 → age 86, outside range (18-85) ✗
- Not eligible due to age
- Status: not_eligible
- List: not_eligible
**MEMBER 71043**
- DOB: 1991-01-17, age 35 on 2026-12-31 → within range ✓
- Enrolment: continuous, no gaps ✓
- Event: 2026-02-12 Office visit, I10 → within range ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-02-12 and ≤ 2026-12-31
- 2026-02-12 Office, BP 126/73
- 2026-03-21 Office, BP 135/73
- 2026-05-22 Office, BP 119/102
- 2026-10-02 Office, BP 136/103
- Most recent outpatient: 2026-10-02, BP 136/103 → 136 < 140 ✓ but 103 ≥ 90 ✗ → NOT controlled
- Status: non_compliant
**MEMBER 71044**
- DOB: 1956-05-26, age 70 on 2026-12-31 → within range ✓
- Enrolment: continuous ✓
- Event: 2026-04-23 Office visit, I10 → within range ✓
- Exclusions: 2024-06-20 Diagnosis N18.6 (ESRD) → E1 exclusion applies
- Status: excluded
- List: excluded
**MEMBER 71045**
- DOB: 1982-06-22, age 44 on 2026-12-31 → within range ✓
- Enrolment: 2026-04-05 through 2026-12-31, not enrolled before 2026-04-05
- This is NOT continuous enrolment for the full measurement year. The member wasn't enrolled for the full year.
- Continuous enrolment: "enrolled for the full measurement year with no more than one gap of up to 45 days"
- Not enrolled from 2026-01-01 to 2026-04-04 → this is a gap of more than 45 days (Jan 1 to Apr 4 = about 93 days)
- Actually, the member wasn't enrolled at all from Jan 1 to Apr 4. This isn't a "gap" - they were never enrolled. The continuous enrolment requirement says "enrolled for the full measurement year." Since the member wasn't enrolled for the full year, they don't meet the continuous enrolment requirement.
- Status: not_eligible
- List: not_eligible
Wait, let me reconsider. The continuous enrolment says "enrolled for the full measurement year with no more than one gap of up to 45 days." If the member was not enrolled from 2026-01-01 to 2026-04-04, that's a gap of about 93 days which exceeds 45 days. But also, the member simply wasn't enrolled for the full year. Either way, this is not eligible.
Actually, I need to think about this more carefully. Is the period from Jan 1 to Apr 4 considered a "gap" or is it just non-enrollment? The spec says "enrolled for the full measurement year with no more than one gap of up to 45 days." The member started enrollment on Apr 5, so they weren't enrolled for the full year. That's a gap from Jan 1 to Apr 4 (93+ days), which exceeds 45 days. So not_eligible.
Status: not_eligible
**MEMBER 71046**
- DOB: 1991-10-18, age 35 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days.
- "no more than one gap of up to 45 days" → one gap of 58 days exceeds 45 days ✗
- Not eligible due to enrolment gap > 45 days
- Status: not_eligible
**MEMBER 71047**
- DOB: 2008-04-06, age 18 on 2026-12-31 → within range (18-85) ✓
- Enrolment: continuous, no gaps ✓
- Event: 2026-06-17 Office visit, I10 → within 2026-01-01 to 2026-06-30 ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-06-17 and ≤ 2026-12-31
- 2026-06-17 Office, BP 138/76
- 2026-07-25 Office, BP 137/73
- 2026-11-21 Inpatient, BP 118/88 (inpatient - skipped)
- Most recent outpatient: 2026-07-25, BP 137/73 → 137 < 140 ✓ and 73 < 90 ✓ → controlled
- Status: compliant
**MEMBER 71048**
- DOB: 1991-04-26, age 35 on 2026-12-31 → within range ✓
- Enrolment: continuous ✓
- Event: 2026-05-15 Office visit, I10 → within range ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-05-15 and ≤ 2026-12-31
- 2026-05-15 Office, BP 134/93 → 134 < 140 ✓ but 93 ≥ 90 ✗ → NOT controlled
- Status: non_compliant
**MEMBER 71049**
- DOB: 1965-05-12, age 61 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days.
- One gap of 33 days ≤ 45 days ✓ → meets continuous enrolment
- Event: 2026-08-25 Office visit, I10 → BUT this is after 2026-06-30! The event must be on or between 2026-01-01 and 2026-06-30.
- Wait, are there any encounters with I10 between 2026-01-01 and 2026-06-30?
- Encounters: 2026-08-25 (I10), 2026-11-28 (ED, R07.9), 2026-12-25 (I10)
- None between 2026-01-01 and 2026-06-30 with I10
- No qualifying event → not eligible
- Status: not_eligible
Wait, let me re-read. The member has:
- 2026-08-25 Office visit, diagnosis I10
- 2026-11-28 Emergency department visit, diagnosis R07.9
- 2026-12-25 Office visit, diagnosis I10
None of these are between 2026-01-01 and 2026-06-30. The first I10 encounter is on 2026-08-25, which is after 2026-06-30. So no qualifying event.
Status: not_eligible
**MEMBER 71050**
- DOB: 1942-01-04, age 84 on 2026-12-31 → within range ✓
- Enrolment: continuous ✓
- Event: 2026-06-23 Office visit, I10 → within range ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-06-23 and ≤ 2026-12-31
- 2026-06-23 Office, BP 122/84
- 2026-09-08 Office, BP 129/71
- Most recent outpatient: 2026-09-08, BP 129/71 → 129 < 140 ✓ and 71 < 90 ✓ → controlled
- Status: compliant
**MEMBER 71051**
- DOB: 1991-04-19, age 35 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days.
- Two gaps → "two or more gaps of any length" removes from denominator ✗
- Not eligible due to two gaps
- Wait, but the member also has hospice election on 2026-10-27. But exclusions are evaluated only for members in the eligible population. Since the member fails continuous enrolment, they're not_eligible, not excluded.
- Status: not_eligible
Actually wait, let me re-read the rules: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
So since this member fails enrolment (two gaps), they are not_eligible, even though they have a hospice election. The exclusion is not evaluated.
Status: not_eligible
**MEMBER 71052**
- DOB: 1991-11-27, age 35 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days.
- One gap of exactly 45 days → "no more than one gap of up to 45 days" → 45 ≤ 45 ✓
- Meets continuous enrolment
- Event: 2026-04-08 Office visit, I10 → within 2026-01-01 to 2026-06-30 ✓
- Also 2026-06-04 Office, I10 and 2026-07-13 Office, I10 (but the event only needs one in the window)
- Exclusions: none
- Numerator: Most recent outpatient BP on or after the date of the qualifying hypertension encounter and ≤ 2026-12-31
- The qualifying encounter date: the first I10 encounter within the window is 2026-04-08. But wait, does "the date of the qualifying hypertension encounter" refer to the first qualifying encounter, or any qualifying encounter?
Let me re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31"
I think "the qualifying hypertension encounter" refers to the encounter that establishes the event - i.e., the outpatient encounter with I10 between 2026-01-01 and 2026-06-30. The first such encounter is 2026-04-08.
Outpatient BP readings on or after 2026-04-08:
- 2026-04-08 Office, BP 121/76 → 121 < 140 ✓ and 76 < 90 ✓
- 2026-06-04 Office, BP 149/73 → 149 ≥ 140 ✗
- 2026-07-13 Office, BP 127/73 → 127 < 140 ✓ and 73 < 90 ✓
- 2026-07-16 ED, BP 119/89 (ED - skipped)
Most recent outpatient reading: 2026-07-13, BP 127/73 → 127 < 140 ✓ and 73 < 90 ✓ → controlled
- Status: compliant
**MEMBER 71053**
- DOB: 1942-08-07, age 84 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days.
- One gap of 22 days ≤ 45 days ✓ → meets continuous enrolment
- Event: 2026-05-22 Office visit, I10 → within range ✓
- Also 2026-06-26 Office, I10
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-05-22 and ≤ 2026-12-31
- 2026-05-22 Office, BP 146/72
- 2026-06-26 Office, BP 133/95 → 133 < 140 ✓ but 95 ≥ 90 ✗
- 2026-08-24 Inpatient, BP 112/84 (inpatient - skipped)
- Most recent outpatient: 2026-06-26, BP 133/95 → 133 < 140 ✓ but 95 ≥ 90 ✗ → NOT controlled
- Status: non_compliant
**MEMBER 71054**
- DOB: 1942-12-16, age 84 on 2026-12-31 → within range ✓
- Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days.
- One gap of 42 days ≤ 45 days ✓ → meets continuous enrolment
- Event: 2026-03-21 Office visit, I10 → within range ✓
- Also 2026-05-06 Office, I10
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-03-21 and ≤ 2026-12-31
- 2026-03-21 Office, BP 137/92
- 2026-05-06 Office, BP 138/85 → 138 < 140 ✓ and 85 < 90 ✓
- 2026-06-05 Inpatient, BP 132/76 (inpatient - skipped)
- 2026-10-28 Office, BP 132/95 → 132 < 140 ✓ but 95 ≥ 90 ✗
- Most recent outpatient: 2026-10-28, BP 132/95 → 132 < 140 ✓ but 95 ≥ 90 ✗ → NOT controlled
- Status: non_compliant
**MEMBER 71055**
- DOB: 1940-08-21, age 86 on 2026-12-31 → age 86, outside range (18-85) ✗
- Not eligible due to age
- Status: not_eligible
**MEMBER 71056**
- DOB: 1942-01-17, age 84 on 2026-12-31 → within range ✓
- Enrolment: continuous ✓
- Event: 2026-01-19 Office visit, I10 → within range ✓
- Also 2026-03-20 Office, I10
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-01-19 and ≤ 2026-12-31
- 2026-01-19 Office, BP 125/88 → 125 < 140 ✓ and 88 < 90 ✓
- 2026-03-20 Office, BP 153/86 → 153 ≥ 140 ✗
- Most recent outpatient: 2026-03-20, BP 153/86 → 153 ≥ 140 ✗ → NOT controlled
- Status: non_compliant
Now let me compile:
**Compliant members:** 71047, 71050, 71052
**Non-compliant members:** 71041, 71043, 71048, 71053, 71054, 71056
**Excluded members:** 71044
**Not eligible members:** 71042, 71045, 71046, 71049, 71051, 71055
Let me count:
- Compliant: 3 (71047, 71050, 71052)
- Non-compliant: 6 (71041, 71043, 71048, 71053, 71054, 71056)
- Excluded: 1 (71044)
- Not eligible: 6 (71042, 71045, 71046, 71049, 71051, 71055)
Total: 3 + 6 + 1 + 6 = 16 ✓
Denominator = compliant + non_compliant = 3 + 6 = 9
Numerator = 3
Excluded = 1
Not eligible = 6
Rate = 3/9 × 100 = 33.333... → 33.3
Let me double-check each member:
**71041**: Age 85 ✓, continuous enrolment ✓, event 2026-02-18 I10 ✓, no exclusions, most recent outpatient BP after 2026-02-18: 2026-02-18 (150/72) → 150 ≥ 140 → non_compliant ✓
**71042**: Age 86 → not_eligible ✓
**71043**: Age 35 ✓, continuous ✓, event 2026-02-12 I10 ✓, no exclusions, most recent outpatient BP: 2026-10-02 (136/103) → 103 ≥ 90 → non_compliant ✓
**71044**: Age 70 ✓, continuous ✓, event 2026-04-23 I10 ✓, ESRD N18.6 → excluded ✓
**71045**: Age 44 ✓, but enrolment starts 2026-04-05, not enrolled for full year → not_eligible ✓
**71046**: Age 35 ✓, but one gap of 58 days > 45 → not_eligible ✓
**71047**: Age 18 ✓, continuous ✓, event 2026-06-17 I10 ✓, no exclusions, most recent outpatient BP: 2026-07-25 (137/73) → 137 < 140 and 73 < 90 → compliant ✓
**71048**: Age 35 ✓, continuous ✓, event 2026-05-15 I10 ✓, no exclusions, most recent outpatient BP: 2026-05-15 (134/93) → 93 ≥ 90 → non_compliant ✓
**71049**: Age 61 ✓, one gap of 33 days ✓, but event: first I10 encounter is 2026-08-25 (after 2026-06-30) → no qualifying event → not_eligible ✓
**71050**: Age 84 ✓, continuous ✓, event 2026-06-23 I10 ✓, no exclusions, most recent outpatient BP: 2026-09-08 (129/71) → 129 < 140 and 71 < 90 → compliant ✓
**71051**: Age 35 ✓, but two gaps (26 and 14 days) → not_eligible (even though hospice, enrolment fails first) ✓
**71052**: Age 35 ✓, one gap of 45 days ✓ (≤ 45), event 2026-04-08 I10 ✓, no exclusions, most recent outpatient BP: 2026-07-13 (127/73) → 127 < 140 and 73 < 90 → compliant ✓
**71053**: Age 84 ✓, one gap of 22 days ✓, event 2026-05-22 I10 ✓, no exclusions, most recent outpatient BP: 2026-06-26 (133/95) → 95 ≥ 90 → non_compliant ✓
**71054**: Age 84 ✓, one gap of 42 days ✓, event 2026-03-21 I10 ✓, no exclusions, most recent outpatient BP: 2026-10-28 (132/95) → 95 ≥ 90 → non_compliant ✓
**71055**: Age 86 → not_eligible ✓
**71056**: Age 84 ✓, continuous ✓, event 2026-01-19 I10 ✓, no exclusions, most recent outpatient BP: 2026-03-20 (153/86) → 153 ≥ 140 → non_compliant ✓
All checks out. Let me compile the final answer:
denominator = 9
numerator = 3
excluded = 1
not_eligible = 6
rate = 33.3
compliant_members = ["71047", "71050", "71052"]
non_compliant_members = ["71041", "71043", "71048", "71053", "71054", "71056"]
excluded_members = ["71044"]
not_eligible_members = ["71042", "71045", "71046", "71049", "71051", "71055"]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,071 tokens
Let me work through each member systematically against the measure specification.
**MEASURE QM-CBP — BLOOD PRESSURE CONTROL IN HYPERTENSION**
Measurement year: 2026-01-01 through 2026-12-31.
**ELIGIBLE POPULATION (denominator):**
- Age: 18 through 85 years as of 2026-12-31.
- Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event.
- Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator.
**NUMERATOR:**
- The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold.
- A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading.
- If no qualifying reading exists, the member is in the denominator and not in the numerator.
**REQUIRED EXCLUSIONS (remove from the denominator before scoring):**
- E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31.
- E2. Pregnancy (any O00-O9A code) during the measurement year.
- E3. Enrolled in hospice or receiving palliative care at any time during the measurement year.
- E4. Died during the measurement year.
Let me go through each member:
---
**MEMBER 71041:**
- DOB: 1941-07-25 → 85 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-02-18 Office visit, diagnosis I10. This is within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-02-18.
- Exclusions: No ESRD, no pregnancy, no hospice, alive at year end. None.
- Numerator: Most recent outpatient BP reading on or after 2026-02-18 and on or before 2026-12-31.
- 2026-02-18 Office visit BP 150/72 (outpatient, qualifies)
- 2026-05-18 Inpatient admission BP 159/81 (inpatient - skipped)
- Most recent qualifying outpatient reading: 2026-02-18 BP 150/72. Systolic 150 ≥ 140, so NOT below 140. Diastolic 72 < 90. Both must be below threshold. 150 is not below 140. → Non-compliant.
**Status: non_compliant**
---
**MEMBER 71042:**
- DOB: 1940-06-12 → 86 years old on 2026-12-31. ✗ Age must be 18-85. 86 > 85.
- Not eligible due to age.
**Status: not_eligible**
---
**MEMBER 71043:**
- DOB: 1991-01-17 → 35 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-02-12 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-02-12.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-02-12 and on or before 2026-12-31.
- 2026-02-12 Office visit BP 126/73 (outpatient) ✓
- 2026-03-21 Office visit BP 135/73 (outpatient) ✓
- 2026-05-22 Office visit BP 119/102 (outpatient) ✓ - diastolic 102 ≥ 90, not below
- 2026-10-02 Office visit BP 136/103 (outpatient) ✓ - diastolic 103 ≥ 90, not below
- Most recent qualifying outpatient reading: 2026-10-02 BP 136/103. Systolic 136 < 140 ✓, but diastolic 103 ≥ 90 ✗. Not both below. → Non-compliant.
**Status: non_compliant**
---
**MEMBER 71044:**
- DOB: 1956-05-26 → 70 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-04-23 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-04-23.
- Exclusions: 2024-06-20 Diagnosis N18.6, end stage renal disease. E1 applies - ESRD any time on or before 2026-12-31. → Excluded.
**Status: excluded**
---
**MEMBER 71045:**
- DOB: 1982-06-22 → 44 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05. This means not enrolled for the full measurement year (2026-01-01 through 2026-12-31). The enrolment requirement says "enrolled for the full measurement year with no more than one gap of up to 45 days." Not enrolled from 2026-01-01 to 2026-04-04 is more than a gap - it's a lack of enrolment at the start. Actually, wait. Let me re-read: "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator."
Not being enrolled from 2026-01-01 to 2026-04-05 means they weren't enrolled for the full measurement year. The gap from 2026-01-01 to 2026-04-04 is about 93 days, which is longer than 45 days. So this fails the continuous enrolment requirement. → Not eligible.
Actually, let me think about this more carefully. The member is enrolled from 2026-04-05 through 2026-12-31. They were not enrolled before that. So there's a gap from 2026-01-01 to 2026-04-04. That's 93 days (January has 31 days, February 28, March 31, plus April 1-4 = 4 days, total = 31+28+31+4 = 94 days). Wait, let me count: from 2026-01-01 to 2026-04-04. January: 31 days, February: 28 days (2026 is not a leap year), March: 31 days, April 1-4: 4 days. Total = 31+28+31+4 = 94 days. That's way more than 45 days.
So the member is not enrolled for the full measurement year. The gap is longer than 45 days. → Not eligible.
**Status: not_eligible**
---
**MEMBER 71046:**
- DOB: 1991-10-18 → 35 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days.
- Gap from 2026-04-27 to 2026-06-23. Let me count: April 27-30 = 4 days, May = 31 days, June 1-23 = 23 days. Total = 4+31+23 = 58 days. This is longer than 45 days. → Not eligible due to enrolment gap > 45 days.
**Status: not_eligible**
---
**MEMBER 71047:**
- DOB: 2008-04-06 → 18 years old on 2026-12-31. ✓ Age 18-85 (18 is inclusive).
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-06-17 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-06-17.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-06-17 and on or before 2026-12-31.
- 2026-06-17 Office visit BP 138/76 (outpatient) ✓ - systolic 138 < 140 ✓, diastolic 76 < 90 ✓
- 2026-07-25 Office visit BP 137/73 (outpatient) ✓ - systolic 137 < 140 ✓, diastolic 73 < 90 ✓
- 2026-11-21 Inpatient admission BP 118/88 (inpatient - skipped)
- Most recent qualifying outpatient reading: 2026-07-25 BP 137/73. Systolic 137 < 140 ✓, diastolic 73 < 90 ✓. Both below. → Compliant.
**Status: compliant**
---
**MEMBER 71048:**
- DOB: 1991-04-26 → 35 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-05-15 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-05-15.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-05-15 and on or before 2026-12-31.
- 2026-05-15 Office visit BP 134/93 (outpatient) ✓ - systolic 134 < 140 ✓, diastolic 93 ≥ 90 ✗. Not both below. → Non-compliant.
**Status: non_compliant**
---
**MEMBER 71049:**
- DOB: 1965-05-12 → 61 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days.
- Gap from 2026-06-27 to 2026-07-29. Let me count: June 27-30 = 4 days, July 1-29 = 29 days. Total = 4+29 = 33 days. This is ≤ 45 days. One gap. ✓ Continuous enrolment satisfied.
- Event: 2026-08-25 Office visit, diagnosis I10. Is this within 2026-01-01 to 2026-06-30? No, August 25 is after June 30. The qualifying encounter must be on or between 2026-01-01 and 2026-06-30. There are no other encounters with I10 before that. Let me check all encounters:
- 2026-08-25 Office visit, diagnosis I10 - after 2026-06-30, doesn't establish event
- 2026-11-28 Emergency department visit, diagnosis R07.9 - not I10, and ED
- 2026-12-25 Office visit, diagnosis I10 - after 2026-06-30, doesn't establish event
No qualifying I10 outpatient encounter between 2026-01-01 and 2026-06-30. → Not eligible (no qualifying event).
Wait, the event requirement says: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." The encounters on 2026-08-25 and 2026-12-25 have I10 but are after 2026-06-30. The one on 2026-11-28 is ED and R07.9. So no qualifying event in the first half of the year. → Not eligible.
**Status: not_eligible**
---
**MEMBER 71050:**
- DOB: 1942-01-04 → 84 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-06-23 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-06-23.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-06-23 and on or before 2026-12-31.
- 2026-06-23 Office visit BP 122/84 (outpatient) ✓ - systolic 122 < 140 ✓, diastolic 84 < 90 ✓
- 2026-09-08 Office visit BP 129/71 (outpatient) ✓ - systolic 129 < 140 ✓, diastolic 71 < 90 ✓
- Most recent qualifying outpatient reading: 2026-09-08 BP 129/71. Both below. → Compliant.
**Status: compliant**
---
**MEMBER 71051:**
- DOB: 1991-04-19 → 35 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days.
- Two gaps. "Two or more gaps of any length, removes the member from the denominator." → Not eligible due to two gaps.
Wait, but let me check exclusions first. Actually, the task says: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
So if a member fails age, event, or enrolment, they are not_eligible regardless of exclusions. Member 71051 has two gaps, so fails enrolment. They also have a hospice election (2026-10-27), which is an exclusion E3. But since they fail enrolment, they are not_eligible, not excluded.
**Status: not_eligible**
---
**MEMBER 71052:**
- DOB: 1991-11-27 → 35 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days.
- Gap from 2026-04-09 to 2026-05-23. Let me count: April 9-30 = 22 days, May 1-23 = 23 days. Total = 22+23 = 45 days. The specification says "no more than one gap of up to 45 days." 45 is within "up to 45 days" (inclusive). One gap of 45 days. ✓ Continuous enrolment satisfied.
- Event: 2026-04-08 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-04-08.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-04-08 and on or before 2026-12-31.
- 2026-04-08 Office visit BP 121/76 (outpatient) ✓
- 2026-06-04 Office visit BP 149/73 (outpatient) ✓ - systolic 149 ≥ 140 ✗
- 2026-07-13 Office visit BP 127/73 (outpatient) ✓ - systolic 127 < 140 ✓, diastolic 73 < 90 ✓
- 2026-07-16 Emergency department visit BP 119/89 (ED - skipped)
- Most recent qualifying outpatient reading: 2026-07-13 BP 127/73. Systolic 127 < 140 ✓, diastolic 73 < 90 ✓. Both below. → Compliant.
**Status: compliant**
---
**MEMBER 71053:**
- DOB: 1942-08-07 → 84 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days.
- Gap from 2026-05-16 to 2026-06-06. May 16-31 = 16 days, June 1-6 = 6 days. Total = 16+6 = 22 days. ≤ 45 days. One gap. ✓
- Event: 2026-05-22 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-05-22.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-05-22 and on or before 2026-12-31.
- 2026-05-22 Office visit BP 146/72 (outpatient) ✓ - systolic 146 ≥ 140 ✗
- 2026-06-26 Office visit BP 133/95 (outpatient) ✓ - systolic 133 < 140 ✓, diastolic 95 ≥ 90 ✗
- 2026-08-24 Inpatient admission BP 112/84 (inpatient - skipped)
- Most recent qualifying outpatient reading: 2026-06-26 BP 133/95. Systolic 133 < 140 ✓, but diastolic 95 ≥ 90 ✗. Not both below. → Non-compliant.
**Status: non_compliant**
---
**MEMBER 71054:**
- DOB: 1942-12-16 → 84 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days.
- Gap from 2026-05-07 to 2026-06-17. May 7-31 = 25 days, June 1-17 = 17 days. Total = 25+17 = 42 days. ≤ 45 days. One gap. ✓
- Event: 2026-03-21 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-03-21.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-03-21 and on or before 2026-12-31.
- 2026-03-21 Office visit BP 137/92 (outpatient) ✓ - diastolic 92 ≥ 90 ✗
- 2026-05-06 Office visit BP 138/85 (outpatient) ✓ - systolic 138 < 140 ✓, diastolic 85 < 90 ✓
- 2026-06-05 Inpatient admission BP 132/76 (inpatient - skipped)
- 2026-10-28 Office visit BP 132/95 (outpatient) ✓ - systolic 132 < 140 ✓, diastolic 95 ≥ 90 ✗
- Most recent qualifying outpatient reading: 2026-10-28 BP 132/95. Systolic 132 < 140 ✓, diastolic 95 ≥ 90 ✗. Not both below. → Non-compliant.
**Status: non_compliant**
---
**MEMBER 71055:**
- DOB: 1940-08-21 → 86 years old on 2026-12-31. 86 > 85. ✗ Age not 18-85.
**Status: not_eligible**
---
**MEMBER 71056:**
- DOB: 1942-01-17 → 84 years old on 2026-12-31. ✓ Age 18-85.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Event: 2026-01-19 Office visit, diagnosis I10. Within 2026-01-01 to 2026-06-30. ✓ Qualifying encounter date: 2026-01-19.
- Exclusions: No ESRD, no pregnancy, no hospice, alive. None.
- Numerator: Most recent outpatient BP reading on or after 2026-01-19 and on or before 2026-12-31.
- 2026-01-19 Office visit BP 125/88 (outpatient) ✓ - systolic 125 < 140 ✓, diastolic 88 < 90 ✓
- 2026-03-20 Office visit BP 153/86 (outpatient) ✓ - systolic 153 ≥ 140 ✗
- Most recent qualifying outpatient reading: 2026-03-20 BP 153/86. Systolic 153 ≥ 140 ✗. Not both below. → Non-compliant.
**Status: non_compliant**
---
Now let me compile the results:
**Compliant:** 71047, 71050, 71052
**Non-compliant:** 71041, 71043, 71048, 71053, 71054, 71056
**Excluded:** 71044
**Not eligible:** 71042, 71045, 71046, 71049, 71051, 71055
Let me verify the counts:
- Compliant: 3 members
- Non-compliant: 6 members
- Excluded: 1 member
- Not eligible: 6 members
Total: 3 + 6 + 1 + 6 = 16 ✓ (matches 16 members)
Denominator = compliant + non-compliant = 3 + 6 = 9
Numerator = 3 (compliant)
Excluded = 1
Not eligible = 6
Rate = 3/9 × 100 = 33.333... → 33.3 (rounded half up to one decimal place)
Let me double-check some tricky ones:
**71045:** Not enrolled before 2026-04-05. The gap from start of year to 2026-04-04 is about 93 days. But wait - is this really a "gap" in the sense of the enrolment rule? The rule says "enrolled for the full measurement year with no more than one gap of up to 45 days." If the member simply wasn't enrolled at the start of the year, that's not a gap within an enrolment period - that's not being enrolled for the full year. Either way, the member doesn't meet the continuous enrolment requirement. Not eligible. ✓
**71052:** Gap of exactly 45 days. "up to 45 days" - this is inclusive, so 45 days is allowed. ✓
**71049:** The I10 encounters are on 2026-08-25 and 2026-12-25, both after 2026-06-30. No qualifying I10 encounter in the first half of the year. Not eligible. ✓
**71051:** Two gaps (26 and 14 days). Two or more gaps of any length removes from denominator. Not eligible. Even though there's a hospice election (exclusion), the member fails enrolment first, so not_eligible. ✓
Let me re-check member 71041:
- 2026-02-18 Office visit, I10 - qualifying event
- 2026-05-18 Inpatient admission - skipped for BP
- Most recent outpatient BP after qualifying encounter date (2026-02-18): only the 2026-02-18 reading (150/72). The inpatient one is skipped. 150 ≥ 140. Non-compliant. ✓
Actually wait - the 2026-05-18 is inpatient, so it's skipped. The only outpatient BP after 2026-02-18 is the 2026-02-18 reading itself (150/72). 150 ≥ 140, so non-compliant. ✓
Let me also re-check 71047 more carefully:
- 2026-06-17 Office visit I10 - qualifying event (within 01-01 to 06-30)
- 2026-07-25 Office visit I10 BP 137/73 - outpatient, after qualifying encounter date
- 2026-11-21 Inpatient admission - skipped
- Most recent outpatient BP: 2026-07-25 137/73. 137 < 140 and 73 < 90. Compliant. ✓
All checks out. Let me write the final answer.
Compliant members: ["71047", "71050", "71052"]
Non-compliant members: ["71041", "71043", "71048", "71053", "71054", "71056"]
Excluded members: ["71044"]
Not eligible members: ["71042", "71045", "71046", "71049", "71051", "71055"]
Denominator: 9
Numerator: 3
Excluded: 1
Not eligible: 6
Rate: 33.3json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
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},
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},
{
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},
{
"field": "rate",
"want": 33.3,
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},
{
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"want": [
"71047",
"71050",
"71052"
],
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],
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},
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],
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},
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"71044"
],
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"71044"
],
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},
{
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"want": [
"71042",
"71045",
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"71049",
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],
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"71042",
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"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,084 tokens
Let me work through each member systematically.
**MEMBER 71041**
- Age: 85 on 2026-12-31 ✓ (18-85)
- Enrolment: continuous, no gaps ✓
- Event: 2026-02-18 office visit, diagnosis I10, within 2026-01-01 to 2026-06-30 ✓
- Exclusions: none
- Numerator: Most recent outpatient BP reading on or after the qualifying encounter date (2026-02-18) and on or before 2026-12-31, excluding ED/inpatient.
- 2026-02-18 office visit: BP 150/72 — not below 140 systolic
- 2026-05-18 inpatient admission: skipped (inpatient)
- Most recent qualifying reading: 150/72, not below 140/90
- Status: non_compliant
**MEMBER 71042**
- Age: 86 on 2026-12-31 — exceeds 85. NOT ELIGIBLE.
- Status: not_eligible
**MEMBER 71043**
- Age: 35 ✓
- Enrolment: continuous ✓
- Event: 2026-02-12 office visit, I10 ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-02-12, excluding ED/inpatient:
- 2026-02-12: 126/73
- 2026-03-21: 135/73
- 2026-05-22: 119/102 — diastolic not below 90
- 2026-10-02: 136/103 — diastolic not below 90
- Most recent: 2026-10-02, 136/103 — not below 140/90
- Status: non_compliant
**MEMBER 71044**
- Age: 70 ✓
- Enrolment: continuous ✓
- Event: 2026-04-23 office visit, I10 ✓
- Exclusion E1: N18.6 (ESRD) diagnosed 2024-06-20, on or before 2026-12-31 ✓
- Status: excluded
**MEMBER 71045**
- Age: 44 ✓
- Enrolment: 2026-04-05 through 2026-12-31, not enrolled before. Not full year. Gap from 2026-01-01 to 2026-04-04 = 93 days. This is more than 45 days gap.
- Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. Not enrolled 2026-01-01 to 2026-04-04 — that's a gap of more than 45 days.
- Status: not_eligible
**MEMBER 71046**
- Age: 35 ✓
- Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days. Gap > 45 days.
- Status: not_eligible
**MEMBER 71047**
- Age: 18 ✓
- Enrolment: continuous ✓
- Event: 2026-06-17 office visit, I10, within 2026-01-01 to 2026-06-30 ✓ (also 2026-07-25 but that's after 06-30)
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-06-17, excluding ED/inpatient:
- 2026-06-17: 138/76 ✓
- 2026-07-25: 137/73 ✓
- 2026-11-21 inpatient: skipped
- Most recent qualifying: 2026-07-25, 137/73 — below 140/90 ✓
- Status: compliant
**MEMBER 71048**
- Age: 35 ✓
- Enrolment: continuous ✓
- Event: 2026-05-15 office visit, I10 ✓
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-05-15:
- 2026-05-15: 134/93 — diastolic not below 90
- Status: non_compliant
**MEMBER 71049**
- Age: 61 ✓
- Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days. ≤45 days, one gap. ✓
- Event: 2026-08-25 office visit, I10 ✓ (within 2026-01-01 to 2026-06-30? No, 2026-08-25 is after 2026-06-30.)
Wait, the event needs to be on or between 2026-01-01 and 2026-06-30. 2026-08-25 is after 06-30. 2026-11-28 is ED. 2026-12-25 is after 06-30.
So no qualifying event. The qualifying hypertension encounter must be between 2026-01-01 and 2026-06-30. None of the I10 office visits are in that window.
- Status: not_eligible (fails event requirement)
Wait, let me re-read: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30."
The encounters:
- 2026-08-25 office visit, I10 — after 06-30
- 2026-11-28 ED, R07.9 — not I10, and ED
- 2026-12-25 office visit, I10 — after 06-30
None qualify. Not eligible.
Status: not_eligible
**MEMBER 71050**
- Age: 84 ✓
- Enrolment: continuous ✓
- Event: 2026-06-23 office visit, I10 ✓ (within window)
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-06-23:
- 2026-06-23: 122/84 ✓
- 2026-09-08: 129/71 ✓
- Most recent: 2026-09-08, 129/71 — below 140/90 ✓
- Status: compliant
**MEMBER 71051**
- Age: 35 ✓
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days. Two gaps → removes from denominator.
- Status: not_eligible
Wait, but there's also hospice (E3). But exclusions are only evaluated for members in the eligible population. This member fails continuous enrolment (two gaps), so not_eligible. Per the rules: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
Status: not_eligible
**MEMBER 71052**
- Age: 35 ✓
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days. 45 days ≤ 45 days ✓. One gap ✓.
- Event: 2026-04-08 office visit, I10 ✓ (within window). Also 2026-06-04, 2026-07-13 I10 office visits, but after 06-30.
- Actually wait, 2026-04-08 is within 2026-01-01 to 2026-06-30 ✓. So the qualifying encounter date is 2026-04-08.
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-04-08, excluding ED:
- 2026-04-08: 121/76 ✓
- 2026-06-04: 149/73 — systolic not below 140
- 2026-07-13: 127/73 ✓
- 2026-07-16 ED: skipped
- Most recent qualifying: 2026-07-13, 127/73 — below 140/90 ✓
- Status: compliant
**MEMBER 71053**
- Age: 84 ✓
- Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days ✓.
- Event: 2026-05-22 office visit, I10 ✓ (within window). Also 2026-06-26 I10 office visit (after 06-30).
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-05-22, excluding inpatient:
- 2026-05-22: 146/72 — systolic not below 140
- 2026-06-26: 133/95 — diastolic not below 90
- 2026-08-24 inpatient: skipped
- Most recent qualifying: 2026-06-26, 133/95 — not below 140/90
- Status: non_compliant
**MEMBER 71054**
- Age: 84 ✓
- Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days ✓ (≤45).
- Event: 2026-03-21 office visit, I10 ✓ (within window). Also 2026-05-06 I10 office visit (within window).
- Exclusions: none
- Numerator: Most recent outpatient BP on or after the qualifying encounter date. The qualifying encounter is the first one that establishes the event. Let me re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter."
The qualifying hypertension encounter is the one that establishes the event (I10 office visit between 01-01 and 06-30). The first one is 2026-03-21. So BP readings on or after 2026-03-21:
- 2026-03-21: 137/92 — diastolic not below 90
- 2026-05-06: 138/85 ✓
- 2026-06-05 inpatient: skipped
- 2026-10-28 office visit (E78.5): 132/95 — diastolic not below 90
- Most recent qualifying outpatient: 2026-10-28, 132/95 — not below 140/90
- Status: non_compliant
Wait, but the numerator says "outpatient blood pressure reading" — it doesn't require the reading to be from a hypertension encounter. It just needs to be an outpatient BP reading on or after the qualifying encounter date. So 2026-10-28 office visit with E78.5 diagnosis, BP 132/95, counts as an outpatient BP reading.
So most recent is 2026-10-28: 132/95 — not below 90 diastolic. Non-compliant.
Status: non_compliant
**MEMBER 71055**
- Age: 86 on 2026-12-31 — exceeds 85. NOT ELIGIBLE.
- Status: not_eligible
**MEMBER 71056**
- Age: 84 ✓
- Enrolment: continuous ✓
- Event: 2026-01-19 office visit, I10 ✓ (within window). Also 2026-03-20 I10 office visit.
- Exclusions: none
- Numerator: Most recent outpatient BP on or after 2026-01-19:
- 2026-01-19: 125/88 ✓
- 2026-03-20: 153/86 — systolic not below 140
- Most recent: 2026-03-20, 153/86 — not below 140/90
- Status: non_compliant
Let me compile:
Compliant: 71047, 71050, 71052
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056
Excluded: 71044
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055
Let me verify counts:
- Compliant: 3
- Non-compliant: 6
- Excluded: 1
- Not eligible: 6
- Total: 16 ✓
Denominator = compliant + non_compliant = 3 + 6 = 9
Numerator = 3
Rate = 3/9 × 100 = 33.333... → 33.3json{
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"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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{
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Opus 4.8 · Anthropic24.6s · 2,267 out | 27.7s · 2,506 out | 29.0s · 2,401 out
Reasoning · 2,092 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
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"excluded_members": ["71044"],
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}
Grader detail
json{
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"71049",
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,331 tokens
[omitted]json{
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"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
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Grader detail
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{
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,226 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
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}
Grader detail
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},
{
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"present": true
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{
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"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Sonnet 5 · Anthropic43.4s · 5,299 out | 40.2s · 4,647 out | 39.1s · 4,416 out
Reasoning · 5,124 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
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}
Grader detail
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{
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{
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},
{
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,472 tokens
[omitted]json{
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"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
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}
Grader detail
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"present": true
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"got": [
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"ok": true,
"present": true
},
{
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"ok": true,
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}
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"fabricated": false,
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}Reasoning · 4,241 tokens
[omitted]json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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}100Claude Sonnet 4.6 · Anthropic117.0s · 7,758 out | 122.1s · 7,956 out | 110.0s · 7,930 out
Reasoning · 7,601 tokens
Let me analyze each member against the measure specification.
**MEASURE QM-CBP — BLOOD PRESSURE CONTROL IN HYPERTENSION**
**Eligible Population Criteria:**
- Age: 18-85 as of 2026-12-31
- Event: at least one outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30
- Continuous enrollment: full year with no more than one gap of up to 45 days
**Numerator:**
- Most recent outpatient BP reading on or after qualifying encounter date and on or before 2026-12-31
- BP < 140 systolic AND < 90 diastolic, excluding ED and inpatient readings
**Exclusions:**
- ESRD/dialysis, pregnancy, hospice/palliative care, or death during the measurement year
Now I'm working through each member one at a time, checking Member 71041 first: born 1941, turning 85 by year-end so they qualify on age, and I'm verifying their enrollment start date.
Continuous enrollment confirmed, qualifying visit on 2026-02-18 with hypertension diagnosis, no exclusions found - they're in the denominator. Checking BP readings after that date, I skip the inpatient one and use the office visit reading of 150/72, which is above threshold, so this member is non_compliant. Moving to Member 71042, they'll be 86 by year-end which exceeds the age cap, so they're not_eligible.
Looking at the outpatient BP readings for member 71043, the most recent qualifying one is 2026-10-02 at 136/103 — systolic passes but diastolic 103 fails the <90 threshold, so this member is non_compliant.
Moving to member 71044: DOB 1956-05-26, age 70, continuous enrollment, qualifying event on 2026-04-23.
This member has ESRD diagnosed 2024-06-20, which triggers exclusion E1, so they're excluded.
For member 71045, enrollment doesn't start until 2026-04-05, leaving a 93-day gap before that — well over the allowed 45 days — so this member fails eligibility and is not_eligible.
For member 71046, age checks out, but there's a 58-day enrollment gap between April 26 and June 24, exceeding the 45-day limit, so this member is also not_eligible.
For member 71047, age is 18 and enrollment is continuous, with a qualifying office visit on June 17 for I10 placing them in the denominator with no exclusions. I'm now reviewing their outpatient BP readings from that visit onward — 138/76 on June 17, 137/73 on July 25, and checking the November 21 reading next.
I found the November 21 reading was during an inpatient admission, so I'm excluding it and using the July 25 reading (137/73) as the most recent qualifying result, which meets both thresholds, making this member compliant.
Member 71048 checks out for age and continuous enrollment with a qualifying May 15 office visit for I10. Their only outpatient BP reading is 134/93 from that same visit — systolic is fine but diastolic exceeds 90, making them non_compliant.
Now looking at member 71049, age 61 confirmed, with a 33-day enrollment gap that's within tolerance. I need to find a qualifying outpatient I10 encounter in the first half of the year, but the visit I see is from August 25, which falls outside that window.
Continuing on 71049 — both available encounters (August 25 and December 25) fall after the June 30 cutoff, so there's no qualifying event in the required window, making this member not_eligible.
Moving to member 71050, age 84, continuously enrolled, with a qualifying June 23 visit. I'm checking their outpatient BP readings after that date — the June visit shows 122/84 and a September visit shows 129/71, with the September reading being most recent and meeting both thresholds, so this member is compliant.
Now starting on member 71051, confirming age 35 and beginning to trace their enrollment periods, which show a gap starting after April 8.
Tracing the enrollment segments further, I find two gaps (26 and 14 days), which fails the enrollment continuity requirement, making this member not_eligible regardless of the hospice exclusion also present — since the spec states age, event, or enrollment failures override any documented exclusion.
Moving to member 71052, age 35, I'm checking their enrollment which shows a single 45-day gap that's exactly at the allowed limit, and verifying their April 8 office visit qualifies as the required event within the window. I'm double-checking the exact gap calculation to confirm it doesn't exceed the 45-day threshold.
Filtering out the emergency department visit, the most recent qualifying office reading is 127/73 on 2026-07-13, which passes both thresholds — this member is compliant.
Moving to member 71053, checking DOB and enrollment periods to confirm eligibility.
For the outpatient I10 encounter requirement, there's a 2026-05-22 visit, but that falls within a gap in enrollment (05-16 to 06-06), so I'm questioning whether the encounter itself needs to occur during an enrolled period or if continuous enrollment is just a separate eligibility criterion.
take the spec at face value here: the event window just requires the encounter to fall between 01-01 and 06-30, without explicitly requiring enrollment at that moment. The member's 05-22 encounter falls right in the gap period (05-16 to 06-06), which raises an ambiguity—technically it's within the date window, but the member wasn't enrolled then. The spec doesn't clearly address whether enrollment status at the encounter date matters separately from the overall continuous enrollment check.
Since the roster explicitly lists this encounter, I'm leaning toward counting it as qualifying, treating enrollment and the event as distinct criteria. I also want to check the 06-26 encounter with I10, which falls after enrollment resumes on 06-07, as another possible qualifying event.
So the member has two potential qualifying events, no exclusions, and passes enrollment and age checks. For BP readings, I need to determine which qualifying encounter date establishes the earliest valid window for outpatient readings taken on or after that date, since the spec allows multiple qualifying encounters but ties the reading window to "the qualifying hypertension encounter."
Whichever encounter serves as the reference, the most recent qualifying BP reading is 133/95 on 06-26 -- systolic passes but diastolic fails, so this member is non_compliant.
Moving to member 71054: DOB confirms age 84, enrollment has one 42-day gap which meets the requirement, and I'm checking the gap dates against the qualifying encounter window.
I confirm both office visits (03-21 and 05-06) fall within the enrollment window with I10 diagnosis, no exclusions apply, so this member is in the denominator. Now I'm pulling the outpatient BP readings on or after 03-21 to determine compliance.
For member 71055, BP readings from 03-21 through 10-28 show the most recent qualifying value on 10-28 at 132/95 -- systolic passes but diastolic fails at 95, so this member is non-compliant. This member is over the age limit at 86, so they're not eligible; then I move to member 71056, who at age 84 passes the age check and has continuous enrollment.
For 71056, I check the qualifying events on 01-19 and 03-20, confirm no exclusions apply, and pull outpatient BP readings from those visits. The most recent qualifying reading is 153/86 on 03-20, and since systolic is 153 (at or above 140), this member is non-compliant.
Now I'm compiling the not_eligible list: 71042 exceeds the age limit, 71045 and 71046 have enrollment gaps exceeding 45 days, 71049 lacks a qualifying diagnosis event before mid-year, and 71051 is also excluded.
Rechecking 71042, the member is 86, outside the 18-85 age range, so age alone disqualifies them regardless of their enrollment gaps. For 71049, all I10 encounters fall after 06-30, so there's no qualifying event and they're not_eligible.
I'm now verifying 71051's enrollment gaps more carefully — with periods of coverage broken by 26 and 14 day gaps, that's two separate gaps, which confirms not_eligible rather than excluded status.
Going through exclusions across the eligible population, only 71044 has an ESRD diagnosis warranting exclusion; everyone else (71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056) passes into the denominator. That gives me categories: not_eligible for 71042, 71045, 71046, 71049, 71051, 71055; excluded for 71044; compliant for 71047, 71050, 71052; and non_compliant for 71041, 71043, 71048, 71053, 71054, 71056. I'm now going back through each member one more time to confirm these classifications are correct, starting with 71041.
For 71041, the patient is 85, meets continuous enrollment, has the qualifying I10 event on 02-18, has no exclusions, and the most recent applicable outpatient BP reading (skipping the inpatient one) is 150/72 — since 150 exceeds the 140 threshold, this is correctly non_compliant.
For 71047, I'm verifying age eligibility (turns 18 in April 2026, so qualifies as of year-end), confirming continuous enrollment and the June 17 office visit with I10, checking there are no exclusions, and now looking at their BP readings from that visit onward to determine final compliance status.
Checking 71050, 71052, and starting 71043 for the same criteria — age, enrollment gaps, qualifying diagnosis events, exclusions, and identifying the most recent outpatient BP reading (skipping inpatient/ED visits) to determine whether both systolic and diastolic values fall under the compliance thresholds.
**71048** - non_compliant: BP 134/93 fails since diastolic 93 exceeds 90.
**71053** - I'm now confirming denominator eligibility: age 84, one 22-day enrollment gap acceptable, and checking for a qualifying I10 encounter within the measurement window, starting with the 05-22 office visit.
The 05-22 encounter falls in a gap where the member wasn't enrolled (gap ran 05-16 to 06-06, reenrolled 06-07), so it doesn't count, but the 06-26 office visit does since the member was enrolled and it's within the window. Using 06-26 as the qualifying event, the most recent outpatient BP reading is 133/95 (skipping the 08-24 inpatient reading), and diastolic 95 exceeds 90, making this non_compliant. I'm second-guessing whether the 05-22 encounter should count despite the enrollment gap, since the spec's language just refers to an outpatient encounter without explicitly requiring concurrent enrollment.
Moving on, I'm going through the remaining cases: 71054 is non_compliant since diastolic 95 exceeds threshold, and 71056 is non_compliant since systolic 153 exceeds 140. Now I'm compiling the not_eligible list, checking each member's disqualifying reason like age or enrollment gaps exceeding 45 days.
Totaling everything: 6 not_eligible, 1 excluded, 3 compliant (71047, 71050, 71052), and 6 non_compliant (71041, 71043, 71048, 71053, 71054, 71056), which sums to 16 members correctly. This gives a denominator of 9 and numerator of 3, so the rate calculates to 33.3%.
Now checking 71046's enrollment gap between April 27 and June 23 — I'm counting the days remaining in April, all of May, and the days in June to determine the total gap length.
Total confirmed at 58 days, exceeding the 45-day threshold, so this member is not_eligible.
For 71045, I'm calculating the gap from January 1 to April 4 before enrollment begins, summing January through early April, which comes to 94 days — far above the 45-day limit, confirming not_eligible.
With both verifications matching my earlier findings, I'm ready to finalize the results starting with the denominator.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
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"fabricated": false,
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}Reasoning · 7,798 tokens
Let me analyze each member against the measure specification QM-CBP.
**ELIGIBLE POPULATION criteria:**
1. Age: 18-85 years as of 2026-12-31
2. Event: at least one outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30
3. Continuous enrollment: enrolled full year with no more than one gap of up to 45 days
**EXCLUSIONS:**
- E1: ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31
- E2: Pregnancy (O00-O9A) during measurement year
- E3: Hospice/palliative care
- E4: Died during measurement year
**NUMERATOR:** Most recent outpatient BP reading on or after the qualifying encounter date, with systolic <140 and diastolic <90; ED and inpatient readings don't count.
Now I'm working through members individually. Member 71041 (age 85) qualifies for the denominator with no exclusions, but their most recent outpatient BP reading on 2026-02-18 was 150/72, which fails the threshold — non-compliant. Member 71042 is 86 years old, so they're excluded for age and marked not eligible. I'm moving on to check member 71043's date of birth and eligibility next.
For member 71043 (age 35), enrollment and exclusions look clean, so they're in the denominator with qualifying I10 encounters in February and March. I'm now checking their BP readings and realizing the numerator criteria doesn't require the BP reading itself to occur at an I10-coded visit — any outpatient BP reading on or after the qualifying encounter date counts, including non-hypertension visits like the E78.5 encounters later in the year.
For 71043 specifically, the most recent outpatient BP is 136/103 from October 2nd — systolic passes but diastolic at 103 fails the <90 threshold, so this member is non-compliant.
Member 71044 (age 70) has a qualifying I10 visit and continuous enrollment, but a 2024 ESRD diagnosis (N18.6) excludes them from the measure entirely.
Now looking at member 71045 (age 44), I'm checking enrollment continuity and finding they weren't enrolled from January 1st through April 4th — a 94-day gap right at the start of the year, which exceeds the allowed 45-day gap threshold, so I need to determine if this disqualifies them from the denominator.
Confirming that gap makes 71045 not_eligible since it exceeds 45 days. Moving to member 71046 (age 35), who has qualifying office visits with I10 in both March and May, but their enrollment has a 58-day gap between April 26th and June 24th, which also exceeds the 45-day threshold, making them not_eligible on enrollment grounds.
Now checking member 71047 (age 18, born April 2008), who has a qualifying June 17th office visit with I10, continuous enrollment, and no exclusions — they belong in the denominator. For the numerator, I'm looking at outpatient BP readings on or after the June 17th qualifying date: 138/76 that same day, 137/73 on July 25th, and I'm skipping the November inpatient admission since it doesn't count as outpatient, leaving July 25th as the most recent qualifying reading.
That July 25th reading of 137/73 falls under both thresholds (140 systolic, 90 diastolic), so 71047 is compliant.
Member 71048 (age 35) qualifies via a May 15th office visit with I10, has continuous enrollment and no exclusions, putting them in the denominator. Their only BP reading is 134/93 from that same visit — systolic passes but diastolic at 93 fails the under-90 threshold, making them non-compliant.
For member 71049 (age 61), I'm checking for a qualifying I10 encounter in the first half of the year, but all three I10-related events (office visits and an ED visit) fall in August, November, and December — none within the January-June window — so this member is not_eligible. I'm also double-checking their enrollment, which shows a 33-day gap between late June and late July, well under the 45-day limit, though it doesn't matter since they already fail on the encounter timing requirement.
For member 71050 (age 84), the June 23rd office visit with I10 establishes eligibility with continuous enrollment and no exclusions. Checking their outpatient BP readings on or after that date, September 8th shows 129/71 as the most recent qualifying reading — both values pass, so this member is compliant.
Member 71051 (age 35) has two separate enrollment gaps of 26 and 14 days each, which under the rule that two or more gaps of any length disqualifies a member, makes them not_eligible regardless of their I10 encounters or hospice exclusion.
Member 71052 (age 35) has an April 8th I10 visit and a single 45-day enrollment gap that falls right at the limit, so they're in the denominator. Working through their BP readings after April 8th and skipping the ED visit, the July 13th reading of 127/73 is the most recent qualifying one, and both values pass — compliant.
Member 71053 (age 84) raises a tricky interpretation question: their May 22nd I10 encounter falls during an enrollment gap. I'm reasoning through whether the encounter must occur during enrolled periods per the spec, and concluding the specification doesn't explicitly require this, so I'll count it at face value along with BP readings taken during the gap. Following that logic, their most recent qualifying outpatient BP is June 26th at 133/95 — diastolic fails, so non-compliant.
Member 71054 (age 84) has two I10 visits early in the year and a 42-day enrollment gap, keeping them in the denominator. Tracing their outpatient BP readings from the earliest qualifying encounter and skipping the inpatient admission, the October 28th reading of 132/95 is most recent — diastolic fails, non-compliant.
Member 71055 fails outright at age 86, exceeding the eligibility cutoff, so not_eligible.
Member 71056 (age 84) has two I10 visits in January and March, continuous enrollment, and no exclusions. Their most recent qualifying BP from the March 20th visit is 153/86 — systolic fails at 153, making them non-compliant.
Now I'm consolidating results across all members into three groups: those who are not_eligible (71042, 71045, 71046, 71049, 71051, 71055) for failing age, enrollment gap rules, or missing qualifying encounters; those excluded (71044 for ESRD); and the remaining nine members who are in the denominator with defined compliant/non-compliant statuses I've calculated for each.
I'm now going back through each denominator member one more time to verify my compliance determinations are consistent — checking 71041's non-compliant status from their 150/72 reading, 71043's non-compliant status from failing the diastolic threshold, and reconfirming 71047's compliant status, before moving to double-check 71048 and 71050's determinations as well.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
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],
"ok": true,
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},
{
"field": "excluded_members",
"want": [
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],
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],
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},
{
"field": "not_eligible_members",
"want": [
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"ok": true,
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}
],
"fabricated": false,
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}Reasoning · 7,773 tokens
Let me analyze each member against the QM-CBP measure specification.
**ELIGIBLE POPULATION CRITERIA:**
1. Age: 18-85 as of 2026-12-31
2. Event: ≥1 outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30
3. Continuous enrollment: full year with no more than one gap of up to 45 days
**EXCLUSIONS:**
- E1: ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31
- E2: Pregnancy during the measurement year
- E3: Hospice/palliative care during the measurement year
- E4: Died during the measurement year
**NUMERATOR:** the most recent qualifying outpatient BP reading on or after the hypertension encounter date and by year-end must show systolic under 140 and diastolic under 90.
Now I'm working through each member individually, starting with member 71041 — checking their age (85, eligible), enrollment continuity, and other qualifying criteria.
For member 71041, the qualifying encounter is a 2026-02-18 office visit with an I10 diagnosis, which falls in the right window and has no exclusions, so they land in the denominator. Their most recent outpatient BP reading before year-end is 150/72 from that same visit (the later inpatient admission doesn't count), and since 150 systolic is above the 140 threshold, this member is non-compliant. I'm now checking member 71042, whose age of 86 as of year-end puts them over the eligibility limit, excluding them from the measure entirely.
For member 71043, age 35 keeps them eligible with continuous enrollment, and I'm finding qualifying I10 encounters on 2026-02-12 and 2026-03-21 (a later E78.5 visit doesn't count). With no exclusions present, they're in the denominator, and I'm now pulling their BP reading of 126/73 from the qualifying 2026-02-12 visit to check the numerator.
Continuing through their BP readings — 135/73, then 119/102 on the E78.5 visit, then 136/103 on 2026-10-02, which becomes the most recent qualifying outpatient reading. Since 103 ≥ 90 fails the diastolic threshold, this member is non-compliant.
Moving to member 71044: DOB 1956-05-26 puts them at age 70, well within range, with continuous enrollment. I find a qualifying I10 diagnosis on 2026-04-23, but then I spot an N18.6 diagnosis from 2024-06-20, which triggers the E1 exclusion.
Member 71045: age 44, eligible. But looking at enrollment, they weren't covered until 2026-04-05, leaving a gap from January 1st to April 4th — roughly 94 days. That's well beyond the 45-day threshold for continuous enrollment, so this member fails eligibility.
Moving to member 71046: age 35, eligible age-wise. Enrollment runs 2026-01-01 to 2026-04-26, then resumes 2026-06-24 through year end, creating a 58-day gap in between — exceeding the 45-day limit, so this member is also not eligible.
Member 71047: born 2008-04-06, turning exactly 18 by year end, so age-eligible. Their enrollment is continuous with no gaps, so that checks out fine. I see an office visit event on 2026-06-17 with an I10 diagnosis code.
This member qualifies for the initial population window. No exclusions apply — no ESRD, pregnancy, hospice, and they're alive — so they land in the denominator. For the numerator, I need the most recent outpatient BP reading on or after 2026-06-17: there's a 138/76 reading on 6/17 and a 137/73 reading on 7/25, then an inpatient admission on 11/21 that I skip since it's not outpatient. The most recent qualifying reading is 137/73 from 7/25, which is under both thresholds — so this member is compliant.
Now checking member 71048: born 1991-04-26, turning 35 this year so age-eligible, with continuous enrollment and no gaps. I see an event dated 2026-05-15.
For member 71049, born 1965-05-12, age 61 — eligible. Enrollment has a 33-day gap from 6/27 to 7/29, which stays within the 45-day allowance, so they're still qualifying. I'm now checking for a required I10 diagnosis between 1/1 and 6/30, and I see a date of 2026-08-25 to evaluate against that window.
Since both encounters (8/25 and 12/25) fall after 6/30, they don't establish the qualifying event, so this member is NOT_ELIGIBLE.
For member 71050, born 1942-01-04, age 84 — eligible. Enrollment is continuous with no gaps. There's a qualifying office visit with I10 on 6/23, which falls within the required window.
No exclusions apply (no ESRD, pregnancy, or hospice, and the member is alive), so they're in the denominator. For the numerator, I need the most recent outpatient BP reading on or after 6/23. The 9/8 visit (J06.9, still outpatient) shows BP 129/71, which is more recent than the 6/23 reading of 122/84. Since 129 and 71 are both under threshold, this member is COMPLIANT.
Moving to member 71051, born 1991-04-19, age 35 — eligible. Checking their enrollment periods, which show a 26-day gap between 4/8 and 5/5.
Now checking the gap length between the enrollment periods - counting days from 2026-04-09 to 2026-05-23, working through April and May separately to get the total gap duration.
That gives 45 days, matching the spec's limit of "up to 45 days" exactly, so enrollment holds. With the April office visit event confirmed within the qualifying window and no exclusions applying, this patient belongs in the denominator, so now I'm checking numerator criteria by looking for the most recent outpatient blood pressure reading.
Scanning through visits from April onward, I skip the ED visit and land on the July 13 office visit with BP 127/73, which is well under the 140/90 threshold — this member is compliant.
Moving to member 71053, born in 1942, age 84 and eligible, with an enrollment gap of 22 days that needs verification against the spec's limits.
The gap runs from May 16 to June 6, exactly 22 days, so it's within the allowed threshold. But there's an office visit on May 22 with an I10 diagnosis that falls right inside this gap period — I need to think through whether an encounter during a permissible gap still counts toward satisfying the measure's event requirement.
The spec's language doesn't explicitly tie the encounter to being during continuous enrollment, it just specifies the encounter must fall within the date range. Since I'm meant to work strictly from what's stated in the prompt rather than assuming typical HEDIS conventions, I'll treat the encounter as valid based on its literal reading.
Following that logic, the 2026-05-22 encounter with I10 qualifies since it falls within the window. Checking 71053's other encounters, the 2026-06-26 visit also falls within enrollment and the window, so that one counts too.
So 71053 goes into the denominator, with no exclusions since there's no ESRD, pregnancy, or hospice. For the numerator, I need the most recent outpatient BP on or after the qualifying encounter date, checking which readings fall on or after 2026-05-22.
Either way the most recent qualifying reading is 133/95, so this member is NON_COMPLIANT regardless of which encounter date is used.
Moving to member 71054: DOB 1942-12-16, age 84 at year end, eligible. Enrollment runs 2026-01-01 to 2026-05-06, then a gap, then 2026-06-18 to 2026-12-31. I'm calculating the gap length between the two enrollment periods.
The 42-day gap falls within the allowed 45 days, so it's fine. Qualifying encounters occur on 2026-03-21 and 2026-05-06 (office visits, I10 diagnosis), putting the member in the denominator. No exclusions apply (no ESRD, pregnancy, or hospice, and the member is alive). For the numerator I'm checking outpatient BP readings after the qualifying encounter: 137/92 on 3/21, 138/85 on 5/6, then a 6/5 inpatient admission I'm skipping since it doesn't count.
The most recent qualifying outpatient reading is 2026-10-28 at 132/95 - systolic passes at 132 but diastolic fails at 95, so this member is non-compliant.
Member 71055 is ineligible due to age (86 as of year-end, exceeding the 85 cutoff).
Member 71056 is 84, so eligible by age, with continuous enrollment and no gaps. Their first qualifying encounter is an office visit on 2026-01-19 with I10 diagnosis.
A second qualifying event on 2026-03-20 confirms this member is in the denominator, with no exclusions (no ESRD, pregnancy, hospice, and alive). Looking at the numerator, the most recent outpatient BP reading on or after the initial qualifying encounter is 153/86 from 2026-03-20 - systolic fails at 153, so this member is non-compliant. Now I need to go back and revisit member 71051's situation more carefully.
Checking their enrollment periods, I count two separate gaps (26 days and 14 days), which pushes them to not-eligible on enrollment grounds - and since enrollment fails, any documented hospice exclusion becomes moot per the rule that age, event, or enrollment failures override exclusion status. I'm starting to compile the final summary lists, beginning with the not-eligible members: 71042 for age, 71045 for an enrollment gap exceeding 45 days at the start.
Continuing that list, I add 71046 for another oversized enrollment gap, 71049 for missing a qualifying I10 event in the window, 71051 for its two gaps, and 71055 for age. For exclusions, only 71044 qualifies through ESRD (E1) - I confirm 71051's hospice exclusion doesn't count since it's already not-eligible on enrollment grounds. Now I'm moving toward assembling the denominator population.
That gives 9 members in the denominator: 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056. Now I'm checking each one's compliance status based on their most recent blood pressure readings - 71041 and 71043 are non-compliant due to elevated readings, 71047 is compliant, 71048 is non-compliant on diastolic, and 71050 and 71052 look compliant based on their outpatient readings.
So the final tally: numerator (compliant) is 71047, 71050, 71052 for 3 members; non-compliant is 71041, 71043, 71048, 71053, 71054, 71056 for 6 members; excluded is just 71044; and not eligible covers 71042, 71045, 71046, 71049, 71051, 71055 for 6 members. Total adds up correctly across all categories.
Rate calculation: 3/9 × 100 = 33.3%.
Let me double-check member 71041 though - office visit on 2026-02-18 with BP 150/72 as an outpatient encounter, then an inpatient admission on 2026-05-18 that gets skipped. The most recent outpatient BP is that same 2026-02-18 reading, and 150/72 has systolic 150 ≥ 140, confirming non-compliant status.
Now checking member 71047: qualifying encounter 2026-06-17, with outpatient BPs of 138/76 on that date, 137/73 on 2026-07-25, and an inpatient encounter on 2026-11-21 that's excluded. The most recent outpatient reading is 137/73, which is under both thresholds — compliant.
Now moving to member 71050.
Filtering out an ED visit, the most recent outpatient BP for this member is 127/73, which is compliant, giving a rate of 3/9 = 33.3%. Now I'm verifying member 71053's enrollment periods, noting the gap from 2026-05-16 to 2026-06-06 before re-enrollment.
The gap totals 22 days, well within the 45-day allowance, so it doesn't break continuous enrollment. I need to figure out which encounter qualifies for the numerator—there's one on 2026-05-22 during the gap and another on 2026-06-26 that's clearly within the enrolled period, so I'm checking whether the most recent outpatient BP reading should be pulled from the 2026-06-26 encounter (133/95) onward.
Either way I check it, the most recent qualifying BP is 133/95, with diastolic 95 exceeding the 90 threshold, making patient 71053 non-compliant. Now I'm finalizing the full breakdown: compliant patients are 71047, 71050, 71052; non-compliant are 71041, 71043, 71048, 71053, 71054, 71056; 71044 is excluded; and 71042, 71045, 71046, 71049, 71051, 71055 are not eligible—giving a denominator of 9, numerator of 3, 1 excluded, and 6 not eligible.
The compliance rate comes out to 3/9 × 100 = 33.3%.
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
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"71050",
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"ok": true,
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{
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"fabricated": false,
"abstained": false
}100Qwen3.7 Max · Alibaba95.7s · 6,877 out | 152.0s · 10,637 out | 84.0s · 6,206 out
Reasoning · 6,674 tokens
Let me evaluate each member against the measure specification QM-CBP.
**ELIGIBLE POPULATION (denominator):**
- Age: 18 through 85 years as of 2026-12-31
- Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
- Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator.
**NUMERATOR:**
- Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic.
- ED or inpatient readings don't count and are skipped.
- If no qualifying reading exists, member is in denominator but not numerator.
**EXCLUSIONS:**
- E1: ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31
- E2: Pregnancy (O00-O9A) during measurement year
- E3: Hospice or palliative care during measurement year
- E4: Died during measurement year
Let me go through each member:
---
**MEMBER 71041:**
- Age: 85 on 2026-12-31. 18-85? Yes, 85 is included.
- Enrolment: continuous, no gaps. OK.
- Event: 2026-02-18 Office visit, I10. This is between 2026-01-01 and 2026-06-30. OK.
- Exclusions: No hospice, alive, no ESRD, no pregnancy. None.
- Numerator: Most recent outpatient BP on or after 2026-02-18 and on or before 2026-12-31.
- 2026-02-18: Office visit, BP 150/72. This is the qualifying encounter date, so it counts.
- 2026-05-18: Inpatient admission. Skip.
- Most recent outpatient BP is 2026-02-18: 150/72. Systolic 150 >= 140. Not controlled.
- Status: **non_compliant**
---
**MEMBER 71042:**
- Age: 86 on 2026-12-31. Not in 18-85 range.
- Status: **not_eligible** (age)
---
**MEMBER 71043:**
- Age: 35 on 2026-12-31. OK.
- Enrolment: continuous, no gaps. OK.
- Event: 2026-02-12 Office visit, I10. Between 2026-01-01 and 2026-06-30. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-02-12 and on or before 2026-12-31.
- 2026-02-12: Office visit, I10, BP 126/73.
- 2026-03-21: Office visit, I10, BP 135/73.
- 2026-05-22: Office visit, E78.5, BP 119/102.
- 2026-10-02: Office visit, E78.5, BP 136/103.
- Most recent outpatient BP is 2026-10-02: 136/103. Diastolic 103 >= 90. Not controlled.
- Status: **non_compliant**
---
**MEMBER 71044:**
- Age: 70 on 2026-12-31. OK.
- Enrolment: continuous, no gaps. OK.
- Event: 2026-04-23 Office visit, I10. Between 2026-01-01 and 2026-06-30. OK.
- Exclusions: E1 - N18.6 (ESRD) on 2024-06-20, which is on or before 2026-12-31. EXCLUDED.
- Status: **excluded**
---
**MEMBER 71045:**
- Age: 44 on 2026-12-31. OK.
- Enrolment: 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05. This means not enrolled for the full measurement year. The gap from 2026-01-01 to 2026-04-04 is about 94 days. That's more than one gap, or rather, the member wasn't enrolled from the start. Let me think about this.
- "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days."
- The member was not enrolled from 2026-01-01 to 2026-04-04. That's a gap of about 94 days at the beginning. This is a gap longer than 45 days.
- Actually, is it a gap? The member's enrollment starts 2026-04-05. If they weren't enrolled before that, they don't have coverage for the full year. The gap from the start of the year to 2026-04-05 is 94 days (Jan 1 to Apr 4). That's one gap but longer than 45 days.
- Status: **not_eligible** (enrolment - gap > 45 days)
---
**MEMBER 71046:**
- Age: 35 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days.
- One gap, but 58 days > 45 days. Not eligible.
- Status: **not_eligible** (enrolment - gap > 45 days)
---
**MEMBER 71047:**
- Age: 18 on 2026-12-31. OK (18 is included).
- Enrolment: continuous, no gaps. OK.
- Event: 2026-06-17 Office visit, I10. Between 2026-01-01 and 2026-06-30. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-06-17 and on or before 2026-12-31.
- 2026-06-17: Office visit, I10, BP 138/76.
- 2026-07-25: Office visit, I10, BP 137/73.
- 2026-11-21: Inpatient admission, I10, BP 118/88. Skip (inpatient).
- Most recent outpatient BP is 2026-07-25: 137/73. Systolic 137 < 140 and diastolic 73 < 90. Controlled!
- Status: **compliant**
---
**MEMBER 71048:**
- Age: 35 on 2026-12-31. OK.
- Enrolment: continuous, no gaps. OK.
- Event: 2026-05-15 Office visit, I10. Between 2026-01-01 and 2026-06-30. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-05-15 and on or before 2026-12-31.
- 2026-05-15: Office visit, I10, BP 134/93. Diastolic 93 >= 90. Not controlled.
- Status: **non_compliant**
---
**MEMBER 71049:**
- Age: 61 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days.
- One gap, 33 days <= 45 days. OK.
- Event: Need outpatient encounter with I10 between 2026-01-01 and 2026-06-30.
- 2026-08-25: Office visit, I10. This is after 2026-06-30. Does NOT establish the event.
- 2026-11-28: ED visit, R07.9. Not I10, and ED.
- 2026-12-25: Office visit, I10. After 2026-06-30.
- No qualifying I10 encounter between 2026-01-01 and 2026-06-30.
- Status: **not_eligible** (no event)
---
**MEMBER 71050:**
- Age: 84 on 2026-12-31. OK.
- Enrolment: continuous, no gaps. OK.
- Event: 2026-06-23 Office visit, I10. Between 2026-01-01 and 2026-06-30. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-06-23 and on or before 2026-12-31.
- 2026-06-23: Office visit, I10, BP 122/84.
- 2026-09-08: Office visit, J06.9, BP 129/71.
- Most recent outpatient BP is 2026-09-08: 129/71. Systolic 129 < 140 and diastolic 71 < 90. Controlled!
- Status: **compliant**
---
**MEMBER 71051:**
- Age: 35 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days.
- Two gaps of any length. Not eligible.
Wait, let me re-read: "A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator."
Two gaps: 26 days and 14 days. Two or more gaps of any length -> not eligible.
- Status: **not_eligible** (enrolment - two gaps)
Wait, but I should also check exclusions. The task says "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
So since 71051 fails enrolment, they are not_eligible, even though they also have hospice (E3).
- Status: **not_eligible**
---
**MEMBER 71052:**
- Age: 35 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days.
- One gap, 45 days <= 45 days. OK.
- Event: Need outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-04-08: Office visit, I10. Yes, between 2026-01-01 and 2026-06-30. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-04-08 and on or before 2026-12-31.
- 2026-04-08: Office visit, I10, BP 121/76.
- 2026-06-04: Office visit, I10, BP 149/73.
- 2026-07-13: Office visit, I10, BP 127/73.
- 2026-07-16: ED visit. Skip.
- Most recent outpatient BP is 2026-07-13: 127/73. Systolic 127 < 140 and diastolic 73 < 90. Controlled!
- Status: **compliant**
---
**MEMBER 71053:**
- Age: 84 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days.
- One gap, 22 days <= 45 days. OK.
- Event: Need outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-05-22: Office visit, I10. Yes. OK.
- 2026-06-26: Office visit, I10. Yes. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after the qualifying encounter and on or before 2026-12-31.
- The qualifying encounters are 2026-05-22 and 2026-06-26. The "date of the qualifying hypertension encounter" - I think we need the most recent reading on or after the date of any qualifying encounter. Actually, re-reading: "on or after the date of the qualifying hypertension encounter." Since there could be multiple qualifying encounters, I think the reading must be on or after the date of at least one qualifying encounter. But typically, we want the most recent BP reading. Let me re-read.
"The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31..."
If there are multiple qualifying encounters, any reading on or after any of them counts. So the most recent outpatient BP reading on or after 2026-05-22 (the earliest qualifying encounter) and on or before 2026-12-31.
Actually, I think the intent is: the reading must be on or after the date of the qualifying encounter. If there are multiple qualifying encounters, we look at all readings on or after any qualifying encounter. But practically, we just need the most recent outpatient BP reading in the measurement year that is on or after any qualifying encounter date.
Let me look at the readings:
- 2026-05-22: Office visit, I10, BP 146/72. On or after 2026-05-22.
- 2026-06-26: Office visit, I10, BP 133/95. On or after 2026-05-22 and 2026-06-26.
- 2026-08-24: Inpatient admission. Skip.
Most recent outpatient BP is 2026-06-26: 133/95. Diastolic 95 >= 90. Not controlled.
- Status: **non_compliant**
---
**MEMBER 71054:**
- Age: 84 on 2026-12-31. OK.
- Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days.
- One gap, 42 days <= 45 days. OK.
- Event: Need outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-03-21: Office visit, I10. Yes. OK.
- 2026-05-06: Office visit, I10. Yes. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-03-21 (earliest qualifying encounter) and on or before 2026-12-31.
- 2026-03-21: Office visit, I10, BP 137/92.
- 2026-05-06: Office visit, I10, BP 138/85.
- 2026-06-05: Inpatient admission. Skip.
- 2026-10-28: Office visit, E78.5, BP 132/95.
- Most recent outpatient BP is 2026-10-28: 132/95. Diastolic 95 >= 90. Not controlled.
- Status: **non_compliant**
---
**MEMBER 71055:**
- Age: 86 on 2026-12-31. Not in 18-85 range.
- Status: **not_eligible** (age)
---
**MEMBER 71056:**
- Age: 84 on 2026-12-31. OK.
- Enrolment: continuous, no gaps. OK.
- Event: Need outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-01-19: Office visit, I10. Yes. OK.
- 2026-03-20: Office visit, I10. Yes. OK.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-01-19 and on or before 2026-12-31.
- 2026-01-19: Office visit, I10, BP 125/88.
- 2026-03-20: Office visit, I10, BP 153/86.
- Most recent outpatient BP is 2026-03-20: 153/86. Systolic 153 >= 140. Not controlled.
- Status: **non_compliant**
---
Let me summarize:
**Compliant:** 71047, 71050, 71052
**Non-compliant:** 71041, 71043, 71048, 71053, 71054, 71056
**Excluded:** 71044
**Not eligible:** 71042, 71045, 71046, 71049, 71051, 71055
Let me double-check each:
71041: Age 85, continuous, I10 on 2026-02-18. BP 150/72 on 2026-02-18 (most recent outpatient). Non-compliant. ✓
71042: Age 86. Not eligible. ✓
71043: Age 35, continuous, I10 on 2026-02-12. Most recent outpatient BP: 2026-10-02, 136/103. Diastolic >= 90. Non-compliant. ✓
71044: Age 70, continuous, I10 on 2026-04-23. ESRD N18.6 on 2024-06-20. Excluded. ✓
71045: Age 44, enrolled from 2026-04-05. Gap from start of year = 94 days. Not eligible. ✓
71046: Age 35, one gap of 58 days > 45. Not eligible. ✓
71047: Age 18, continuous, I10 on 2026-06-17. Most recent outpatient: 2026-07-25, 137/73. Compliant. ✓
71048: Age 35, continuous, I10 on 2026-05-15. Most recent outpatient: 2026-05-15, 134/93. Diastolic >= 90. Non-compliant. ✓
71049: Age 61, one gap 33 days. No I10 encounter between 2026-01-01 and 2026-06-30. Not eligible. ✓
71050: Age 84, continuous, I10 on 2026-06-23. Most recent outpatient: 2026-09-08, 129/71. Compliant. ✓
71051: Age 35, two gaps (26 and 14 days). Not eligible. ✓
71052: Age 35, one gap 45 days. I10 on 2026-04-08. Most recent outpatient: 2026-07-13, 127/73. Compliant. ✓
71053: Age 84, one gap 22 days. I10 on 2026-05-22. Most recent outpatient: 2026-06-26, 133/95. Diastolic >= 90. Non-compliant. ✓
71054: Age 84, one gap 42 days. I10 on 2026-03-21. Most recent outpatient: 2026-10-28, 132/95. Diastolic >= 90. Non-compliant. ✓
71055: Age 86. Not eligible. ✓
71056: Age 84, continuous, I10 on 2026-01-19. Most recent outpatient: 2026-03-20, 153/86. Systolic >= 140. Non-compliant. ✓
Counts:
- Compliant: 3 (71047, 71050, 71052)
- Non-compliant: 6 (71041, 71043, 71048, 71053, 71054, 71056)
- Excluded: 1 (71044)
- Not eligible: 6 (71042, 71045, 71046, 71049, 71051, 71055)
Denominator = compliant + non_compliant = 3 + 6 = 9
Numerator = compliant = 3
Excluded = 1
Not eligible = 6
Rate = 3 / 9 * 100 = 33.333... = 33.3
Let me verify total: 3 + 6 + 1 + 6 = 16. Correct.
Let me re-verify 71045:
- Enrolled 2026-04-05 through 2026-12-31. Not enrolled 2026-01-01 through 2026-04-04.
- The gap from the beginning of the year: Is this considered a gap? The member was not enrolled from the start of the measurement year.
- "enrolled for the full measurement year with no more than one gap of up to 45 days"
- If the member is not enrolled from 2026-01-01, that's a gap at the beginning. The gap is from 2026-01-01 to 2026-04-04 = 94 days. One gap, but > 45 days. Not eligible.
Let me re-verify 71049:
- Encounters: 2026-08-25 (I10), 2026-11-28 (ED, R07.9), 2026-12-25 (I10).
- No I10 encounter between 2026-01-01 and 2026-06-30. Not eligible.
- Wait, but the member has one gap of 33 days (2026-06-27 to 2026-07-29). The gap is during the period when the event should be established. But regardless, there's no I10 encounter in the first half of the year. Not eligible due to no event.
Let me re-verify 71051:
- Two gaps: 26 days (2026-04-09 to 2026-05-04) and 14 days (2026-08-08 to 2026-08-21).
- Two or more gaps of any length -> not eligible.
- Also has hospice election on 2026-10-27, but since not eligible due to enrolment, that doesn't matter.
All looks correct.
Rate = 3/9 * 100 = 33.333... rounded half up to one decimal = 33.3.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
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},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 10,434 tokens
Let me evaluate each member against the QM-CBP measure specification.
**ELIGIBLE POPULATION (denominator)**
- Age: 18 through 85 years as of 2026-12-31
- Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
- Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member.
**NUMERATOR**
- Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic.
- ED or inpatient readings don't count and are skipped.
- If no qualifying reading exists, member is in denominator but not numerator.
**EXCLUSIONS** (remove from denominator before scoring)
- E1. ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31
- E2. Pregnancy (O00-O9A) during measurement year
- E3. Hospice or palliative care during measurement year
- E4. Died during measurement year
Exclusions evaluated before numerator, only for members in eligible population. A member who fails age, event, or enrolment is not_eligible even if exclusion is also documented. A member who meets both exclusion and numerator is excluded, not compliant.
Let me go through each member:
---
**MEMBER 71041**
- DOB: 1941-07-25, age 85 on 2026-12-31. Age 18-85: YES (85 is included)
- Enrolment: continuous, no gaps. YES
- Event: 2026-02-18 Office visit, I10. This is outpatient, between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Qualifying encounter is 2026-02-18. Most recent outpatient BP on or after 2026-02-18 and on or before 2026-12-31:
- 2026-02-18: BP 150/72 (outpatient) - this is the only outpatient BP on or after the qualifying encounter.
- 2026-05-18: Inpatient admission - skip (inpatient doesn't count)
- So most recent qualifying outpatient BP is 150/72. Systolic 150 >= 140. NOT controlled.
- Status: **non_compliant**
---
**MEMBER 71042**
- DOB: 1940-06-12, age 86 on 2026-12-31. Age 18-85: NO (86 > 85)
- Status: **not_eligible** (age)
---
**MEMBER 71043**
- DOB: 1991-01-17, age 35 on 2026-12-31. Age 18-85: YES
- Enrolment: continuous, no gaps. YES
- Event:
- 2026-02-12 Office visit, I10. Outpatient, between 2026-01-01 and 2026-06-30. YES
- 2026-03-21 Office visit, I10. Also qualifies.
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Qualifying encounter date - the earliest is 2026-02-12. We need the most recent outpatient BP on or after 2026-02-12 and on or before 2026-12-31.
- Wait, the spec says "on or after the date of the qualifying hypertension encounter". Which qualifying encounter? "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter..."
I think "the qualifying hypertension encounter" refers to the encounter that established the event (i.e., any I10 outpatient encounter in the first half). If there are multiple qualifying encounters, which one do we use? The spec says "the date of the qualifying hypertension encounter" - singular. Let me re-read.
"at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30"
"The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31"
Hmm, if there are multiple qualifying encounters, I think we should use the earliest one (since any of them establishes the event), and then find the most recent BP reading after that date. Or perhaps we should use the latest qualifying encounter? Let me think about this more carefully.
Actually, re-reading: "the qualifying hypertension encounter" - I think this means the encounter that qualifies the member for the measure. If there are multiple, I think the standard interpretation is to use the first qualifying encounter, because that's when the member entered the measure. But actually, for BP control measures like this (similar to HEDIS CBP), the approach is typically: identify all qualifying encounters, then find the most recent BP reading after ANY qualifying encounter.
Actually, let me re-read more carefully: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31"
I think "the qualifying hypertension encounter" means any encounter that qualifies the member. If there are multiple, we need to find BP readings that are on or after any qualifying encounter. The most recent such reading is what we evaluate.
Actually, the simplest interpretation: the qualifying encounter establishes the member in the denominator. The most recent outpatient BP reading on or after that encounter date (the earliest qualifying encounter? or the latest?) is evaluated.
Let me think about this differently. In HEDIS CBP, the approach is:
- Identify the measurement year
- Find encounters with HTN diagnosis in the first half
- The most recent BP reading during the measurement year (on or after the first qualifying encounter) is evaluated
I'll interpret "the qualifying hypertension encounter" as the first qualifying encounter (the one that establishes the event). Then find the most recent outpatient BP on or after that date.
Wait, actually, re-reading again: "on or after the date of the qualifying hypertension encounter". If there are multiple qualifying encounters, each has a date. A BP reading taken on or after ANY of those dates would qualify. The most recent such reading is what we evaluate.
Actually, I think the most natural reading is: find the earliest qualifying encounter. Then find the most recent outpatient BP reading on or after that date. Let me just go with that interpretation.
For 71043:
- Earliest qualifying encounter: 2026-02-12 (I10)
- Outpatient BP readings on or after 2026-02-12:
- 2026-02-12: BP 126/73
- 2026-03-21: BP 135/73
- 2026-05-22: BP 119/102
- 2026-10-02: BP 136/103
- Most recent: 2026-10-02, BP 136/103. Diastolic 103 >= 90. NOT controlled.
Wait, let me reconsider. What if "the qualifying hypertension encounter" means the LAST qualifying encounter? That would change things.
Actually, I think the most standard interpretation in HEDIS-like measures is: the qualifying encounter is any encounter that meets the event criteria. The BP reading must be on or after the date of ANY qualifying encounter. So effectively, the BP reading must be on or after the EARLIEST qualifying encounter. Then we take the MOST RECENT outpatient BP reading.
For 71043, earliest qualifying encounter is 2026-02-12. Most recent outpatient BP is 2026-10-02, BP 136/103. Diastolic 103 >= 90. NOT controlled.
Status: **non_compliant**
---
**MEMBER 71044**
- DOB: 1956-05-26, age 70 on 2026-12-31. Age 18-85: YES
- Enrolment: continuous, no gaps. YES
- Event: 2026-04-23 Office visit, I10. Outpatient, between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions:
- E1: 2024-06-20 Diagnosis N18.6, end stage renal disease. This is "any time on or before 2026-12-31". YES, meets E1.
- Status: **excluded** (E1)
---
**MEMBER 71045**
- DOB: 1982-06-22, age 44 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05.
- This means there's a gap from 2026-01-01 to 2026-04-04. That's about 94 days. That's a gap longer than 45 days.
- Wait, is this a "gap"? The member wasn't enrolled at the start of the year. The enrolment starts 2026-04-05.
- "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days."
- "Enrolled for the full measurement year" means enrolled from 2026-01-01 through 2026-12-31, allowing gaps.
- If the member is not enrolled from 2026-01-01 to 2026-04-04, that's a gap of about 94 days (Jan 1 to Apr 4 = 31 + 28 + 31 + 4 = 94 days). This is more than 45 days.
- Actually, let me think about this. Is the period before enrolment considered a "gap"? If the member's enrolment starts on 2026-04-05, they were not enrolled from Jan 1 to Apr 4. This would be a gap of 94 days, which exceeds 45 days.
- Status: **not_eligible** (enrolment gap > 45 days)
---
**MEMBER 71046**
- DOB: 1991-10-18, age 35 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days.
- One gap of 58 days > 45 days. NOT eligible.
- Status: **not_eligible** (enrolment gap > 45 days)
---
**MEMBER 71047**
- DOB: 2008-04-06, age 18 on 2026-12-31. Age 18-85: YES (18 is included)
- Enrolment: continuous, no gaps. YES
- Event:
- 2026-06-17 Office visit, I10. Outpatient, between 2026-01-01 and 2026-06-30. YES
- 2026-07-25 Office visit, I10. This is after 2026-06-30, so it doesn't establish the event on its own, but the 2026-06-17 visit already established it.
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Qualifying encounter: 2026-06-17 (earliest qualifying encounter).
- Outpatient BP readings on or after 2026-06-17:
- 2026-06-17: BP 138/76
- 2026-07-25: BP 137/73 (outpatient, I10)
- 2026-11-21: Inpatient admission - SKIP
- Most recent qualifying outpatient BP: 2026-07-25, BP 137/73. Systolic 137 < 140 AND Diastolic 73 < 90. CONTROLLED.
- Status: **compliant**
---
**MEMBER 71048**
- DOB: 1991-04-26, age 35 on 2026-12-31. Age 18-85: YES
- Enrolment: continuous, no gaps. YES
- Event: 2026-05-15 Office visit, I10. Outpatient, between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Qualifying encounter: 2026-05-15.
- Outpatient BP readings on or after 2026-05-15:
- 2026-05-15: BP 134/93. Diastolic 93 >= 90. NOT controlled.
- Most recent: 2026-05-15, BP 134/93. NOT controlled.
- Status: **non_compliant**
---
**MEMBER 71049**
- DOB: 1965-05-12, age 61 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days.
- One gap of 33 days <= 45 days. YES, eligible.
- Event:
- 2026-08-25 Office visit, I10. This is AFTER 2026-06-30. Does NOT establish the event.
- 2026-11-28 ED visit, R07.9. Not I10, and it's an ED visit.
- 2026-12-25 Office visit, I10. After 2026-06-30. Does NOT establish the event.
- No qualifying encounter between 2026-01-01 and 2026-06-30.
- Status: **not_eligible** (no qualifying event in first half)
Wait, let me re-check. The event requires "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30."
71049's encounters:
- 2026-08-25 Office visit, I10 - after 2026-06-30
- 2026-11-28 ED visit, R07.9 - not I10, and ED
- 2026-12-25 Office visit, I10 - after 2026-06-30
None of the I10 encounters are between 2026-01-01 and 2026-06-30. So no qualifying event.
Status: **not_eligible** (no event)
---
**MEMBER 71050**
- DOB: 1942-01-04, age 84 on 2026-12-31. Age 18-85: YES
- Enrolment: continuous, no gaps. YES
- Event: 2026-06-23 Office visit, I10. Outpatient, between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Qualifying encounter: 2026-06-23.
- Outpatient BP readings on or after 2026-06-23:
- 2026-06-23: BP 122/84
- 2026-09-08: BP 129/71 (outpatient, J06.9 - but it's still an outpatient BP reading)
- Most recent: 2026-09-08, BP 129/71. Systolic 129 < 140 AND Diastolic 71 < 90. CONTROLLED.
Wait, does the BP reading need to be at an encounter with I10 diagnosis? Let me re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic."
It says "outpatient blood pressure reading" - it doesn't say it needs to be at an encounter with I10 diagnosis. So any outpatient BP reading counts. The 2026-09-08 visit with J06.9 diagnosis has a BP reading of 129/71, which is an outpatient BP reading.
So most recent outpatient BP is 129/71. CONTROLLED.
- Status: **compliant**
---
**MEMBER 71051**
- DOB: 1991-04-19, age 35 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days.
- TWO gaps. "A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator."
- Two gaps = not eligible.
- Status: **not_eligible** (two gaps in enrolment)
Wait, but the member also has hospice election on 2026-10-27. However, exclusions are only evaluated for members in the eligible population. Since this member is not_eligible due to enrolment, the hospice exclusion doesn't apply (they're not_eligible, not excluded).
Status: **not_eligible**
---
**MEMBER 71052**
- DOB: 1991-11-27, age 35 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days.
- One gap of exactly 45 days. "no more than one gap of up to 45 days." 45 days is "up to 45 days". YES, eligible.
- Event:
- 2026-04-08 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- 2026-06-04 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- 2026-07-13 Office visit, I10. After 2026-06-30.
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Earliest qualifying encounter: 2026-04-08.
- Outpatient BP readings on or after 2026-04-08:
- 2026-04-08: BP 121/76
- 2026-06-04: BP 149/73
- 2026-07-13: BP 127/73
- 2026-07-16: ED visit - SKIP
- Most recent qualifying outpatient BP: 2026-07-13, BP 127/73. Systolic 127 < 140 AND Diastolic 73 < 90. CONTROLLED.
- Status: **compliant**
---
**MEMBER 71053**
- DOB: 1942-08-07, age 84 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days.
- One gap of 22 days <= 45 days. YES, eligible.
- Event:
- 2026-05-22 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- 2026-06-26 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Earliest qualifying encounter: 2026-05-22.
- Outpatient BP readings on or after 2026-05-22:
- 2026-05-22: BP 146/72
- 2026-06-26: BP 133/95
- 2026-08-24: Inpatient admission - SKIP
- Most recent qualifying outpatient BP: 2026-06-26, BP 133/95. Diastolic 95 >= 90. NOT controlled.
- Status: **non_compliant**
---
**MEMBER 71054**
- DOB: 1942-12-16, age 84 on 2026-12-31. Age 18-85: YES
- Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days.
- One gap of 42 days <= 45 days. YES, eligible.
- Event:
- 2026-03-21 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- 2026-05-06 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Earliest qualifying encounter: 2026-03-21.
- Outpatient BP readings on or after 2026-03-21:
- 2026-03-21: BP 137/92
- 2026-05-06: BP 138/85
- 2026-06-05: Inpatient admission - SKIP
- 2026-10-28: BP 132/95 (outpatient, E78.5)
- Most recent qualifying outpatient BP: 2026-10-28, BP 132/95. Diastolic 95 >= 90. NOT controlled.
- Status: **non_compliant**
---
**MEMBER 71055**
- DOB: 1940-08-21, age 86 on 2026-12-31. Age 18-85: NO (86 > 85)
- Status: **not_eligible** (age)
---
**MEMBER 71056**
- DOB: 1942-01-17, age 84 on 2026-12-31. Age 18-85: YES
- Enrolment: continuous, no gaps. YES
- Event:
- 2026-01-19 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- 2026-03-20 Office visit, I10. Between 2026-01-01 and 2026-06-30. YES
- Eligible population: YES
- Exclusions: No ESRD, no pregnancy, no hospice, alive. No exclusions.
- Numerator: Earliest qualifying encounter: 2026-01-19.
- Outpatient BP readings on or after 2026-01-19:
- 2026-01-19: BP 125/88
- 2026-03-20: BP 153/86
- Most recent qualifying outpatient BP: 2026-03-20, BP 153/86. Systolic 153 >= 140. NOT controlled.
- Status: **non_compliant**
---
Let me summarize:
| Member | Status | Reason |
|--------|--------|--------|
| 71041 | non_compliant | BP 150/72, systolic >= 140 |
| 71042 | not_eligible | Age 86 > 85 |
| 71043 | non_compliant | BP 136/103, diastolic >= 90 |
| 71044 | excluded | E1 - ESRD (N18.6) |
| 71045 | not_eligible | Enrolment gap > 45 days |
| 71046 | not_eligible | Enrolment gap 58 days > 45 |
| 71047 | compliant | BP 137/73, both below thresholds |
| 71048 | non_compliant | BP 134/93, diastolic >= 90 |
| 71049 | not_eligible | No I10 encounter in first half |
| 71050 | compliant | BP 129/71, both below thresholds |
| 71051 | not_eligible | Two gaps in enrolment |
| 71052 | compliant | BP 127/73, both below thresholds |
| 71053 | non_compliant | BP 133/95, diastolic >= 90 |
| 71054 | non_compliant | BP 132/95, diastolic >= 90 |
| 71055 | not_eligible | Age 86 > 85 |
| 71056 | non_compliant | BP 153/86, systolic >= 140 |
Counts:
- Compliant: 71047, 71050, 71052 = 3
- Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 = 6
- Excluded: 71044 = 1
- Not eligible: 71042, 71045, 71046, 71049, 71051, 71055 = 6
Denominator = compliant + non_compliant = 3 + 6 = 9
Numerator = 3
Excluded = 1
Not eligible = 6
Rate = 3 / 9 * 100 = 33.333... = 33.3 (rounded half up to one decimal)
Wait, let me double-check 71045's enrolment gap calculation.
71045: Enrolment 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05.
- Gap from start of year (2026-01-01) to 2026-04-04.
- Days: Jan (31) + Feb (28) + Mar (31) + Apr 1-4 (4) = 94 days.
- This is one gap of 94 days, which is > 45 days.
- Not eligible. Correct.
Let me double-check 71046's gap:
- 2026-01-01 through 2026-04-26; gap; 2026-06-24 through 2026-12-31.
- Gap from 2026-04-27 to 2026-06-23.
- Apr 27-30: 4 days, May: 31 days, Jun 1-23: 23 days = 58 days.
- One gap of 58 days > 45 days. Not eligible. Correct.
Let me double-check 71051's gaps:
- 2026-01-01 through 2026-04-08; gap; 2026-05-05 through 2026-08-07; gap; 2026-08-22 through 2026-12-31.
- Gap 1: 2026-04-09 to 2026-05-04. Apr 9-30: 22 days, May 1-4: 4 days = 26 days.
- Gap 2: 2026-08-08 to 2026-08-21. Aug 8-21: 14 days.
- Two gaps (26 and 14 days). Two or more gaps of any length removes from denominator.
- Not eligible. Correct.
Let me double-check 71052's gap:
- 2026-01-01 through 2026-04-08; gap; 2026-05-24 through 2026-12-31.
- Gap: 2026-04-09 to 2026-05-23.
- Apr 9-30: 22 days, May 1-23: 23 days = 45 days.
- One gap of 45 days. "up to 45 days" includes 45. Eligible. Correct.
Let me double-check 71053's gap:
- 2026-01-01 through 2026-05-15; gap; 2026-06-07 through 2026-12-31.
- Gap: 2026-05-16 to 2026-06-06.
- May 16-31: 16 days, Jun 1-6: 6 days = 22 days.
- One gap of 22 days. Eligible. Correct.
Let me double-check 71054's gap:
- 2026-01-01 through 2026-05-06; gap; 2026-06-18 through 2026-12-31.
- Gap: 2026-05-07 to 2026-06-17.
- May 7-31: 25 days, Jun 1-17: 17 days = 42 days.
- One gap of 42 days. Eligible. Correct.
Let me double-check 71049's gap:
- 2026-01-01 through 2026-06-26; gap; 2026-07-30 through 2026-12-31.
- Gap: 2026-06-27 to 2026-07-29.
- Jun 27-30: 4 days, Jul 1-29: 29 days = 33 days.
- One gap of 33 days <= 45. Eligible from enrolment standpoint.
- But no qualifying I10 encounter between 2026-01-01 and 2026-06-30. Not eligible. Correct.
Now let me re-verify the numerator calculations more carefully.
**71041:**
- Qualifjson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,955 tokens
The task is to evaluate 16 members against the measure specification QM-CBP (Blood Pressure Control in Hypertension) and output a JSON object with the population counts and member lists.
Let's evaluate each member:
**MEMBER 71041**
- Age: 85 on 2026-12-31. (Eligible: 18-85) -> Yes.
- Enrolment: Continuous, no gaps. -> Yes.
- Event: Outpatient encounter with I10 between 2026-01-01 and 2026-06-30.
- 2026-02-18 Office visit, I10. -> Yes.
- Exclusions:
- E1: ESRD (N18.6) or dialysis (Z99.2)? No.
- E2: Pregnancy? No.
- E3: Hospice/palliative? No.
- E4: Died? No.
- Numerator: Most recent outpatient BP reading on or after qualifying encounter (2026-02-18) and on or before 2026-12-31.
- 2026-02-18: BP 150/72 (Outpatient).
- 2026-05-18: Inpatient admission. (Skip inpatient).
- Most recent qualifying outpatient BP is 2026-02-18: 150/72.
- Is it < 140 AND < 90? 150 is not < 140. -> Non-compliant.
- Status: non_compliant
**MEMBER 71042**
- Age: 86 on 2026-12-31. (Eligible: 18-85) -> No.
- Status: not_eligible
**MEMBER 71043**
- Age: 35 on 2026-12-31. -> Yes.
- Enrolment: Continuous, no gaps. -> Yes.
- Event: Outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-02-12 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-02-12.
- 2026-02-12: 126/73
- 2026-03-21: 135/73
- 2026-05-22: 119/102 (Outpatient)
- 2026-10-02: 136/103 (Outpatient)
- Most recent is 2026-10-02: 136/103.
- Is it < 140 AND < 90? 103 is not < 90. -> Non-compliant.
- Status: non_compliant
**MEMBER 71044**
- Age: 70. -> Yes.
- Enrolment: Continuous. -> Yes.
- Event: 2026-04-23 Office visit, I10. -> Yes.
- Exclusions:
- E1: 2024-06-20 Diagnosis N18.6 (ESRD). -> Excluded.
- Status: excluded
**MEMBER 71045**
- Age: 44. -> Yes.
- Enrolment: 2026-04-05 through 2026-12-31. Not enrolled for full measurement year (gap from Jan 1 to Apr 4 is > 45 days, or rather not enrolled from start). Wait, "enrolled for the full measurement year with no more than one gap of up to 45 days." Here, enrolled from 2026-04-05. This means a gap of ~94 days at the beginning of the year. So fails continuous enrolment.
- Status: not_eligible
**MEMBER 71046**
- Age: 35. -> Yes.
- Enrolment: 2026-01-01 to 2026-04-26; 2026-06-24 to 2026-12-31. Gap is 58 days (Apr 27 to Jun 23).
- "A gap longer than 45 days ... removes the member from the denominator." -> Not eligible.
- Status: not_eligible
**MEMBER 71047**
- Age: 18. -> Yes.
- Enrolment: Continuous. -> Yes.
- Event: 2026-06-17 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-06-17.
- 2026-06-17: 138/76
- 2026-07-25: 137/73 (Outpatient)
- 2026-11-21: Inpatient (Skip).
- Most recent outpatient is 2026-07-25: 137/73.
- Is it < 140 AND < 90? Yes (137 < 140, 73 < 90). -> Compliant.
- Status: compliant
**MEMBER 71048**
- Age: 35. -> Yes.
- Enrolment: Continuous. -> Yes.
- Event: 2026-05-15 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-05-15.
- 2026-05-15: 134/93.
- Is it < 140 AND < 90? 93 is not < 90. -> Non-compliant.
- Status: non_compliant
**MEMBER 71049**
- Age: 61. -> Yes.
- Enrolment: 2026-01-01 to 2026-06-26; 2026-07-30 to 2026-12-31. Gap of 33 days. (<= 45 days, one gap). -> Yes.
- Event: Outpatient I10 between 2026-01-01 and 2026-06-30.
- 2026-08-25 Office visit, I10. (After 2026-06-30).
- 2026-11-28 ED visit (Not outpatient? ED is excluded from BP, but does it count as an encounter for the event? "at least one outpatient encounter with a hypertension diagnosis... An encounter after 2026-06-30 does not establish the event." ED is usually not considered a standard outpatient encounter for establishing the denominator in some specs, but let's check: "outpatient encounter". Usually ED is outpatient, but even if it is, it's after 06-30.
- 2026-12-25 Office visit, I10. (After 06-30).
- No I10 encounter on or before 2026-06-30. -> Fails event.
- Status: not_eligible
**MEMBER 71050**
- Age: 84. -> Yes.
- Enrolment: Continuous. -> Yes.
- Event: 2026-06-23 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-06-23.
- 2026-06-23: 122/84.
- 2026-09-08: 129/71 (Outpatient).
- Most recent is 2026-09-08: 129/71.
- Is it < 140 AND < 90? Yes. -> Compliant.
- Status: compliant
**MEMBER 71051**
- Age: 35. -> Yes.
- Enrolment: Gaps of 26 and 14 days. "two or more gaps of any length, removes the member". -> Not eligible.
- Status: not_eligible
**MEMBER 71052**
- Age: 35. -> Yes.
- Enrolment: One gap of 45 days. (<= 45 days). -> Yes.
- Event: 2026-04-08 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-04-08.
- 2026-04-08: 121/76
- 2026-06-04: 149/73
- 2026-07-13: 127/73
- 2026-07-16: ED visit (Skip).
- Most recent outpatient is 2026-07-13: 127/73.
- Is it < 140 AND < 90? Yes. -> Compliant.
- Status: compliant
**MEMBER 71053**
- Age: 84. -> Yes.
- Enrolment: One gap of 22 days. -> Yes.
- Event: 2026-05-22 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-05-22.
- 2026-05-22: 146/72
- 2026-06-26: 133/95
- 2026-08-24: Inpatient (Skip).
- Most recent outpatient is 2026-06-26: 133/95.
- Is it < 140 AND < 90? 95 is not < 90. -> Non-compliant.
- Status: non_compliant
**MEMBER 71054**
- Age: 84. -> Yes.
- Enrolment: One gap of 42 days. -> Yes.
- Event: 2026-03-21 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-03-21.
- 2026-03-21: 137/92
- 2026-05-06: 138/85
- 2026-06-05: Inpatient (Skip).
- 2026-10-28: 132/95 (Outpatient).
- Most recent outpatient is 2026-10-28: 132/95.
- Is it < 140 AND < 90? 95 is not < 90. -> Non-compliant.
- Status: non_compliant
**MEMBER 71055**
- Age: 86. -> No. (Eligible 18-85).
- Status: not_eligible
**MEMBER 71056**
- Age: 84. -> Yes.
- Enrolment: Continuous. -> Yes.
- Event: 2026-01-19 Office visit, I10. -> Yes.
- Exclusions: None.
- Numerator: Most recent outpatient BP on or after 2026-01-19.
- 2026-01-19: 125/88
- 2026-03-20: 153/86
- Most recent outpatient is 2026-03-20: 153/86.
- Is it < 140 AND < 90? 153 is not < 140. -> Non-compliant.
- Status: non_compliant
Let's double check all members.
71041: Age 85. Enrolled full year. I10 on 2026-02-18. BP 150/72. Non-compliant.
71042: Age 86. Not eligible.
71043: Age 35. Enrolled full year. I10 on 2026-02-12. Most recent BP 2026-10-02 (136/103). Non-compliant.
71044: Age 70. Enrolled full year. I10 on 2026-04-23. Exclusion E1 (N18.6 in 2024). Excluded.
71045: Age 44. Enrolled 2026-04-05 to 12-31. Gap > 45 days (or not enrolled full year). Not eligible.
71046: Age 35. Gap 58 days. Not eligible.
71047: Age 18. Enrolled full year. I10 on 2026-06-17. Most recent outpatient BP 2026-07-25 (137/73). Compliant.
71048: Age 35. Enrolled full year. I10 on 2026-05-15. BP 134/93. Non-compliant.
71049: Age 61. Gap 33 days (OK). I10 encounters: 2026-08-25, 2026-12-25. No I10 encounter <= 2026-06-30. Not eligible.
71050: Age 84. Enrolled full year. I10 on 2026-06-23. Most recent BP 2026-09-08 (129/71). Compliant.
71051: Age 35. Two gaps (26 and 14 days). Not eligible.
71052: Age 35. One gap 45 days (OK). I10 on 2026-04-08. Most recent outpatient BP 2026-07-13 (127/73). Compliant.
71053: Age 84. One gap 22 days (OK). I10 on 2026-05-22. Most recent outpatient BP 2026-06-26 (133/95). Non-compliant.
71054: Age 84. One gap 42 days (OK). I10 on 2026-03-21. Most recent outpatient BP 2026-10-28 (132/95). Non-compliant.
71055: Age 86. Not eligible.
71056: Age 84. Enrolled full year. I10 on 2026-01-19. Most recent outpatient BP 2026-03-20 (153/86). Non-compliant.
Let's recount:
Compliant:
71047
71050
71052
Total compliant = 3
Non-compliant:
71041
71043
71048
71053
71054
71056
Total non-compliant = 6
Excluded:
71044
Total excluded = 1
Not eligible:
71042
71045
71046
71049
71051
71055
Total not eligible = 6
Total members = 3 + 6 + 1 + 6 = 16. Correct.
Denominator = compliant + non-compliant = 3 + 6 = 9.
Numerator = 3.
Rate = 3 / 9 * 100 = 33.333... -> 33.3.
Let's double check 71049:
Enrolment: 2026-01-01 to 2026-06-26; 2026-07-30 to 2026-12-31. One gap of 33 days.
Encounters:
2026-08-25 Office visit, I10
2026-11-28 ED visit, R07.9
2026-12-25 Office visit, I10
Event requires: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30."
Since there is no I10 encounter on or before 2026-06-30, the member does not meet the event criterion. Thus, not_eligible. Correct.
Let's double check 71052:
Gap of 45 days. "no more than one gap of up to 45 days." 45 days is "up to 45 days", so it's allowed.
Event: 2026-04-08 I10.
BP readings:
2026-04-08: 121/76
2026-06-04: 149/73
2026-07-13: 127/73
2026-07-16: ED (skip)
Most recent is 2026-07-13: 127/73. <140 and <90. Compliant. Correct.
Let's double check 71045:
Enrolment: 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05.
This means a gap from Jan 1 to Apr 4. Jan (31) + Feb (28) + Mar (31) + 4 = 94 days gap.
More than 45 days. Not eligible. Correct.
Let's double check 71046:
Gap of 58 days. More than 45 days. Not eligible. Correct.
Let's double check 71051:
Gaps of 26 and 14 days. "two or more gaps of any length, removes the member". Not eligible. Correct.
Let's double check 71047:
Age 18.
Event: 2026-06-17 I10.
BP:
2026-06-17: 138/76
2026-07-25: 137/73
2026-11-21: Inpatient (skip)
Most recent outpatient: 2026-07-25 (137/73). Compliant. Correct.
Let's double check 71050:
Age 84.
Event: 2026-06-23 I10.
BP:
2026-06-23: 122/84
2026-09-08: 129/71
Most recent outpatient: 2026-09-08 (129/71). Compliant. Correct.
Let's double check 71041:
Age 85.
Event: 2026-02-18 I10.
BP:
2026-02-18: 150/72
2026-05-18: Inpatient (skip)
Most recent outpatient: 2026-02-18 (150/72). Non-compliant. Correct.
Let's double check 71043:
Age 35.
Event: 2026-02-12 I10.
BP:
2026-02-12: 126/73
2026-03-21: 135/73
2026-05-22: 119/102
2026-10-02: 136/103
Most recent outpatient: 2026-10-02 (136/103). Non-compliant. Correct.
Let's double check 71048:
Age 35.
Event: 2026-05-15 I10.
BP:
2026-05-15: 134/93
Most recent: 134/93. Non-compliant. Correct.
Let's double check 71053:
Age 84.
Event: 2026-05-22 I10.
BP:
2026-05-22: 146/72
2026-06-26: 133/95
2026-08-24: Inpatient (skip)
Most recent: 2026-06-26 (133/95). Non-compliant. Correct.
Let's double check 71054:
Age 84.
Event: 2026-03-21 I10.
BP:
2026-03-21: 137/92
2026-05-06: 138/85
2026-06-05: Inpatient (skip)
2026-10-28: 132/95
Most recent: 2026-10-28 (132/95). Non-compliant. Correct.
Let's double check 71056:
Age 84.
Event: 2026-01-19 I10.
BP:
2026-01-19: 125/88
2026-03-20: 153/86
Most recent: 2026-03-20 (153/86). Non-compliant. Correct.
Check Exclusions again:
71044: N18.6 in 2024. E1 says "any time on or before 2026-12-31". So excluded. Correct.
71051: Hospice election 2026-10-27. But 71051 is already not_eligible due to two gaps in enrolment. "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So 71051 is not_eligible. Correct.
Summary of lists:
compliant_members: ["71047", "71050", "71052"]
non_compliant_members: ["71041", "71043", "71048", "71053", "71054", "71056"]
excluded_members: ["71044"]
not_eligible_members: ["71042", "71045", "71046", "71049", "71051", "71055"]
Counts:
denominator: 9
numerator: 3
excluded: 1
not_eligible: 6
rate: 33.3
Everything looks solid.
Rate calculation: 3 / 9 = 0.333333... * 100 = 33.333... -> 33.3.
JSON structure matches requirements.
No other formatting.
Just the JSON block.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
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},
{
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{
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{
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"want": 33.3,
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"ok": true,
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{
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"want": [
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"ok": true,
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},
{
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{
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"want": [
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"ok": true,
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{
"field": "not_eligible_members",
"want": [
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"got": [
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"ok": true,
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],
"fabricated": false,
"abstained": false
}100GLM-5.3 · Z.ai61.1s · 7,685 out | 9.0s · 1,378 out | 9.5s · 1,472 out
Reasoning · 5,966 tokens
Let me work through each member carefully against the QM-CBP specification.
Eligible population requirements:
1. Age 18-85 as of 2026-12-31.
2. At least one outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30.
3. Continuous enrolment: full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from denominator.
Exclusions (evaluated before numerator, only for eligible population):
- E1: ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31.
- E2: Pregnancy during measurement year.
- E3: Hospice or palliative care any time during measurement year.
- E4: Died during the measurement year.
Numerator: most recent outpatient BP reading on or after the date of the qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. ED/inpatient readings are skipped. If no qualifying reading, in denominator but not numerator.
Note: "the most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". So the qualifying hypertension encounter is the I10 outpatient encounter in the first half of the year. If there are multiple I10 encounters, presumably the earliest qualifying one establishes the event? Or "the date of the qualifying hypertension encounter" — if multiple, we could use the first (the one that establishes the event). Actually, let's think: for the numerator, the reading must be on or after the date of the qualifying hypertension encounter. If there are multiple qualifying encounters, the most conservative interpretation is the first one that establishes the event. But actually, readings on or after the earliest qualifying encounter would be a superset of readings on or after later encounters. Since we take the most recent reading, the date of the qualifying encounter matters only if the most recent reading is before some later qualifying encounter... Hmm, let's think.
The numerator: most recent outpatient BP reading on or after the date of the qualifying hypertension encounter and on or before 2026-12-31. If there are multiple qualifying I10 encounters, the "qualifying hypertension encounter" is ambiguous. But since the most recent reading is what matters, using the earliest qualifying encounter gives the largest window, so the most recent reading in that window would be the same as the most recent reading in any smaller window only if the most recent reading is after all encounters. Actually, if the most recent reading is after the last I10 encounter, then it doesn't matter which qualifying encounter we pick — the most recent reading is the same. Let me check the members with multiple I10 encounters:
71043: I10 encounters on 2026-02-12 and 2026-03-21. Later readings: 2026-05-22 (E78.5, BP 119/102) and 2026-10-02 (E78.5, BP 136/103). The most recent outpatient reading after either encounter date is 2026-10-02: 136/103. Diastolic 103 ≥ 90, so not numerator. Non-compliant.
71047: I10 encounters on 2026-06-17 and 2026-07-25. Readings: 2026-06-17 138/76, 2026-07-25 137/73, 2026-11-21 inpatient (skipped). Most recent outpatient reading: 2026-07-25: 137/73. Both below thresholds → compliant.
71052: I10 encounters on 2026-04-08, 2026-06-04, 2026-07-13. ED 2026-07-16 skipped. Most recent outpatient: 2026-07-13: 127/73 → compliant. But enrolment gap: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. Gap of 45 days (2026-04-09 through 2026-05-23 = 45 days). "no more than one gap of up to 45 days" — a gap of exactly 45 days is allowed. So one gap of 45 days → still eligible. Let me count: 2026-04-09 to 2026-05-23 inclusive: April 9-30 is 22 days, May 1-23 is 23 days, total 45 days. The roster says "One gap of 45 days." So it's allowed (up to 45 days inclusive). Eligible.
Wait, but also need to check: does the enrolment need to be "full measurement year"? "enrolled for the full measurement year with no more than one gap of up to 45 days". Hmm, this is a bit contradictory, but the standard interpretation given the roster is: continuous enrolment with no more than one gap of up to 45 days is OK. The roster explicitly labels gaps, so the test is: gaps > 45 days → not eligible; two or more gaps → not eligible; one gap ≤ 45 days → eligible.
71053: I10 encounters 2026-05-22, 2026-06-26. Inpatient 2026-08-24 skipped. Most recent outpatient reading: 2026-06-26: 133/95. Diastolic 95 ≥ 90 → not numerator. But wait — is 2026-06-26 after the qualifying encounter date? The qualifying encounter (event) is 2026-05-22 (first half). Reading 2026-06-26 is after. So most recent outpatient reading on or before 2026-12-31 is 2026-06-26: 133/95 → non-compliant.
Hmm, but wait — should we consider whether the encounter that qualifies is the first one only? The event is "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30". Both 2026-05-22 and 2026-06-26 qualify. The reading after either date: the most recent is still 2026-06-26 itself (BP taken at that visit). Non-compliant regardless.
71054: I10 encounters 2026-03-21 (137/92), 2026-05-06 (138/85). Inpatient 2026-06-05 skipped. Office visit 2026-10-28 E78.5 BP 132/95 — is this on or after the qualifying encounter? Yes (after 2026-03-21 and 2026-05-06). It's an outpatient reading. Most recent outpatient reading: 2026-10-28: 132/95. Diastolic 95 ≥ 90 → non-compliant.
Wait, but hold on. The E78.5 office visit — does it count as a "blood pressure reading taken... on or after the date of the qualifying hypertension encounter"? The numerator says "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". It doesn't say the reading must be at an encounter with an I10 diagnosis; it just needs to be an outpatient BP reading after the qualifying encounter date. So yes, the 2026-10-28 reading counts.
Enrolment for 71054: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days (2026-05-07 through 2026-06-17 = 42 days). May 7-31 is 25 days, June 1-17 is 17 days, total 42. Allowed (≤45). Eligible.
Now let me go member by member:
MEMBER 71041: DOB 1941-07-25, 85 on 2026-12-31. Age 18-85 inclusive → eligible age. Enrolment continuous full year. Event: office visit 2026-02-18 with I10 → qualifying (in first half). No exclusions (no ESRD, no pregnancy, no hospice, alive). Numerator: most recent outpatient BP reading on or after 2026-02-18 and ≤ 2026-12-31. Readings: 2026-02-18 office 150/72; 2026-05-18 inpatient (skipped). Most recent outpatient: 2026-02-18: 150/72. Systolic 150 ≥ 140 → not numerator. Non-compliant.
MEMBER 71042: DOB 1940-06-12, 86 on 2026-12-31. Age 86 > 85 → not_eligible. (Even though there are exclusions? No exclusions documented. Not eligible due to age.) not_eligible.
MEMBER 71043: Age 35. Enrolment continuous. Event: I10 office visits 2026-02-12, 2026-03-21 → qualifying. No exclusions. Numerator: most recent outpatient reading after 2026-02-12: 2026-10-02 (office, E78.5): 136/103. 103 ≥ 90 → not numerator. Non-compliant.
MEMBER 71044: Age 70. Enrolment continuous. Event: office visit 2026-04-23 with I10 → qualifying. Exclusion E1: N18.6 ESRD diagnosed 2024-06-20, which is "any time on or before 2026-12-31" → excluded. Excluded.
MEMBER 71045: Age 44. Enrolment: 2026-04-05 through 2026-12-31, not enrolled before 2026-04-05. Is this "enrolled for the full measurement year"? No — she's not enrolled 2026-01-01 through 2026-04-04. Is that considered a gap? The spec says "enrolled for the full measurement year with no more than one gap of up to 45 days." Not being enrolled from Jan 1 to Apr 4 is a gap of... well, it's not a gap in continuous enrolment; she just wasn't enrolled for the full year. Hmm.
The standard NCQA-style continuous enrollment requires enrollment from the start of the measurement period. But the spec here says "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days." The roster for 71045 says "Not enrolled before 2026-04-05." The gap from 2026-01-01 to 2026-04-04 is 94 days (Jan 1 to Apr 4: Jan 31 + Feb 28 + Mar 31 + Apr 4 = 94 days). That's longer than 45 days. So she fails continuous enrolment → not_eligible.
Hmm, but wait. Could one argue that the measurement period for continuous enrolment starts at her enrollment date? The spec says "enrolled for the full measurement year". She wasn't. The gap interpretation: not enrolled 2026-01-01 through 2026-04-04 is a gap longer than 45 days. Either way, not_eligible.
Actually, let me reconsider. Some measures allow enrolment to start before a certain date (e.g., NCQA allows "enrolled on or before the anchor date" or similar). But this spec says "enrolled for the full measurement year with no more than one gap of up to 45 days." The natural reading: the member must be enrolled for the full measurement year (2026-01-01 through 2026-12-31), allowing at most one gap of up to 45 days. 71045 was not enrolled for the first ~94 days. Whether that counts as a "gap" of 94 days (>45) or simply failure to be enrolled for the full year, she's not eligible. The roster deliberately contrasts her with the others who have labeled gaps. I'll call her not_eligible.
Hmm, wait, but let me double-check whether this could be intended as eligible with an allowed gap. If the spec intended "one gap of up to 45 days" to cover the pre-enrollment period, then 94 days > 45, so still not eligible. Yes, not_eligible either way.
MEMBER 71046: Age 35. Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days (>45) → removed from denominator → not_eligible. Let me verify: 2026-04-27 through 2026-06-23: April 27-30 is 4 days, May 31 days, June 1-23 is 23 days, total 58. Yes, >45. not_eligible.
MEMBER 71047: DOB 2008-04-06, 18 on 2026-12-31. Age 18-85 → eligible. Enrolment continuous. Event: office visits with I10 on 2026-06-17 (within Jan 1–Jun 30) → qualifying. Also 2026-07-25 I10 (after Jun 30, doesn't establish event, but event already established). No exclusions. Numerator: most recent outpatient reading after qualifying encounter: 2026-07-25 office 137/73 (2026-11-21 inpatient skipped). 137 < 140 and 73 < 90 → numerator. Compliant.
Wait — which qualifying encounter date? The event-establishing encounter is 2026-06-17 (first-half I10). The 2026-07-25 I10 encounter is after 2026-06-30 so it doesn't establish the event, but is it "the qualifying hypertension encounter"? The qualifying one is the one in the window. Readings after 2026-06-17: 2026-07-25 (137/73) is the most recent outpatient reading. 137/73 → compliant.
MEMBER 71048: Age 35. Enrolment continuous. Event: 2026-05-15 office I10 → qualifying. No exclusions. Numerator: most recent outpatient reading after 2026-05-15: 2026-05-15: 134/93. Systolic 134 < 140 but diastolic 93 ≥ 90 → not numerator. Non-compliant.
MEMBER 71049: Age 61. Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days (2026-06-27 through 2026-07-29: June 27-30 is 4 days, July 1-29 is 29 days = 33). ≤45, one gap → eligible. Event: office visit 2026-08-25 with I10 — wait, that's after 2026-06-30! The event requires an I10 outpatient encounter between 2026-01-01 and 2026-06-30. 71049's encounters: 2026-08-25 office I10; 2026-11-28 ED R07.9; 2026-12-25 office I10. None in the first half of the year. So no qualifying event → not_eligible.
Hmm interesting. The event requirement: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." 71049 has I10 encounters on 2026-08-25 and 2026-12-25, both after 2026-06-30. So the event is not established → not_eligible. Yes.
MEMBER 71050: Age 84. Enrolment continuous. Event: 2026-06-23 office I10 → qualifying (within window). No exclusions. Numerator: most recent outpatient reading after 2026-06-23: 2026-09-08 office (J06.9) 129/71. 129 < 140, 71 < 90 → compliant.
Wait — the 2026-09-08 visit is a J06.9 (acute upper respiratory infection) office visit. It's an outpatient reading on or after the qualifying encounter date. Counts. Most recent outpatient reading = 2026-09-08: 129/71 → compliant.
MEMBER 71051: Age 35. Enrolment: three segments: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps: 2026-04-09 through 2026-05-04 (26 days) and 2026-08-08 through 2026-08-21 (14 days). Two gaps → "two or more gaps of any length removes the member from the denominator." So not_eligible. Even though she has a hospice election (E3), the exclusion doesn't apply because she's not in the eligible population. "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So 71051 is not_eligible.
Wait, let me double check the gap calculation: 2026-04-09 to 2026-05-04: April 9-30 = 22 days, May 1-4 = 4 days, total 26 days. Yes. Second gap: 2026-08-08 to 2026-08-21 = 14 days. Two gaps → not_eligible. Correct per the rules: "two or more gaps of any length" removes from denominator. And the event: 2026-03-21 and 2026-04-06 I10 office visits are in the first half — event established. But enrolment fails. not_eligible.
MEMBER 71052: Age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. Gap: 2026-04-09 through 2026-05-23 = 45 days (April 9-30 = 22, May 1-23 = 23, total 45). One gap of exactly 45 days → allowed ("no more than one gap of up to 45 days"). Eligible on enrolment. Event: I10 office visits 2026-04-08, 2026-06-04, 2026-07-13 — first two are in window (2026-06-04 ≤ 2026-06-30). Qualifying. No exclusions. Numerator: most recent outpatient reading: 2026-07-13 office 127/73 (2026-07-16 ED skipped). 127 < 140, 73 < 90 → compliant.
Hmm wait, one subtlety: the qualifying encounter date. If we take the earliest qualifying I10 encounter (2026-04-08), the reading window starts 2026-04-08. The most recent outpatient reading in that window is 2026-07-13: 127/73. Compliant.
MEMBER 71053: Age 84. Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap: 2026-05-16 through 2026-06-06 = 22 days (May 16-31 = 16, June 1-6 = 6, total 22). Allowed. Event: I10 office visits 2026-05-22 and 2026-06-26 — both in window. Qualifying. No exclusions. Numerator: most recent outpatient reading after qualifying encounter: 2026-06-26 office 133/95. Inpatient 2026-08-24 skipped. 133 < 140 but 95 ≥ 90 → not numerator. Non-compliant.
MEMBER 71054: Age 84. Enrolment: one gap of 42 days → eligible. Event: I10 office visits 2026-03-21 and 2026-05-06, both in window. Qualifying. No exclusions. Numerator: most recent outpatient reading: 2026-10-28 office (E78.5) 132/95. Inpatient 2026-06-05 skipped. 132 < 140, 95 ≥ 90 → not numerator. Non-compliant.
MEMBER 71055: DOB 1940-08-21, 86 on 2026-12-31 → age 86 > 85 → not_eligible.
MEMBER 71056: Age 84. Enrolment continuous. Event: I10 office visits 2026-01-19 and 2026-03-20, both in window. Qualifying. No exclusions. Numerator: most recent outpatient reading after qualifying encounter: 2026-03-20: 153/86. 153 ≥ 140 → not numerator. Non-compliant.
Hmm wait — for 71056, which qualifying encounter? Both 2026-01-19 and 2026-03-20 are in the window. If we take the first (2026-01-19), the window includes both readings; most recent is 2026-03-20: 153/86. If we take 2026-03-20 as the qualifying encounter, the most recent reading after that date: none (the 2026-03-20 reading itself — is a reading on the same date "on or after"? Yes, "taken on or after the date" — the reading at the encounter itself is on that date, so it counts). Either way, most recent = 2026-03-20: 153/86 → non-compliant.
Now let me also double-check 71043 more carefully. Event: 2026-02-12 I10 office (qualifying). Readings after: 2026-03-21 (135/73), 2026-05-22 (119/102), 2026-10-02 (136/103). Most recent: 2026-10-02: 136/103. 103 ≥ 90 → non-compliant. Yes.
And 71041: age check. DOB 1941-07-25. On 2026-12-31, age = 85 (birthday July 25, 2026 → turned 85). The roster confirms "85 years old on 2026-12-31." Eligible age (18-85 inclusive). Event: 2026-02-18 I10 office → qualifying. Readings: 2026-02-18 office 150/72; 2026-05-18 inpatient 159/81 (skipped). Most recent outpatient: 2026-02-18: 150/72 → systolic 150 ≥ 140 → non-compliant.
71044: Exclusion E1 — N18.6 on 2024-06-20, "any time on or before 2026-12-31" — yes, 2024-06-20 is on or before 2026-12-31. Excluded. Note: the exclusion applies even though the diagnosis is from 2024, because E1 says "any time on or before 2026-12-31." Excluded.
Now tally:
Compliant: 71047, 71050, 71052. That's 3.
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056. That's 6.
Excluded: 71044. That's 1.
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055. That's 6.
Total: 3 + 6 + 1 + 6 = 16. ✓
Denominator = compliant + non_compliant = 3 + 6 = 9.
Numerator = 3.
Excluded = 1.
Not eligible = 6.
Rate = 3/9 × 100 = 33.333...% → rounded half up to one decimal = 33.3.
Let me double check each non-eligible determination:
71042: age 86 → not_eligible. ✓ (Roster says 86 on 2026-12-31; age requirement is 18 through 85.)
71045: not enrolled full year. Enrolment starts 2026-04-05. Gap 2026-01-01 through 2026-04-04 = 94 days > 45 → not_eligible. ✓
71046: gap of 58 days > 45 → not_eligible. ✓
71049: no I10 encounter in first half → event not established → not_eligible. ✓ Let me recheck: encounters 2026-08-25 (I10), 2026-11-28 (ED R07.9), 2026-12-25 (I10). The earliest I10 outpatient encounter is 2026-08-25, after 2026-06-30. "An encounter after 2026-06-30 does not establish the event." → not_eligible. ✓
71051: two gaps → not_eligible. ✓ (Even though hospice E3 documented, she fails enrolment, so not_eligible per the stated precedence rule.)
71055: age 86 → not_eligible. ✓
Double-check compliant members:
71047: age 18 (turned 18 on 2008-04-06... wait, DOB 2008-04-06 means on 2026-12-31 he is 18). Age 18 → within 18-85. ✓ Continuous enrolment ✓. Event: I10 office 2026-06-17 (≤ 2026-06-30) ✓. No exclusions ✓. Most recent outpatient reading on/after 2026-06-17 and ≤ 2026-12-31: 2026-07-25 office 137/73. Inpatient 2026-11-21 skipped. 137 < 140 ✓, 73 < 90 ✓ → compliant. ✓
71050: age 84 ✓, continuous enrolment ✓, event 2026-06-23 I10 office ✓ (within window), no exclusions ✓. Most recent outpatient reading after 2026-06-23: 2026-09-08 office J06.9 129/71. 129 < 140 ✓, 71 < 90 ✓ → compliant. ✓
71052: age 35 ✓, enrolment one gap of exactly 45 days → allowed ✓, event: I10 office 2026-04-08 (within window) ✓, no exclusions ✓. Most recent outpatient reading: 2026-07-13 office 127/73 (ED 2026-07-16 skipped). 127 < 140 ✓, 73 < 90 ✓ → compliant. ✓
Hmm, one consideration on 71052: the enrolment segments are "2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31." The gap between 2026-04-08 and 2026-05-24: the last covered day is 2026-04-08, next covered day is 2026-05-24. Gap days: 2026-04-09 to 2026-05-23 = 45 days. The roster explicitly says "One gap of 45 days." The rule: "no more than one gap of up to 45 days" — 45 is "up to 45", so allowed. ✓ Also the qualifying encounter 2026-04-08 was on the last day of the first enrolment segment — fine, the encounter just needs to occur during the measurement year window; there's no requirement the member be enrolled on the encounter date per se (and he was enrolled that day anyway).
Also check 71049's gap for completeness: 2026-06-26 last day, 2026-07-30 next. Gap 2026-06-27 to 2026-07-29 = 33 days. One gap ≤ 45 → enrolment OK. But event fails → not_eligible. ✓
Also 71053's gap: 2026-05-15 last, 2026-06-07 next. Gap 2026-05-16 to 2026-06-06 = 22 days. One gap ≤ 45 → enrolment OK. Ejson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
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],
"got": [
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
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"got": [
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"71043",
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
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"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,222 tokens
Let me work through each member.
Measure: age 18-85 as of 2026-12-31. Event: outpatient I10 encounter 2026-01-01 to 2026-06-30. Continuous enrolment full year, ≤1 gap ≤45 days.
71041: age 85 ✓. Enrolled continuous ✓. Event: 2026-02-18 office I10 ✓. Numerator: most recent outpatient BP on/after 2026-02-18 and ≤2026-12-31. Readings: 2026-02-18 office 150/72; 2026-05-18 inpatient (skipped). Most recent qualifying = 150/72 → not <140. Non-compliant.
71042: age 86 → not_eligible (age fails). Even though two gaps also. Not eligible.
71043: age 35 ✓, continuous ✓. Event: I10 office visits Feb/Mar ✓. Most recent outpatient BP after encounter date (2026-02-12): 2026-10-02 office 136/103 → diastolic ≥90, fails. Prior 2026-05-22 119/102 fails. Most recent is 136/103 → non-compliant.
71044: age 70 ✓ continuous ✓ event: 2026-04-23 office I10 ✓. Exclusion E1: N18.6 in 2024 → excluded.
71045: age 44 ✓ but enrolment starts 2026-04-05, not full year → not_eligible.
71046: age 35 ✓. One gap of 58 days >45 → not_eligible.
71047: age 18 ✓ (18 through 85 inclusive). Continuous ✓. Event: 2026-06-17 office I10 ✓ (on/before 06-30). Numerator: most recent outpatient BP on/after 2026-06-17: office 2026-07-25 137/73 ✓ (inpatient 2026-11-21 skipped). 137<140 and 73<90 → compliant.
71048: age 35 ✓ continuous ✓ event 2026-05-15 I10 ✓. Most recent BP: 134/93 → diastolic ≥90 → non-compliant.
71049: age 61 ✓. Enrolment gap 33 days, one gap ≤45 → OK, eligible. Event: office I10 encounters — 2026-08-25 office I10 but after 06-30. First qualifying event? Need at least one outpatient I10 encounter between 01-01 and 06-30. None: encounters are 08-25 (I10), 11-28 ED, 12-25 office I10. No event in window → not_eligible.
71050: age 84 ✓ continuous ✓ event 2026-06-23 office I10 ✓. Most recent outpatient BP on/after 06-23: 2026-09-08 office 129/71 ✓ → compliant.
71051: age 35 ✓. Two gaps (26, 14) → two or more gaps removes from denominator → not_eligible. (Also hospice, but enrolment fails first.)
71052: age 35 ✓. One gap of 45 days — "no more than one gap of up to 45 days" — 45 is up to 45, allowed. Continuous OK. Event: 2026-04-08 office I10 ✓. Numerator: most recent outpatient BP on/after 04-08, skipping ED 07-16: office 07-13 127/73 ✓ → compliant.
71053: age 84 ✓. One gap 22 days OK. Event: 2026-05-22 office I10 ✓. Numerator: readings after 05-22: 06-26 office 133/95 (fails diastolic); 08-24 inpatient skipped. Most recent outpatient = 133/95 → non-compliant.
71054: age 84 ✓. One gap 42 days OK. Event: 03-21 office I10 ✓. Numerator: most recent outpatient BP on/after 03-21: 10-28 office 132/95 → diastolic fails → non-compliant. (Inpatient 06-05 skipped.)
71055: age 86 → not_eligible.
71056: age 84 ✓ continuous ✓ event 2026-01-19 I10 ✓. Most recent outpatient BP after 01-19: 03-20 153/86 → fails systolic → non-compliant.
Counts:
Compliant: 71047, 71050, 71052 → 3
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
Excluded: 71044 → 1
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Denominator = 3+6 = 9. Numerator = 3. Rate = 3/9*100 = 33.333... → 33.3.
Check 71041: most recent outpatient after 02-18 — 02-18 itself counts (on/after encounter date). Inpatient 05-18 skipped. So 150/72, fails. Non-compliant. ✓
Check 71047 age: born 2008-04-06, 18 on 2026-12-31 ✓.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,316 tokens
Let me work through each member.
Eligibility: age 18–85 at 2026-12-31; event: outpatient I10 encounter 2026-01-01 to 2026-06-30; continuous enrolment with ≤1 gap ≤45 days (two gaps of any length removes).
Exclusions: ESRD/dialysis, pregnancy, hospice/palliative, died.
Numerator: most recent outpatient BP on/after qualifying encounter date and ≤2026-12-31, both <140 and <90.
71041: age 85 (born 1941-07-25 → 85 on 2026-12-31, OK). Enrolled continuous. Event: 2026-02-18 office visit I10 (before 06-30, OK). Numerator: most recent outpatient reading after 2026-02-18: inpatient 2026-05-18 skipped, so 2026-02-18 BP 150/72 → systolic 150 ≥140 → not compliant. Denominator, non_compliant.
71042: age 86 → not_eligible.
71043: age 35, continuous. Event: 2026-02-12 I10. Most recent outpatient reading after that: 2026-10-02 BP 136/103 → diastolic ≥90 → non_compliant. Wait — most recent is 10-02 (136/103). Yes non_compliant.
71044: age 70, continuous, event 2026-04-23 I10. ESRD N18.6 2024 → excluded (E1).
71045: enrolment starts 2026-04-05 — not full year, gap >45 days? Not enrolled 2026-01-01 to 2026-04-04 → gap longer than 45 days → not_eligible.
71046: one gap of 58 days >45 → not_eligible.
71047: age 18 (born 2008-04-06, turns 18 on 2024... wait 2008+18=2026, April 6 2026 → 18 on 2026-12-31, OK). Continuous. Event: 2026-06-17 I10 office. Numerator: most recent outpatient reading after 2026-06-17: 2026-07-25 office 137/73; inpatient 11-21 skipped. 137<140, 73<90 → compliant.
71048: age 35, continuous. Event 2026-05-15 I10. Most recent reading: 134/93 → diastolic ≥90 → non_compliant.
71049: age 61. Gap 33 days, one gap → OK. Event: outpatient I10 encounter between 01-01 and 06-30? Encounters: 2026-08-25 I10, 11-28 ED, 12-25 office I10. No encounter in first half with I10 → event fails → not_eligible. Wait, event must be on or between 2026-01-01 and 2026-06-30. First I10 is 08-25. So not_eligible. Enrolment fine but event fails → not_eligible.
71050: age 84, continuous. Event: 2026-06-23 office I10. Numerator: most recent outpatient reading after 06-23: 2026-09-08 office 129/71 → compliant.
71051: two gaps (26 and 14) → not_eligible (even though hospice, exclusions evaluated only for eligible; not_eligible wins).
71052: age 35. Gap of 45 days — "no more than one gap of up to 45 days" — 45 days allowed. Event: 2026-04-08 office I10 (before 06-30, OK). Numerator: most recent outpatient after 04-08: 2026-07-13 office 127/73 (ED 07-16 skipped, but it's after 07-13... most recent outpatient: 07-16 is ED, skip; so 07-13 office). 127/73 → compliant. Check dates: 04-08, 06-04, 07-13 office, 07-16 ED. Most recent outpatient = 07-13, compliant.
71053: age 84. One gap 22 days OK. Event: 2026-05-22 office I10? Yes, within window. Numerator: most recent outpatient after 05-22: 2026-06-26 office 133/95 → diastolic ≥90 → non_compliant. (Inpatient 08-24 skipped.)
71054: age 84. Gap 42 days OK. Event: 2026-03-21 office I10. Numerator: most recent outpatient after 03-21: 2026-10-28 office 132/95 → diastolic ≥90 → non_compliant.
71055: age 86 → not_eligible.
71056: age 84, continuous. Event: 2026-01-19 office I10. Most recent outpatient after 01-19: 2026-03-20 office 153/86 → systolic ≥140 → non_compliant.
Counts:
- compliant: 71047, 71050, 71052 → 3
- non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
- excluded: 71044 → 1
- not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Total 16 ✓.
Denominator = 3+6 = 9. Numerator = 3. Rate = 3/9*100 = 33.333 → 33.3.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
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"71050",
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Max · Alibaba200.9s · 8,570 out | 230.6s · 10,353 out | 179.1s · 7,751 out
Reasoning · 8,367 tokens
We need answer JSON only. Need solve measure population for 16 members. Need carefully apply rules.
We need classify each member: eligible population: age 18-85 as of 2026-12-31, at least one outpatient encounter with I10 between Jan 1 and Jun 30 2026. Continuous enrollment full measurement year with <=1 gap up to 45 days. Exclusions evaluated before numerator only for eligible: E1 ESRD/dialysis any time on/before 2026-12-31, E2 pregnancy O codes during year, E3 hospice/palliative during year, E4 died during year.
Numerator: most recent outpatient BP reading taken on/after date of qualifying HTN encounter and on/before 2026-12-31 is <140 systolic AND <90 diastolic. ED/inpatient readings don't count and are skipped when identifying most recent reading. If no qualifying reading exists, denominator not numerator.
Need classify not_eligible if fails age/event/enrollment. Excluded if eligible and exclusion. Compliant if eligible, not excluded, numerator. Non_compliant otherwise.
Let's parse each.
Measurement year 2026.
Age criterion: 18 through 85 as of 2026-12-31. DOB given ages. 86 not eligible. 18 eligible. 85 eligible.
Event: outpatient encounter with I10 on/between 2026-01-01 and 2026-06-30. Need what counts outpatient? Office visit likely outpatient. Emergency department? The event criterion says outpatient encounter; ED is maybe outpatient? But numerator says ED/inpatient readings don't count. For qualifying event, likely office visit outpatient. ED might be outpatient encounter? Need infer. It says outpatient encounter with hypertension diagnosis. Usually outpatient includes office visits, ED maybe outpatient? But numerator explicitly says reading taken in ED or inpatient does not count and skipped. For event, if an ED visit with I10 maybe could be outpatient? But here no ED I10 before Jun? Member 71049 ED 2026-11-28 R07.9, no. 71047 office visits. We can mostly avoid. Need event date: date of qualifying HTN encounter, likely first outpatient I10 in Jan-Jun? The numerator uses date of qualifying hypertension encounter. Could be any qualifying encounter? It says most recent outpatient BP reading taken on or after date of the qualifying hypertension encounter. If multiple I10 office visits before June, which date? Need determine. Typically measure: denominator has office visit with HTN during first 6 months; numerator most recent BP during measurement year on or after date of that visit. If multiple qualifying visits, perhaps use earliest? Or any? Need reason. The spec says "at least one outpatient encounter with a hypertension diagnosis (I10) on or between ... Event". Numerator: "the most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter..." If more than one qualifying encounter, could choose one? Usually the qualifying encounter is the visit that meets denominator; if multiple, maybe earliest? The reading must be on/after the date of the qualifying encounter. If a BP before a later encounter? We need apply. In similar HEDIS CBP, denominator: age 18-85 with diagnosis of HTN and at least one visit during measurement period. Numerator: most recent BP reading during measurement year and on or after date of visit. If multiple visits, the "index date" might be first visit? Actually NCQA CBP: denominator is age 18-85 with diagnosis of hypertension and had an outpatient visit during measurement period. Numerator: most recent blood pressure reading during measurement year and on or after date of visit, with SBP <140 and DBP <90. If there are multiple visits, I think the denominator visit can be any; perhaps use first? But if BP before visit not counted. For members with qualifying office visit and earlier BP? Need see cases.
Member 71042: 86 age fail, enrollment two gaps fail, but event office I10 Apr 5, Apr 11. not_eligible. Exclusions not evaluated.
71043: age 35, enrollment continuous, event Feb 12 I10 and Mar 21 I10. No exclusions. Numerator: most recent outpatient BP reading on/after qualifying encounter and <=Dec31, skipping inpatient/ED. Need all outpatient BP after event. Readings: Feb 12 BP 126/73 (office I10), Mar 21 135/73 (office I10), May 22 119/102 (office E78.5), Oct 2 136/103 (office E78.5). Most recent outpatient reading on/after event date? If qualifying event earliest Feb 12, then Oct 2 136/103 is most recent. Diastolic 103 >=90, fail. If qualifying event could be Mar 21, still Oct 2 fail. Compliant? no. Non_compliant. Need note: readings with non-I10 diagnosis count for numerator? It says most recent outpatient blood pressure reading taken on/after date... doesn't require I10. So yes, office visits with E78.5 count. Therefore fail due diastolic 103. Non_compliant.
71044: age 70, continuous, event Apr 23 I10. Exclusion E1 ESRD 2024-06-20 any time on/before 2026-12-31. Eligible then excluded. excluded.
71045: age 44, enrollment starts Apr 5, not enrolled full measurement year. Continuous enrollment full year with no more than one gap up to 45 days. Does not cover Jan 1-Apr 4, that's a gap >45? Actually not enrolled prior, so gap from Jan1 to Apr4? Length? Since requirement enrolled for full measurement year, not enrolled before Apr 5 => fails. not_eligible. Event May 23. no matter.
71046: age 35, enrollment one gap of 58 days (Apr27-Jun23? Actually 2026-01-01 through 04-26; 06-24 through 12-31. Gap Apr27-Jun23 inclusive 58 days? Given one gap 58 days >45 => fails continuous enrollment. not_eligible. Event Mar 8. no exclusion.
71047: DOB 2008-04-06, age 18 on 2026-12-31? Let's check: 2008 to 2026 is 18, birthday Apr 6, yes 18. Eligible age. Enrollment continuous. Event: 2026-06-17 office I10 BP 138/76 (qualifies before Jun30); 2026-07-25 office I10 after Jun30 does not establish event but could be after? Event established Jun17. Numerator: most recent outpatient BP reading on/after date of qualifying encounter (Jun17) and <=Dec31, skip ED/inpatient. Readings: Jun17 office BP 138/76 outpatient, Jul25 office BP 137/73 outpatient, Nov21 inpatient BP 118/88 skip. Most recent outpatient is Jul25 137/73. Both <140 and <90 yes. Compliant. Need if qualifying event date could be Jul25? No because event must be by Jun30, so qualifying event is Jun17. Good.
71048: age 35, continuous, event May15 I10. Numerator most recent outpatient BP after May15: May15 134/93. Diastolic 93 not <90. fail. Non_compliant.
71049: age 61, enrollment one gap 33 days <=45, okay. Event: need outpatient I10 Jan-Jun. Encounters: 2026-08-25 office I10, 2026-11-28 ED R07.9, 2026-12-25 office I10. None Jan-Jun. Therefore event fail. not_eligible. Even though enrollment okay. Note: if gap? one 33 days okay. not eligible.
71050: age 84, continuous. Event: 2026-06-23 office I10 (within Jun30). Numerator: most recent outpatient BP on/after Jun23. Readings: Jun23 office 122/84, Sep8 office J06.9 129/71. Most recent Sep8 129/71, both below. Compliant.
71051: age 35. Enrollment: 2026-01-01 to 04-08; 05-05 to 08-07; 08-22 to 12-31. Gaps of 26 and 14 days. Two or more gaps any length removes. fails enrollment. not_eligible. Even though hospice exclusion later, exclusions evaluated only for eligible. not eligible. Need check if gap 1 day? Enrollment segments: Apr9-May4 gap 26 days; Aug8-Aug21 gap 14 days. yes two gaps. not eligible.
71052: age 35. Enrollment: Jan1-Apr8; May24-Dec31. One gap 45 days. Allowed one gap up to 45 days. Need confirm gap length exactly 45 days. Given one gap of 45 days. Eligible enrollment. Event: Apr8 office I10 within Jun30. Exclusions none. Numerator: most recent outpatient BP on/after qualifying encounter date. Which date? There are office I10 Apr8, Jun4, Jul13; ED Jul16. Need most recent outpatient reading after event. If qualifying encounter is Apr8 (first), readings after Apr8: Jun4 149/73, Jul13 127/73, ED skip. Most recent outpatient is Jul13 127/73 <140/<90 -> compliant. If somehow qualifying encounter could be Jun4? still Jul13. If event could be Apr8 or Jun4? okay. Compliant.
71053: age 84. Enrollment one gap 22 days okay. Event: May22 office I10 (within Jun30), Jun26 office I10 after but event established. Numerator: most recent outpatient BP on/after event date. Need if qualifying event date May22. Readings: May22 office 146/72, Jun26 office 133/95, Aug24 inpatient skip. Most recent outpatient Jun26 133/95. Diastolic 95 fail. Non_compliant. If qualifying event Jun26? Then reading Jun26 133/95 fail. Non_compliant.
71054: age 84. Enrollment one gap 42 days okay. Event: Mar21 office I10 and May6 office I10 within Jun30. Numerator: most recent outpatient BP on/after qualifying encounter. Need choose qualifying event date. If earliest Mar21: readings after: May6 office 138/85, Jun5 inpatient skip, Oct28 office E78.5 132/95. Most recent outpatient Oct28 132/95, diastolic 95 fail. If choose later qualifying event May6: readings after May6: Oct28 132/95 fail. Non_compliant. But note if most recent BP after event is Oct28 132/95 fail. If inpatient Jun5 132/76 skip. If skip, fail. Non_compliant.
71055: age 86 on 2026-12-31, age fail. not_eligible. Even continuous, event Feb18. Not eligible.
71056: age 84, continuous. Event Jan19 office I10. Numerator: most recent outpatient BP on/after Jan19. Readings: Jan19 125/88, Mar20 153/86. Most recent Mar20 systolic 153 >=140 (diastolic 86 ok) fail. Non_compliant.
71041: age 85 (DOB 1941-07-25; 2026-12-31 age 85). continuous. Event: Feb18 office I10 BP 150/72 within period. Other May18 inpatient R07.9 BP 159/81. Numerator: most recent outpatient BP on/after Feb18, skip inpatient. Only outpatient BP is Feb18 150/72? Need if inpatient skipped. So most recent outpatient is Feb18 150/72. Systolic 150 >=140, fail. Non_compliant. No exclusions. Non_compliant.
Now totals:
Members: 71041 non_compliant
71042 not_eligible (age/enroll)
71043 non_compliant
71044 excluded
71045 not_eligible
71046 not_eligible
71047 compliant
71048 non_compliant
71049 not_eligible
71050 compliant
71051 not_eligible
71052 compliant
71053 non_compliant
71054 non_compliant
71055 not_eligible
71056 non_compliant
Counts: compliant 3: 71047, 71050, 71052.
Non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 = 6. Check 71044 excluded. Not eligible: 71042,71045,71046,71049,71051,71055 = 6. Excluded: 1. Total 3+6+1+6=16. Denominator = compliant + non_compliant = 9. Numerator = 3. Excluded=1. Not eligible=6. Rate = 3/9*100 = 33.333... rounded half up to one decimal = 33.3. Need number 33.3.
Need ensure no pregnancy/hospice/death among eligible. 71051 hospice but not eligible. 71044 ESRD excluded. No O codes. No deaths. Good.
Need verify enrollment gap rules details: "enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from denominator." For 71042: two gaps 15,12 -> fails. Age 86 also fails. not_eligible. 71045: Not enrolled before Apr5. Is that a gap? From Jan1 to Apr4, 94 days? Or no coverage; definitely fails full year. not eligible. 71049: one gap 33 ok but event fail. not eligible. 71052: one gap 45 exactly allowed. Good.
Need think about definition of outpatient encounter for event. Could ED count as outpatient encounter? In 71049 no ED I10 in Jan-Jun. In 71046 event office. Good.
Need think about numerator: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." It says reading taken in ED or inpatient does not count and is skipped when identifying most recent reading. Does it require reading to be from an outpatient encounter? Yes, outpatient BP reading. Office visits count. Inpatient and ED skip. For 71041, inpatient reading May18 skip, only Feb18. Fail.
Potential ambiguity: For members with multiple qualifying hypertension encounters before Jun30, what is "the qualifying hypertension encounter"? Could be latest encounter? If latest, for 71054 event May6; numerator after May6 fail. For 71043 latest Mar21; still fail. For 71053 latest Jun26? Wait event criterion at least one outpatient I10 Jan-Jun. Member 71053 has May22 and Jun26 both I10. If "qualifying encounter" could be the one that establishes event? Usually first? If it allowed choose latest qualifying encounter Jun26, numerator after Jun26: Jun26 133/95, Aug24 inpatient skip -> fail. If choose May22, most recent outpatient after May22 is Jun26 fail. same.
71052: multiple I10: Apr8, Jun4, Jul13. But Jul13 after Jun30 cannot establish event; however can be a qualifying hypertension encounter? The event requires at least one on/between Jan1-Jun30. The "qualifying hypertension encounter" likely the encounter that satisfies event, must be by Jun30. So Jul13 cannot be qualifying for denominator, but could be an encounter after event for BP? Numerator says reading taken on/after date of qualifying encounter. Readings do not need diagnosis I10. If we erroneously choose Jul13 as qualifying, then no reading after? Actually Jul13 reading itself is 127/73 and qualifies if same date; but event not established by it. Not matter because compliant.
71047: qualifying encounter Jun17; Jul25 I10 after Jun30 cannot establish event, but outpatient BP after Jun17 counts. Good.
Could there be issue with 71052: most recent outpatient BP reading on/after event date if event date is Apr8: Jul16 ED skipped, Jul13 office is before ED, so most recent counted is Jul13. compliant. If event date is Jun4? Jul13. If event date is Apr8 and there is a BP Jun4 149/73 after event but later Jul13 127/73 controls. Good.
Need check 71053: if most recent outpatient BP reading on/after event date May22: Jun26 133/95 fail. If the inpatient Aug24 112/84 is skipped, yes fail. If inpatient counted, would pass? But spec says skip. Good.
Need check 71054: event Mar21 or May6; readings: May6 138/85 pass, Jun5 inpatient 132/76 skip, Oct28 office 132/95 fail. Most recent counted Oct28 fail. If only readings with I10 counted? Spec doesn't require diagnosis; if only I10, May6 138/85 would be most recent qualifying I10 outpatient after event (if skip Oct28 E78.5) and would pass. But spec says most recent outpatient blood pressure reading, not necessarily with I10. Need be sure. It says "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter..." no diagnosis requirement. So office visit with E78.5 counts. Therefore fail for 71054. Need consider 71043 similarly: if only I10, most recent I10 outpatient after event is Mar21 135/73 pass; but non-I10 Oct2 136/103 fail. The measure likely uses most recent BP from any outpatient visit? HEDIS uses most recent BP reading during measurement year, regardless of diagnosis? Usually yes, any BP reading. The supplied spec explicitly includes encounters with diagnoses E78.5 and J06.9, likely to test that they count. Thus our interpretation correct.
Need check 71050: includes Sep8 J06.9 BP 129/71 counts pass. If only I10, Jun23 122/84 pass anyway. 71041 includes inpatient R07.9 BP skip. Good.
Need check exclusion E1: "End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31." 71044 has 2024-06-20 N18.6. Excluded. If not eligible? He meets age/enrollment/event. Yes excluded.
Hospice 71051: election 2026-10-27. But not eligible due two gaps. Exclusions evaluated only for members in eligible population. Not eligible. Good.
Need produce JSON with exact keys: denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members. Values arrays of strings. No extra keys. Ensure rate is number with one decimal? JSON can be 33.3. Round half up. 3/9*100=33.333 -> 33.3. If denominator zero? no.
Need ensure IDs are strings numbers after MEMBER. Use e.g. "71047". Any order. Could sort ascending.
Let's double-check each member thoroughly, maybe hidden pitfalls: age calculation, enrollment gap counting, event date, numerator BP threshold. Let's examine all.
Member 71041:
DOB 1941-07-25, age at 2026-12-31 = 85 (turns 85 July 25). Age criterion 18 through 85 inclusive. Eligible. Enrollment full continuous. Event: Office visit 2026-02-18 diagnosis I10. Qualifies. Exclusions: no hospice, alive, no ESRD/pregnancy. Numerator: Most recent outpatient BP reading taken on/after 2026-02-18 and <=12/31. Office visit Feb18 BP 150/72. Inpatient May18 BP 159/81 is inpatient skip. So most recent outpatient = Feb18. SBP 150 not <140. Non-compliant. Good.
Member 71042:
Age 86 -> not eligible. Also enrollment two gaps. Event exists but not needed. not_eligible.
Member 71043:
Age 35, continuous. Event: Feb12 I10. Qualifies. Exclusions none. Numerator: Need date of qualifying encounter. If first qualifying is Feb12. Readings after: Feb12 126/73; Mar21 135/73; May22 119/102; Oct2 136/103. Most recent = Oct2. SBP 136 <140, DBP 103 >=90 => fail. Non-compliant. If there were an inpatient/ED skip? none. Good.
Member 71044:
Age 70, continuous. Event Apr23. Exclusion E1. Excluded. Numerator irrelevant. Note BP 152/76 fail too but excluded takes precedence. Good.
Member 71045:
Enrollment only Apr5-Dec31. Requirement enrolled full measurement year. Not eligible. Even if gap allowed? The period Jan1-Apr4 is a gap of 94 days? More than 45, and also not full year. not_eligible.
Member 71046:
Age 35. Enrollment one gap 58 days >45. not eligible. Event Mar8. Not eligible.
Member 71047:
Age 18. Need age as of Dec31: DOB 2008-04-06, yes turned 18 Apr6 2026. Eligible. Enrollment continuous. Event: Jun17 office I10. Qualifies (within Jan-Jun). Jul25 office I10 after Jun30 does not establish event but is an outpatient BP after qualifying encounter. Numerator: readings after Jun17: Jun17 138/76, Jul25 137/73, Nov21 inpatient skip. Most recent outpatient = Jul25. 137<140 and 73<90. Compliant. Good. Potential: Does office visit with diagnosis I10 on Jul25 count as BP reading if after event? Yes outpatient. Good.
Member 71048:
Age 35, continuous. Event May15. Numerator: most recent outpatient after May15 = May15 134/93. DBP 93 fail. Non-compliant. Good.
Member 71049:
Age 61. Enrollment one gap 33 days. Need continuous enrollment with <=1 gap up to 45: okay. Event: Need I10 outpatient Jan-Jun. Encounters Aug25 I10, Dec25 I10; no. Not eligible. Could the gap period include Jun27-Jul29? Event none. Not eligible. Good.
Member 71050:
Age 84, continuous. Event Jun23 I10. Numerator: readings after Jun23: Jun23 122/84, Sep8 office J06.9 129/71. Most recent Sep8. Both below. Compliant. Good.
Member 71051:
Enrollment two gaps. not eligible. Even though hospice. Good.
Member 71052:
Enrollment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap 45 days. Need confirm gap of 45 days up to 45 inclusive allowed. Text: "up to 45 days"; yes. Age okay. Event Apr8 I10 (also Jun4, Jul13 but Jul13 after). Exclusions none. Numerator: qualifying encounter date? Earliest Apr8. Readings after Apr8: Apr8 itself? It says on or after date, so Apr8 BP 121/76 counts. Then Jun4 149/73, Jul13 127/73, Jul16 ED skip. Most recent counted = Jul13 127/73. Pass. If we consider qualifying encounter as the first I10 in first six months. Good. Compliant.
Member 71053:
Age 84. Enrollment one gap 22 days okay. Event: May22 I10 and Jun26 I10. Qualifies. Numerator: most recent outpatient on/after qualifying date. If qualifying date May22: May22 146/72, Jun26 133/95, Aug24 inpatient skip. Most recent = Jun26 133/95. DBP 95 fail. If qualifying date Jun26: Jun26 133/95 fail. Non-compliant. Good.
Member 71054:
Age 84. Enrollment one gap 42 days okay. Event: Mar21 I10, May6 I10. Qualifies. Numerator: Need most recent outpatient BP after event. If event date Mar21: Mar21 137/92? Wait BP on Mar21 is 137/92, DBP 92 fail if most recent but later readings. May6 138/85 pass, Jun5 inpatient skip, Oct28 office E78.5 132/95 fail. Most recent outpajson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 10,102 tokens
We need answer user's roster classification. Need produce JSON only. Need analyze thoroughly. Task: measure QM-CBP. Need place each of 16 members into statuses: compliant, non_compliant, excluded, not_eligible. Need denominator = compliant+non_compliant (eligible after exclusions). Numerator compliant. excluded count. not_eligible count. rate = numerator/denominator*100 rounded half up one decimal. Need arrays of member IDs strings.
Need apply rules precisely.
Eligible population:
- Age 18 through 85 as of 2026-12-31. Age inclusive 18-85. 86 not eligible.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event. Need outpatient encounter? They list Office visit likely outpatient. ED? Inpatient? Spec says outpatient encounter with I10. ED and inpatient probably not outpatient? Need consider. For event, only outpatient encounters with I10 before June 30. Office visits are outpatient. Inpatient admissions and ED visits likely not outpatient. But ED with I10? None in qualifying period? 71049 ED no I10? 2026-11-28 ED R07.9. 71051 ED S52.501A. 71052 ED S52.501A. So okay. Need event date: date of qualifying hypertension encounter. If multiple, likely earliest? Numerator says most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter. If multiple qualifying encounters, what is "the qualifying hypertension encounter"? Could be first event that establishes eligibility? Usually measure first I10 encounter in first six months? Need infer. It says "at least one outpatient encounter with a hypertension diagnosis (I10) on or between ...". Numerator: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter. If multiple I10 encounters in period, likely date of qualifying encounter could be first? Or any? Need identify. The examples: If member has I10 office visits before June 30, qualifying event likely the first such encounter? We need decide because affects readings before later I10. For members 71043: I10 2/12 BP 126/73, I10 3/21 BP 135/73, then non-I10 visits with high diastolic. If qualifying date first 2/12, most recent outpatient BP on/after 2/12 and before 12/31, excluding ED/inpatient? All office readings: 3/21 135/73 (controlled), 5/22 119/102 (diastolic not controlled), 10/2 136/103 (not controlled). Most recent is 10/2, not controlled -> noncompliant. If qualifying date was 3/21, still most recent 10/2 not controlled. If only I10 encounters count for BP? Numerator says outpatient BP reading, not necessarily with I10. So non-I10 visits count. Thus noncompliant.
Need exclusions: E1 ESRD N18.6 or dialysis Z99.2 any time on/before 2026-12-31. E2 pregnancy O00-O9A during measurement year. E3 hospice/palliative during year. E4 died. Exclusions evaluated before numerator, only for eligible population. If fails age/event/enrollment then not_eligible even if exclusion documented. If meets exclusion and numerator -> excluded.
Continuous enrollment: full measurement year with no more than one gap up to 45 days. Gap >45 days or two+ gaps any length removes from denominator. Need define gap: period between enrollment segments? If enrolled not from Jan 1? Member 71045 enrolled 2026-04-05 through 12/31, not enrolled before. This is not full measurement year? It says enrolled for full measurement year with no more than one gap up to 45 days. If not enrolled Jan 1? Could be gap from Jan 1 to Apr 5? But full measurement year maybe requires enrollment throughout year except allowed gap. If enrollment starts Apr 5, there is a gap Jan 1-Apr 4 of 94 days? Or not enrolled at beginning, fails continuous enrollment. Need treat as not_eligible due enrollment. Also if enrollment ends before Dec 31? none except segments all through Dec 31 except? 71042 segments through 12/31 but gaps. Need count gaps.
Important: Exclusions only for members in eligible population (age, event, enrollment). So if member has hospice but fails enrollment/age/event -> not_eligible, not excluded. Eg 71051 hospice election 10/27 but enrollment has two gaps (26,14) -> fails continuous enrollment; also event? yes. So not_eligible, not excluded. 71044 ESRD but if age/event/enrollment eligible, excluded. 71042 age 86 fails age, not_eligible despite gaps. 71055 age 86 fails age not_eligible.
Need process each member.
Let's list members:
71041: DOB 1941-07-25, age 85 on 2026-12-31 (eligible age). Enrollment continuous full year. Event: 2026-02-18 Office visit I10, within Jan-Jun. Qualifying encounter date 2/18. Exclusions: no hospice, alive, no ESRD/preg. Eligible. Numerator: most recent outpatient BP reading on/after 2/18 and <=12/31, not ED/inpatient. Readings: 2/18 office BP 150/72. 5/18 inpatient BP 159/81 (skip inpatient). Most recent qualifying outpatient reading = 2/18 150/72. Systolic 150 not <140, fails. Non_compliant.
71042: DOB 1940-06-12, age 86 at 12/31. Fails age. Not_eligible. Also gaps but age first. Not excluded.
71043: age 35, continuous. Event: office I10 2/12 (and 3/21) within period. Eligible. Exclusions none. Numerator: most recent outpatient BP on/after qualifying date. Need choose qualifying date. If earliest 2/12. Readings: 2/12 126/73; 3/21 135/73; 5/22 119/102; 10/2 136/103. All office outpatient. Most recent 10/2, diastolic 103 >=90, fails. Non_compliant. Even if qualifying date maybe latest I10 3/21, still 10/2 fails. If only readings with I10? Most recent I10 BP 3/21 controlled -> would compliant, but spec says outpatient BP reading, not diagnosis. Need be sure. It says "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter ... does not count ED/inpatient." It doesn't require I10 diagnosis on BP reading. So include E78.5 visits. Noncompliant.
71044: age 70, continuous. Event: 4/23 office I10. Eligible before exclusions. Exclusion E1: ESRD N18.6 on 2024-06-20, any time on/before 2026-12-31. Yes. Excluded. Not numerator despite BP 152/76. excluded.
71045: age 44. Enrollment from 2026-04-05 through 12/31, not enrolled before. Full measurement year? Fails continuous enrollment because not enrolled Jan 1-Mar? Need determine if "not_eligible" due enrollment. Event 5/23 office I10. Age okay. But continuous enrolment: "enrolled for the full measurement year with no more than one gap of up to 45 days." A member starting Apr 5 has a gap from Jan 1 to Apr 4? If measurement year requires enrollment from Jan 1 except gap? The gap length: Jan 1 through Apr 4 = 94 days? Let's calculate: Jan 31 + Feb 28 (2026 not leap? 2026 not leap) + Mar 31 + Apr 4 = 31+28+31+4=94. Or if not enrolled before start, it's a gap of 94 days >45, fails. Even if one gap allowed up to 45. Therefore not_eligible. If one could say not enrolled full year, fail. Not excluded (no exclusion). So not_eligible.
71046: age 35. Enrollment: 1/1-4/26; 6/24-12/31. One gap 58 days (>45). Fails continuous enrollment. Not_eligible. Event 3/8 I10, but enrollment fails. Not excluded.
Need check if gap count: from 4/27 to 6/23 inclusive =? Apr 27-30 4, May 31, Jun 1-23 23 =58. Yes >45. Not eligible.
71047: DOB 2008-04-06, age 18 on 2026-12-31. Age eligible (18 through 85). Continuous. Event: office I10 6/17 within Jun 30. Also 7/25 after but not establish. Eligible. Exclusions none. Numerator: qualifying date likely 6/17. Readings on/after 6/17 outpatient: 7/25 office BP 137/73 (outpatient); 11/21 inpatient BP 118/88 skip. Most recent = 7/25 137/73. Systolic 137 <140, diastolic 73 <90 -> compliant. Need consider if 6/17 BP 138/76 also controlled but earlier. Compliant.
71048: age 35, continuous. Event 5/15 office I10. Eligible. Numerator: only reading 5/15 134/93. Diastolic 93 not <90 -> noncompliant. (Systolic okay but both needed). Non_compliant.
71049: age 61. Enrollment: 1/1-6/26; 7/30-12/31. One gap of 33 days <=45. Continuous okay. Event? Need outpatient I10 on/before Jun 30. Encounters: 8/25 office I10 (after Jun 30, does not establish); 11/28 ED R07.9; 12/25 office I10 after. No qualifying I10 encounter in Jan-Jun. Therefore not_eligible due event. Even though enrollment okay. Exclusions none. Not eligible.
Potential nuance: Could 8/25 and 12/25 I10 establish? No, after 6/30 does not establish. Not eligible.
71050: age 84, continuous. Event: 6/23 office I10 within period. Eligible. Numerator: qualifying date 6/23. Readings after: 6/23 122/84; 9/8 office J06.9 BP 129/71. Most recent outpatient 9/8 controlled (<140 and <90). Compliant.
71051: age 35. Enrollment: segments 1/1-4/8; 5/5-8/7; 8/22-12/31. Gaps 26 and 14 days. Two or more gaps any length removes denominator. Fails continuous enrollment. Not_eligible. Hospice election 10/27, but exclusion only if in eligible population. Since fails enrollment, not_eligible. Also event yes 3/21, but fail enrollment.
71052: age 35. Enrollment: 1/1-4/8; 5/24-12/31. One gap 45 days. Allowed up to 45 days inclusive. Continuous okay. Event: 4/8 office I10 within Jun 30. Eligible. Exclusions none. Numerator: qualifying date 4/8. Readings after: 4/8 121/76; 6/4 149/73; 7/13 127/73; 7/16 ED skip. Most recent outpatient = 7/13 127/73 controlled. Compliant. Need if ED 7/16 skipped. Yes.
71053: age 84. Enrollment: 1/1-5/15; 6/7-12/31. One gap 22 days <=45. Continuous okay. Event: 5/22 office I10? Wait enrollment gap from May 16 to Jun 6. Event 5/22 occurs during gap (not enrolled?) But event criterion just at least one outpatient encounter with I10 on/between Jan-Jun. Does encounter need while enrolled? Usually continuous enrollment requirement maybe full year, but if eligible, the event can occur during gap? The spec says Event: at least one outpatient encounter with I10 on or between dates. It doesn't explicitly require enrolled on event date. But continuous enrollment full year with gap allowed; if gap, they are not enrolled during gap but allowed. Could an encounter during a gap count? Material doesn't say it doesn't. In synthetic tasks, likely count encounter date if within measurement period, regardless of gap, unless enrollment requirement says must be enrolled. But if not enrolled on date, is it a plan encounter? It says encounters and results; maybe could be outside plan? We must answer from material. Usually measure eligibility requires continuous enrollment, but event can occur in gap? Hm. Need think.
Member 71053: Enrollment segments: through 5/15, resumes 6/7. Office visit 5/22 during 22-day gap. If event counted, then eligible. If not, no event before Jun 30? Also 6/26 office I10 after Jun 30? Actually 6/26 <=6/30 and I10. Wait 6/26 is within period and after enrollment resumes. So there is qualifying event 6/26 regardless. Yes, event qualifies on 6/26. Good. (The 5/22 may also but not needed.) Exclusions none. Numerator: need qualifying hypertension encounter date. If earliest qualifying I10? If 5/22 counts, qualifying date 5/22; readings after include 5/22 146/72 (uncontrolled systolic), 6/26 133/95 (diastolic uncontrolled), 8/24 inpatient skip. Most recent outpatient 6/26 133/95 -> fail. If qualifying date is 6/26 (if 5/22 not count or if choose latest? The only qualifying in enrollment? then readings on/after 6/26: 6/26 133/95 fail. Same result noncompliant. If most recent outpatient reading before 12/31? 6/26 is last outpatient (8/24 inpatient skip), fail. Non_compliant.
71054: age 84. Enrollment: 1/1-5/6; 6/18-12/31, one gap 42 days <=45. Continuous okay. Event: 3/21 office I10 within period; 5/6 office I10 within period (last day of first segment). Qualifies. Exclusions none. Numerator: Need most recent outpatient BP on/after qualifying date and <=12/31, skip inpatient/ED. Encounters: 3/21 office 137/92 (diastolic 92 fail); 5/6 office 138/85 (controlled? 138<140, 85<90, yes); 6/5 inpatient skip; 10/28 office E78.5 BP 132/95 (diastolic fail). Most recent outpatient reading after qualifying date: If qualifying date earliest 3/21, include 10/28 -> 132/95 fail. If qualifying date latest 5/6, also include 10/28 -> fail. If only I10 readings? latest I10 5/6 controlled, but non-I10 visits count per spec. So non_compliant. Need ensure 10/28 office outpatient with BP, diagnosis E78.5, counts. Yes. Noncompliant.
71055: age 86 on 2026-12-31. Fails age. Not_eligible. Event 2/18 I10 but age fail. Not excluded.
71056: age 84, continuous. Event: 1/19 office I10 within period (and 3/20). Eligible. Exclusions none. Numerator: qualifying date maybe 1/19. Readings after: 1/19 125/88 controlled (diastolic 88 <90); 3/20 153/86 systolic fail. Most recent = 3/20, fails. Non_compliant. If qualifying date latest 3/20, reading 3/20 fail. Noncompliant.
Counts: Let's tally.
Compliant: 71047, 71050, 71052. Any others? Check 71041 no, 71043 no, 71048 no, 71053 no, 71054 no, 71056 no. 71044 excluded. 3 compliant.
Non_compliant: 71041, 71043, 71048, 71053, 71054, 71056. Maybe 71049? no not eligible event. 6 noncompliant.
Excluded: 71044 only? 71051 hospice but not eligible due enrollment. No pregnancy, no death. ESRD only 71044. So 1 excluded.
Not_eligible: 71042 (age), 71045 (enrollment), 71046 (enrollment gap >45), 71049 (event), 71051 (enrollment gaps), 71055 (age). That's 6. Total 3+6+1+6=16. Denominator=9, numerator=3, rate=3/9*100=33.333... rounded half up one decimal =33.3. Need check if denominator after exclusions: compliant+non=9. Yes.
Need verify all enrollment gap rules and event details carefully; there may be subtleties around outpatient encounter and inpatient/ED for qualifying event. Also need ensure age calculation: 18 through 85 as of 2026-12-31. Members with DOB 2008-04-06 turn 18 on 2026-04-06, age 18 at year end, eligible. Members DOB 1941-07-25 turn 85 on 2026-07-25, age 85 at year end, eligible. DOB 1940-* turn 86, ineligible. DOB 1942 turn 84, eligible.
Need think about continuous enrollment: "enrolled for the full measurement year with no more than one gap of up to 45 days." Does "full measurement year" imply must be enrolled at least Jan 1 and Dec 31? All but 71045 have segments covering Jan 1 and Dec 31. 71045 starts Apr 5 and ends Dec 31; not full. It has one gap from Jan 1 to Apr 4? If allowed gap up to 45, 94 fail. not eligible. Good.
Need consider if gaps are measured only between enrollment segments, and if starting after Jan 1 counts as gap? The prompt explicitly: Enrolment: 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05. That likely intended fail continuous enrollment. Good.
Need think if two gaps of any length: 71042 has two gaps but age fail. 71051 two gaps; not eligible. 71042 age fail, not_eligible. If both age and enrollment fail, still not_eligible.
Need think exclusions evaluated before numerator only for members in eligible population. For 71044, eligible population? Age/event/enrollment pass, then ESRD exclusion -> excluded. Yes. For 71051, if hospice but not eligible due enrollment, not excluded. The status definitions: excluded = in the eligible population but meets required exclusion. not_eligible = never enters eligible population (age, event, or enrolment). Member who fails age/event/enrollment is not_eligible even if exclusion documented. So yes.
Need think if 71049 event: Has office I10 after Jun 30. Not eligible. But maybe if there is an outpatient encounter with I10 before Jun 30? Enrollment history no encounters before Jun. No. Not eligible.
Need think if 71046: one gap 58 days, fail. Not eligible. Could exclusion? none.
Need think if 71052 gap exactly 45 days. Allowed "up to 45 days" inclusive. They state one gap of 45 days. Pass. Need verify gap length: enrollment 1/1 through 4/8, next starts 5/24. Gap days from 4/9 to 5/23 inclusive. April 9-30 =22, May 1-23 =23, total 45. Pass.
71053 gap 22 days: 5/16-6/6? May 16-31=16, Jun1-6=6 total 22. Pass. Event 6/26. Good.
71054 gap 42 days: 5/7-6/17? May 7-31=25, Jun1-17=17 total 42. Pass.
71049 gap 33 days: 6/27-7/29? Jun 27-30=4, July1-29=29 total33. Pass. But event fail.
Potential ambiguity: Numerator "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. ... A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, member in denominator not numerator."
Need interpret "qualifying hypertension encounter" perhaps the encounter that satisfies event criterion, i.e., at least one outpatient I10 in first six months. If multiple, perhaps choose earliest? It may affect if BP readings before earliest? None relevant? For 71056 earliest 1/19, all readings after. For 71043 earliest 2/12, all after. For 71047 earliest 6/17, readings after. If latest vs earliest could matter if there are readings between earliest and latest? But most recent after either usually same except if there are readings before latest and after earliest; if latest I10 is after a controlled reading? Let's check members with multiple I10 in first period: 71043 (2/12 and 3/21; most recent overall 10/2 fail both); 71047 (6/17 and 7/25 after period? 7/25 I10 after Jun 30 does not establish event, but could be qualifying? no; event date 6/17; reading 7/25 controlled); 71052 (only 4/8 before; 6/4 and 7/13 I10 also before? Wait 71052 has office I10 4/8, 6/4, 7/13. 6/4 and 7/13 are before/equal Jun 30? 6/4 yes, 7/13 after Jun 30. Multiple qualifying 4/8 and 6/4. If qualifying encounter date chosen latest in first six months 6/4, then most recent outpatient after 6/4: 7/13 controlled. If earliest 4/8: still 7/13 controlled. No difference. 71054: I10 3/21 and 5/6. If latest 5/6, most recent overall 10/28 fail. If only I10? no. 71056: 1/19 and 3/20. If latest 3/20, most recent 3/20 fail. If earliest, most recent 3/20 fail. 71041 only one. 71048 one. 71050 one. 71053 I10 5/22 and 6/26; if latest 6/26 fail. If earliest, most recent 6/26 fail. So no status ambiguity.
Potential ambiguity: "outpatient blood pressure reading" maybe only readings from office visits? ED/inpatient skipped. All office visits outpatient. Good.
Potential ambiguity: For numerator, if most recent qualifying outpatient reading is on same day as qualifying encounter and is uncontrolled, but later non-I10 outpatient reading controlled, count controlled. We did that for 71050 (6/23 I10 controlled, later 9/8 J06.9 controlled). For 71054 later non-I10 uncontrolled, fail. For 71043 later non-I10 uncontrolled, fail. This seems intended.
Need consider exclusion E3: "Enrolled in hospice or receiving palliative care at any time during measurement year." 71051 hospice election 2026-10-27. If she were eligible, excluded. But fails enrollment due two gaps. Not_eligible. Need ensure two gaps any length: gaps 26 and 14. Yes. Could one argue continuous enrollment only allows one gap up to 45; two gaps fail. Not eligible. So not excluded. Good.
Potential issue: Member 71042: age 86 and two gaps. Not eligible due age. If age fails, not excluded despite maybe no exclusion. Good.
Potential issue: Member 71045: if not enrolled before 4/5, but event 5/23. Could the continuous enrollment criterion allow a single gap of up to 45 days at beginning? It's >45 so fail. Good.
Need compute rate rounding half up to one decimal. 3/9*100 = 33.333... -> 33.3. If denominator zero would maybe null? Not here.
Need output exactly one fenced JSON code block and nothing else. Need include required keys: denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members. Arrays strings. Any order. Need ensure counts equal arrays.
Let's double-check each member with detailed reasoning to avoid missed exclusion or event.
Let's create table:
ID | age | enroll | event? | exclusion? | numerator reading | status
71041: 85; continuous; eventjson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,500 tokens
We need answer user's request. Need produce JSON only. Need analyze measure population for 16 members. Need compute statuses per spec. Need be careful. Let's parse all members.
Measure QM-CBP:
Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
Age 18 through 85 as of 2026-12-31.
Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event.
Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. Gap >45 days or two or more gaps any length removes.
Numerator:
Most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components below threshold. Reading in ED or inpatient does not count and is skipped when identifying most recent reading. If no qualifying reading exists, denominator not numerator.
Exclusions evaluated before numerator for eligible only:
E1 ESRD N18.6 or dialysis Z99.2 any time on/before 2026-12-31.
E2 Pregnancy O00-O9A during MY.
E3 hospice or palliative care any time during MY.
E4 died.
Status:
compliant denominator not excluded meets numerator.
non_compliant denominator not excluded not numerator.
excluded eligible but meets required exclusion.
not_eligible fails age/event/enrollment (even if exclusion documented).
Need output denominator, numerator, excluded, not_eligible counts, rate numerator/denominator*100 round half up one decimal. arrays of member IDs strings.
We need evaluate each of 16.
Let's list IDs 71041-71056.
Important details: outpatient encounter: office visit likely outpatient. ED and inpatient not outpatient? For qualifying event: "outpatient encounter with I10". Office visits are outpatient. Inpatient/ED not outpatient. For numerator readings: outpatient BP only; ED/inpatient readings skipped. Qualifying BP reading must be outpatient? It says most recent outpatient blood pressure reading taken on or after date of qualifying hypertension encounter... reading in ED/inpatient does not count and skipped. So numerator uses outpatient BP readings. The encounter with I10 in first half is office visit. Need determine most recent outpatient BP after qualifying event date (including same date?) "on or after the date of the qualifying hypertension encounter". If multiple qualifying encounters? date of the qualifying hypertension encounter? Could be earliest? Usually most recent BP after any qualifying encounter? Need interpret: event requires at least one outpatient I10 in Jan-Jun. Numerator: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter. If multiple I10 encounters before Jun 30, which qualifying encounter? Could use earliest? Or any qualifying encounter? Need decide. Usually measure: most recent BP during measurement year and after diagnosis? The spec says "the qualifying hypertension encounter" singular. If a member has more than one qualifying encounter, likely the earliest qualifying encounter establishes event, BP on/after that date counts. Since all BP after earliest anyway; if later qualifying I10 after earliest but before Jun 30, BP before later encounter would not count if using later. Need inspect cases: 71043 has qualifying I10 2026-02-12 and 2026-03-21; later non-I10 readings with high diastolic. If earliest, most recent outpatient BP overall after 2/12 includes 10/2 136/103 -> fail. If latest qualifying encounter 3/21, still includes 10/2 fail. No difference. 71047 qualifying I10 6/17 and 7/25 after Jun? 7/25 after Jun 30 not establish event but is I10 office? Numerator after date of qualifying encounter: if only 6/17 qualifies. Most recent outpatient BP after 6/17: 7/25 office 137/73 (outpatient) counts, pass. If somehow use 7/25 not qualifying? Still same reading on that date maybe pass. 71054 has qualifying I10 3/21 and 5/6. Most recent outpatient BP after 3/21 includes 10/28 E78.5 BP 132/95 -> fail (diastolic 95). If using 5/6 same fail. 71046 has qualifying I10 3/8 and 5/11 (during gap? Need enrollment? one gap 58 days -> not eligible due enrollment, so no). 71049 qualifying event? I10 8/25 after Jun no, 12/25 after Jun no; no qualifying event. Not eligible. 71048 one qualifying 5/15. etc.
Need continuous enrollment: full measurement year with no more than one gap up to 45 days. Need count gaps between segments. If enrolled not from Jan 1 or not to Dec 31? "enrolled for the full measurement year with no more than one gap of up to 45 days." If not enrolled at beginning or end, gap from start? Usually missing enrollment at start/end is gap? Need interpret. For 71045: enrolled 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before. Does not cover full measurement year: likely not eligible because not enrolled full year with permitted gap? Need calculate gap from Jan 1 to Apr 5? Jan 1-Apr 4 =? Jan 31 + Feb 28 + Mar31 + Apr4 =94 days. >45. Not eligible. Even if considered no prior enrollment, fails continuous full year. Yes.
Need gap length calculation maybe given in text. Some supplied gaps. Need verify if one gap exactly 45 allowed. 71052 one gap 45 days allowed. 71046 one gap 58 not allowed. 71042 two gaps (15 and 12) not allowed. 71051 two gaps not allowed. Others one gap <=45 allowed.
Age: age as of 2026-12-31. 18-85 inclusive. 86 not eligible. 71042 86 not eligible. 71055 86 not eligible. 71041 85 eligible age. 71047 18 eligible. Others eligible.
Exclusions: E1 ESRD N18.6 anytime on/before 2026-12-31. 71044 has N18.6 in 2024. If otherwise eligible -> excluded. E3 hospice during year: 71051 hospice election 2026-10-27. But she fails enrollment due two gaps, so not_eligible, exclusion evaluated only for eligible. Need not excluded. Also if not eligible age/event/enrollment, not excluded. Check 71051: two gaps any length removes denominator -> not_eligible despite hospice. Need ensure if event? Yes but not eligible due enrollment. So not_eligible.
Pregnancy none. Death none.
Need carefully evaluate each.
Let's create table.
Member 71041:
DOB 1941-07-25 age 85 on 2026-12-31: eligible age.
Enroll continuous full year no gaps: eligible.
Event: outpatient I10 2026-02-18 office (within Jan-Jun). Yes.
Exclusions: no hospice, alive, no ESRD/pregnancy. Eligible.
Numerator: Qualifying event date 2/18. Need most recent outpatient BP reading on/after 2/18 through 12/31. Encounters: 2/18 office BP 150/72 (outpatient, I10). 5/18 inpatient BP 159/81 (inpatient skipped). Any other outpatient? No. Most recent qualifying outpatient BP is 150/72. Systolic 150 >=140 so fail. Not numerator. Status non_compliant. Note diastolic 72 below but systolic not. non_compliant.
71042:
Age 86 -> not eligible. Enrollment two gaps also fail, event maybe yes. But age fails. Not_eligible. Exclusion not evaluated. Even if two gaps. status not_eligible.
71043:
Age 35, continuous full year. Event: office I10 2/12, 3/21 both within. Eligible. No exclusions.
Numerator: Most recent outpatient BP on/after qualifying event. Outpatient BP readings:
2/12 126/73; 3/21 135/73; 5/22 office E78.5 119/102; 10/2 office E78.5 136/103. All outpatient. Need after event. Most recent overall is 10/2 136/103. Diastolic 103 >=90 -> fail. So non_compliant. Note if readings with non-I10 diagnosis count? Spec says most recent outpatient BP reading, not necessarily I10. Yes any outpatient reading. So fail. If only readings with I10? 3/21 135/73 pass; but spec says reading, not diagnosis. Need confirm: Numerator: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter..." does not require reading at I10 encounter. So include E78.5 visits. Fail. Non_compliant.
71044:
Age 70, continuous. Event office I10 4/23. Eligible population? But E1 ESRD N18.6 2024-06-20, any time on/before 2026-12-31. Meets exclusion. Status excluded. Not numerator. Excluded.
71045:
Age 44. Enroll 2026-04-05 through 12/31. Not enrolled full measurement year. Is there allowed gap? If enrolled from Apr 5, missing Jan1-Apr4 gap 94 days >45 (or not enrolled at start). Fails continuous enrollment. Not_eligible. Event office I10 5/23 within. But not eligible. No exclusion. not_eligible.
71046:
Age 35. Enrollment segments: Jan1-Apr26, Jun24-Dec31. One gap 58 days. >45 -> fails enrollment. Not_eligible. Event 3/8 office I10. Not eligible.
71047:
DOB 2008-04-06 age 18 by 12/31? Yes 18. Continuous. Event: office I10 6/17 within Jan-Jun. Also 7/25 office I10 after Jun doesn't establish event but exists. Eligible. No exclusions.
Numerator: Need most recent outpatient BP after qualifying encounter date. Qualifying encounter likely 6/17. Outpatient BP readings: 6/17 office 138/76; 7/25 office 137/73; 11/21 inpatient 118/88 skipped. Most recent outpatient is 7/25 137/73. Systolic 137 <140, diastolic 73 <90. Pass. Compliant. Need check if 7/25 encounter diagnosis I10 after Jun; still outpatient BP after qualifying event counts. Yes. Status compliant.
71048:
Age 35 continuous. Event office I10 5/15. Eligible. No exclusions. Numerator: only BP 5/15 134/93. Diastolic 93 >=90 fail. non_compliant.
71049:
Age 61. Enrollment Jan1-Jun26, Jul30-Dec31 one gap 33 days <=45, so enrollment okay. Event: requires outpatient I10 Jan1-Jun30. Encounters: 8/25 office I10 after Jun; 11/28 ED R07.9 not outpatient? ED not outpatient and no I10? 12/25 office I10 after Jun. No I10 in first half. Fails event. Not_eligible. Exclusions none. Not eligible.
Need check if continuous enrollment with one gap 33 allowed, yes. But no event.
71050:
Age 84 continuous. Event office I10 6/23 within. Eligible. No exclusions. Numerator: outpatient BP readings after 6/23: 6/23 122/84; 9/8 office J06.9 129/71. Most recent outpatient 9/8 129/71. Both below. Pass. Compliant.
71051:
Age 35. Enrollment Jan1-Apr8; May5-Aug7; Aug22-Dec31. Gaps 26 and 14 days = two gaps any length -> fails enrollment. Not_eligible. Even hospice during year. Exclusion only eligible, so not_eligible. Need not excluded. Event I10 3/21, 4/6 but fail enrollment. not_eligible.
71052:
Age 35. Enrollment Jan1-Apr8; May24-Dec31. One gap 45 days (given) allowed. Event: office I10 4/8 (within Jan-Jun) yes. Need continuous enrollment? gap 45 allowed. Eligible. No exclusions.
Numerator: Most recent outpatient BP after 4/8. Outpatient readings:
4/8 office I10 121/76 (on date)
6/4 office I10 149/73
7/13 office I10 127/73
7/16 ED S52.501A 119/89 skipped.
Most recent outpatient = 7/13 127/73. Both below. Pass. Compliant. Need check gap includes 4/9-May23? 45 days? It says one gap of 45 days. allowed. Yes.
71053:
Age 84. Enrollment Jan1-May15; Jun7-Dec31 one gap 22 days allowed. Event: office I10 5/22? Wait 5/22 is after enrollment gap? Enrollment segments: Jan1-May15, then Jun7-Dec31. 5/22 falls in gap? Not enrolled? The encounter still listed? Could happen? But event requires outpatient I10 between Jan-Jun. 5/22 office I10 occurs during gap (not enrolled). Does that count? Spec says eligible population requires continuous enrollment with permitted gap; event can occur during gap? Usually if member not enrolled on event date? The measure spec says eligible population includes continuous enrolment; event could be during gap? If the member is not enrolled that day, maybe not counted? The prompt doesn't specify event must be while enrolled, just at least one outpatient encounter. But continuous enrollment with gap allows up to 45-day gap; if event in gap, is it valid? HEDIS usually requires continuous enrollment with allowable gap, and event can occur during gap? In HEDIS, continuous enrollment is defined; gaps allowed, but events during gaps? Usually service during gap not counted? Need reason. The material says "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days." It doesn't state encounter must occur during enrolled periods. If there is an allowable gap, member is considered continuously enrolled, so encounters in gap? If not enrolled, can there be encounter? Synthetic data includes encounter during gap maybe to test. For 71053, 5/22 office I10 during gap (May16-Jun6 gap 22 days). Also 6/26 office I10 after gap. If event can count, she has qualifying event 5/22 or 6/26. If event must be while enrolled, 6/26 qualifies. So either way eligible. Need numerator: Most recent outpatient BP after qualifying event. If qualifying event is 5/22 (during gap but allowable), outpatient readings after: 5/22 146/72, 6/26 133/95, 8/24 inpatient skipped. Most recent outpatient 6/26 133/95. Diastolic 95 fail. If event is 6/26, most recent outpatient on/after 6/26 = 6/26 133/95 fail. Non_compliant. If 5/22 doesn't count but 6/26 counts, fail. So status non_compliant. Need ensure no exclusion. Alive no hospice. Eligible due age/enrollment. Event yes via 6/26 if needed. non_compliant.
71054:
Age 84. Enrollment Jan1-May6; Jun18-Dec31 one gap 42 days allowed. Event: office I10 3/21, 5/6 within Jan-Jun. 5/6 is enrollment end date, yes. 6/5 inpatient during gap? no BP numerator skipped. 10/28 office E78.5. Eligible. No exclusions.
Numerator: Most recent outpatient BP after qualifying event. If earliest qualifying 3/21, outpatient readings after: 3/21 137/92, 5/6 138/85, 10/28 132/95. (6/5 inpatient skipped). Most recent outpatient 10/28 132/95, diastolic 95 fail. If using latest qualifying 5/6, same. non_compliant. Need note 3/21 diastolic 92, 5/6 diastolic 85 but most recent is fail. non_compliant.
71055:
Age 86 -> not eligible. Continuous, event 2/18 I10. But age fails. not_eligible.
71056:
Age 84 continuous. Event office I10 1/19, 3/20. Eligible. No exclusions.
Numerator: Most recent outpatient BP after qualifying event. Outpatient readings: 1/19 125/88; 3/20 153/86. Most recent 3/20 153/86. Systolic 153 >=140 fail. non_compliant. Diastolic 86 below, systolic fail.
Counts:
Let's tally statuses:
71041 non_compliant
71042 not_eligible
71043 non_compliant
71044 excluded
71045 not_eligible
71046 not_eligible
71047 compliant
71048 non_compliant
71049 not_eligible
71050 compliant
71051 not_eligible
71052 compliant
71053 non_compliant
71054 non_compliant
71055 not_eligible
71056 non_compliant
Check counts: compliant 3 (71047,71050,71052). non_compliant? 71041,71043,71048,71053,71054,71056 = 6. excluded 1 (71044). not_eligible 6 (71042,71045,71046,71049,71051,71055). Total 16. Denominator = compliant+non_compliant = 9. Numerator=3. Excluded=1. Not eligible=6. Rate = 3/9*100 = 33.333... round half up one decimal = 33.3. Need ensure denominator after exclusions removed: eligible population after exclusions = 9. Yes.
But let's scrutinize each potential ambiguity: continuous enrollment and gap calculation, outpatient classification, event date, exclusion precedence, BP threshold "below 140 systolic AND below 90 diastolic" strict less than. Values exactly 140 or 90 fail. We have 139/82 pass? For 71042 not eligible. 138/68 pass but not eligible. 134/93 fail. 137/92 fail. None exact 140/90. Need maybe 139? Not relevant.
Need maybe 71042: age 86, but enrollment two gaps. Not eligible. Could exclusion? none. not_eligible.
Need maybe 71041: inpatient BP 159/81 skipped. If no other BP after event? There is event BP 150/72 on event date. Counts as outpatient. Most recent = 150/72. Fail. If reading at qualifying encounter maybe included. Yes.
Need maybe numerator requires reading taken on or after date of qualifying hypertension encounter; if only event BP is high, fail.
Need maybe 71053 event 5/22 during gap. Let's examine dates: Enrollment 2026-01-01 through 2026-05-15; gap May16-Jun6 (22 days); resumed Jun7. Encounter 2026-05-22 office I10 in gap. 2026-06-26 office I10. If event must occur during enrollment, 6/26 qualifies. But numerator after 6/26 only 6/26 reading 133/95 (fail). If event 5/22 qualifies, most recent outpatient after 5/22 includes 6/26 fail. Same. So okay.
Need maybe 71049: enrollment gap 33 days, event after gap 8/25 I10 no. Could there be I10 in first half? none. not eligible. If ED/inpatient not outpatient. 11/28 ED R07.9 no. 12/25 after Jun. not eligible.
Need maybe 71046: one gap 58 days fails. If gap length calculation from Apr27 to Jun23? Let's verify: Jan1-Apr26 inclusive? Gap starts Apr27, ends Jun23, enrollment resumes Jun24. Days Apr27-30=4, May=31, Jun1-23=23 =>58. yes. Not eligible. If one gap >45, fail.
Need maybe 71042: enrollment segments Jan1-Mar27, Apr12-Jun29, Jul12-Dec31. Gaps of 15 and 12 days? Let's check: Mar28-Apr11 =15 days? Mar28-31=4, Apr1-11=11 total15. Jun30-Jul11=12? Jun30=1, Jul1-11=11 total12. Two gaps any length fail. Age 86 also fail. not eligible.
Need maybe 71051: gaps 26 and 14. Two gaps fail. Also hospice after enrollment? Hospice 10/27. Not eligible due enrollment. Exclusion evaluated only for eligible. So not_eligible. Good.
Need maybe 71045: not enrolled before Apr5; one gap from Jan1-Apr4 maybe 94 days. Fails. Could one gap up to 45? No. not eligible.
Need maybe 71055: age 86; fails. not eligible.
Need maybe 71044: ESRD in 2024. Exclusion E1 any time on/before 2026-12-31. Yes. Must be in eligible population before exclusion. Does he meet eligible? Age 70, continuous, event I10 4/23. Yes. Excluded. Good.
Need maybe pregnancy: no O codes. No.
Need output JSON only with required keys. Must include arrays strings. Any order okay. Need ensure denominator integer = 9, numerator=3, excluded=1, not_eligible=6, rate=33.3. compliant_members: ["71047", "71050", "71052"] maybe sorted. non_compliant: ["71041","71043","71048","71053","71054","71056"]. excluded_members ["71044"]. not_eligible_members ["71042","71045","71046","71049","71051","71055"].
Double-check if denominator should be members in eligible population after exclusions removed = compliant + non_compliant. Yes.
Potential issue: "outpatient encounter" classification. Office visits outpatient. ED/inpatient not. Maybe "Emergency department visit" not outpatient. Inpatient not. Good.
Potential issue: Numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below..." If a member has multiple qualifying hypertension encounters, maybe use date of first qualifying encounter? Usually yes. If use last qualifying encounter before Jun30? Let's test if any status changes: 71043 last qualifying 3/21; most recent after = 10/2 fail. 71054 last qualifying 5/6; most recent after = 10/28 fail. 71056 last qualifying 3/20; fail. 71050 only one. 71048 one. 71047 only one qualifying before Jun; 7/25 not qualifying. If use last I10 overall even after Jun? 71047 qualifying? If use 7/25 (not qualifying event but I10) BP same pass. 71053 if use 6/26 I10 fail. 71054 if use 10/28? No I10? 10/28 E78.5. If use last I10 5/6 fail. No change.
Potential issue: Exclusion E3 "Enrolled in hospice or receiving palliative care at any time during measurement year." 71051 hospice election 10/27. But not eligible due enrollment. Good.
Potential issue: "not_eligible never enters eligible population (age, event, or enrolment)" If member fails age but also exclusion, not eligible. 71042/71055 no exclusion. 71051 fails enrollment, hospice exclusion would otherwise apply if eligible? But not eligible. Good.
Need final JSON. Ensure no extra keys. rate numeric 33.3 not string. Arrays. Could include all counts. Ensure valid JSON.
Let's consider if 71053 enrollment gap 22 days allowed but event 5/22 occurs during gap. If the measure spec says continuous enrolment with one gap up to 45 days, a service during gap might not count because member not enrolled. But 6/26 I10 qualifies after gap. Numerator after 6/26 is 133/95 fail. If 6/26 is qualifying event, then only BP on that date counts (since 8/24 inpatient skipped). fail. So status non_compliant unchanged.
Consider if 71054 event 5/6 at end of enrollment before gap, after gap 10/28 json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 Flash · Z.ai73.1s · 4,322 out | 58.3s · 3,513 out | 66.1s · 3,681 out
Reasoning · 4,158 tokens
Let me work through each member carefully.
Measure: QM-CBP. Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
- Age 18–85 as of 2026-12-31.
- At least one outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30 (inclusive). Encounter after 2026-06-30 doesn't establish event.
- Continuous enrolment: full year, no more than one gap of up to 45 days. Gap longer than 45 days, or two or more gaps of any length, removes member.
Numerator: most recent outpatient BP reading on or after date of qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. ED or inpatient readings don't count and are skipped. If no qualifying reading, member in denominator, not numerator.
Wait — the numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". So the reading must be on or after the date of the qualifying hypertension encounter (the first qualifying I10 outpatient encounter? Actually "the qualifying hypertension encounter" — presumably any qualifying encounter; typically HEDIS uses the most recent BP reading during the measurement year, but here spec says on or after the date of the qualifying hypertension encounter). Let me interpret: qualifying hypertension encounter = the outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30 that establishes the event. If there are multiple such encounters, which one? Probably the reading must be on or after the date of a qualifying encounter — I'll use the earliest qualifying encounter as the anchor, but readings after later qualifying encounters also qualify since they're on or after the earliest one. Actually the most natural: readings on or after the (first/any) qualifying hypertension encounter date. The most recent outpatient BP reading taken on or after that date and on or before year end.
Exclusions evaluated before numerator, only for members in eligible population:
- E1: ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31.
- E2: pregnancy (O00-O9A) during measurement year.
- E3: hospice or palliative care during measurement year.
- E4: died during measurement year.
Now each member:
**71041**: DOB 1941-07-25, 85 on 2026-12-31. Age OK (18–85 inclusive, 85 qualifies). Enrolment continuous. Encounters: 2026-02-18 office visit I10 (qualifying, within Jan 1–Jun 30). 2026-05-18 inpatient R07.9 — BP 159/81 doesn't count (inpatient). Numerator: most recent outpatient BP reading on or after 2026-02-18 and on or before 12-31. Outpatient readings: 2026-02-18 BP 150/72 (on the date of the qualifying encounter — "on or after the date of the qualifying hypertension encounter" — the reading on 2026-02-18 is on that date, so counts). Most recent outpatient reading = 2026-02-18 BP 150/72. Systolic 150 ≥ 140 → not compliant. Non-compliant.
Status: non_compliant.
**71042**: DOB 1940-06-12, 86 years old on 2026-12-31. Age 86 > 85 → not_eligible. Even though there are encounters. Age fails. not_eligible.
Also enrolment has two gaps but age fails first. not_eligible.
**71043**: DOB 1991-01-17, 35. Continuous enrolment. Encounters: 2026-02-12 office I10 — qualifying. 2026-03-21 office I10. 2026-05-22 office E78.5 BP 119/102. 2026-10-02 office E78.5 BP 136/103.
Numerator: most recent outpatient BP reading on or after 2026-02-12 and ≤ 12-31. That includes all four readings (all outpatient). Most recent = 2026-10-02 BP 136/103. Systolic 136 < 140 OK, diastolic 103 ≥ 90 → fails. Non-compliant.
Note: the reading must be on or after the qualifying hypertension encounter date — 2026-10-02 is after 2026-02-12, so it counts even though diagnosis is E78.5? The spec says "the most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter" — it doesn't require the reading to be at a hypertension encounter. So yes, 136/103. Non-compliant.
**71044**: DOB 1956-05-26, 70. Continuous. Encounter: 2026-04-23 office I10 — qualifying. History: 2024-06-20 N18.6 ESRD — on or before 2026-12-31 → E1 exclusion. Excluded.
Check exclusion before numerator: excluded.
**71045**: DOB 1982-06-22, 44. Enrolment starts 2026-04-05, not full year → not eligible (continuous enrolment requires full measurement year). "Enrolled for the full measurement year" — member enrolled from 2026-04-05, so fails continuous enrolment. not_eligible.
**71046**: DOB 1991-10-18, 35. Enrolment: 2026-01-01 to 2026-04-26; 2026-06-24 to 2026-12-31. One gap of 58 days (2026-04-27 to 2026-06-23 = let's count: April 27–30 is 4 days, May 31, June 1–23 is 23 → 4+31+23 = 58 days). Gap longer than 45 days → removes from denominator. not_eligible.
**71047**: DOB 2008-04-06, 18 on 2026-12-31. Age 18 OK. Continuous. Encounters: 2026-06-17 office I10 — within Jan–Jun → qualifying. 2026-07-25 office I10. 2026-11-21 inpatient I10 BP 118/88 — inpatient, skipped.
Numerator: most recent outpatient reading on or after 2026-06-17: 2026-07-25 BP 137/73 (outpatient). Inpatient 11-21 skipped. 137<140, 73<90 → compliant.
Status: compliant.
**71048**: DOB 1991-04-26, 35. Continuous. Encounter: 2026-05-15 office I10 — qualifying. Numerator: most recent outpatient reading on/after 05-15: BP 134/93. Diastolic 93 ≥ 90 → fails. Non-compliant.
**71049**: DOB 1965-05-12, 61. Enrolment: one gap of 33 days (06-27 to 07-29 = June 27–30 is 4, July 1–29 is 29 → 33 days). One gap up to 45 days → OK, continuous enrolment satisfied.
Encounters: 2026-08-25 office I10 — but that's after 2026-06-30, does NOT establish the event. 2026-11-28 ED R07.9. 2026-12-25 office I10 — after 06-30, doesn't establish event.
Is there any outpatient I10 encounter on or between 2026-01-01 and 2026-06-30? No. So no qualifying event → not eligible (fails event criterion).
Wait — the event criterion: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." The I10 encounters are 08-25 and 12-25, both after 06-30. So fails event → not_eligible.
Hmm, but note the ED visit on 11-28 — ED isn't outpatient for this purpose presumably (outpatient encounter = office visit; ED is excluded from BP readings, and the event says "outpatient encounter"). Even so, diagnosis is R07.9 not I10. So not_eligible.
**71050**: DOB 1942-01-04, 84. Continuous. Encounters: 2026-06-23 office I10 — within Jan–Jun (06-23 ≤ 06-30) → qualifying. 2026-09-08 office J06.9 BP 129/71.
Numerator: most recent outpatient reading on/after 06-23 and ≤ 12-31: candidates 06-23 BP 122/84 and 09-08 BP 129/71. Most recent = 09-08 BP 129/71. 129<140, 71<90 → compliant.
**71051**: DOB 1991-04-19, 35. Enrolment: 01-01 to 04-08; 05-05 to 08-07; 08-22 to 12-31. Gaps: 04-09 to 05-04 (April 9–30 = 22, May 1–4 = 4 → 26 days) and 08-08 to 08-21 (14 days). Two gaps of any length → removes from denominator. not_eligible.
Even though hospice election 10-27 (E3) — but member fails enrolment first, so not_eligible not excluded. Per instructions: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
**71052**: DOB 1991-11-27, 35. Enrolment: 01-01 to 04-08; 05-24 to 12-31. Gap: 04-09 to 05-23 = April 9–30 (22) + May 1–23 (23) = 45 days. One gap of up to 45 days → OK (45 days is allowed).
Encounters: 2026-04-08 office I10 — qualifying (within Jan–Jun). 2026-06-04 office I10. 2026-07-13 office I10. 2026-07-16 ED S52.501A BP 119/89 — ED, skipped.
Numerator: most recent outpatient reading on/after 04-08: 06-04 BP 149/73, 07-13 BP 127/73. Most recent outpatient = 07-13 BP 127/73. 127<140, 73<90 → compliant.
**71053**: DOB 1942-08-07, 84. Enrolment: 01-01 to 05-15; 06-07 to 12-31. Gap: 05-16 to 06-06 = May 16–31 (16) + June 1–6 (6) = 22 days. One gap ≤ 45 → OK.
Encounters: 2026-05-22 office I10 — within Jan–Jun → qualifying. 2026-06-26 office I10. 2026-08-24 inpatient R07.9 BP 112/84 — inpatient, skipped.
Numerator: most recent outpatient reading on/after 05-22: 06-26 BP 133/95. Diastolic 95 ≥ 90 → fails. Non-compliant.
Note: the inpatient reading 112/84 would have passed but it's inpatient and skipped. Non-compliant.
**71054**: DOB 1942-12-16, 84. Enrolment: 01-01 to 05-06; 06-18 to 12-31. Gap: 05-07 to 06-17 = May 7–31 (25) + June 1–17 (17) = 42 days. One gap ≤ 45 → OK.
Encounters: 2026-03-21 office I10 — qualifying. 2026-05-06 office I10. 2026-06-05 inpatient S52.501A BP 132/76 — inpatient, skipped. 2026-10-28 office E78.5 BP 132/95.
Numerator: most recent outpatient reading on/after 03-21: candidates 05-06 BP 138/85, 10-28 BP 132/95. Most recent = 10-28 BP 132/95. Diastolic 95 ≥ 90 → fails. Non-compliant.
**71055**: DOB 1940-08-21, 86 years old on 2026-12-31. Age 86 > 85 → not_eligible.
**71056**: DOB 1942-01-17, 84. Continuous. Encounters: 2026-01-19 office I10 — qualifying. 2026-03-20 office I10 BP 153/86.
Numerator: most recent outpatient reading on/after 01-19: 03-20 BP 153/86. Systolic 153 ≥ 140 → fails. Non-compliant.
Now tally:
- 71041: non_compliant
- 71042: not_eligible (age 86)
- 71043: non_compliant
- 71044: excluded (ESRD)
- 71045: not_eligible (enrolment — not full year)
- 71046: not_eligible (gap 58 days)
- 71047: compliant
- 71048: non_compliant
- 71049: not_eligible (no qualifying I10 encounter in first half)
- 71050: compliant
- 71051: not_eligible (two gaps)
- 71052: compliant
- 71053: non_compliant
- 71054: non_compliant
- 71055: not_eligible (age 86)
- 71056: non_compliant
Counts:
denominator (compliant + non_compliant) = 3 + 6 = 9
numerator = 3 (71047, 71050, 71052)
excluded = 1 (71044)
not_eligible = 6 (71042, 71045, 71046, 71049, 71051, 71055)
Total: 9+1+6 = 16 ✓
Rate = 3/9 × 100 = 33.333... → 33.3 (rounded half up to one decimal).
Lists:
compliant_members: ["71047", "71050", "71052"]
non_compliant_members: ["71041", "71043", "71048", "71053", "71054", "71056"]
excluded_members: ["71044"]
not_eligible_members: ["71042", "71045", "71046", "71049", "71051", "71055"]
Double-check each borderline:
71041 age: born 1941-07-25. On 2026-12-31, age = 2026−1941 = 85, birthday July already passed → 85. Within 18–85. ✓. Event: 02-18 I10 office visit ✓. Numerator: readings — the 05-18 inpatient BP is skipped; the most recent outpatient reading on/after 02-18 is 02-18 itself (150/72). Non-compliant. ✓
71042: age 86 (born 1940-06-12; on 2026-12-31, 86). not_eligible. ✓
71043: most recent outpatient reading = 10-02 (136/103). Diastolic 103 fails. Non-compliant. ✓
71044: ESRD 2024 → E1. Excluded. ✓
71045: enrolment begins 04-05 → not enrolled full year → not_eligible. ✓
71046: gap 58 days > 45 → not_eligible. ✓ (Gap: enrolment ends 04-26, resumes 06-24. Days not enrolled: 04-27 through 06-23. April: 27,28,29,30 = 4; May: 31; June: 1–23 = 23. Total 58. ✓)
71047: event 06-17 ✓ (within Jan–Jun). Most recent outpatient reading: 07-25 (137/73) — inpatient 11-21 skipped. Compliant. ✓
71048: 134/93 → diastolic fails. Non-compliant. ✓
71049: no I10 outpatient encounter in Jan 1–Jun 30 window. Not eligible. Note the spec says "An encounter after 2026-06-30 does not establish the event." So not_eligible. ✓
71050: event 06-23 ✓. Most recent outpatient on/after: 09-08 (129/71). Compliant. ✓
71051: two gaps (26 and 14 days) → not_eligible despite hospice. ✓
71052: gap exactly 45 days — allowed ("one gap of up to 45 days"). Gap: enrolment ends 04-08, resumes 05-24. Days not enrolled: 04-09 to 05-23. April 9–30 = 22; May 1–23 = 23. Total 45. ✓ Allowed. Event: 04-08 I10 office visit ✓ (within window). Numerator: most recent outpatient reading on/after 04-08: 07-13 (127/73). ED 07-16 skipped. Compliant. ✓
71053: gap 22 days OK. Event 05-22 ✓. Most recent outpatient: 06-26 (133/95) fails diastolic. Inpatient 08-24 skipped. Non-compliant. ✓
71054: gap 42 days OK. Event 03-21 ✓. Most recent outpatient: 10-28 (132/95) fails diastolic. Non-compliant. ✓
71055: age 86 → not_eligible. ✓
71056: event 01-19 ✓. Most recent outpatient: 03-20 (153/86) fails systolic. Non-compliant. ✓
Rate: 3/9 = 33.333...% → 33.3.
Output JSON with required keys only.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,355 tokens
Let me work through each member carefully.
Measure: QM-CBP. Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
- Age 18–85 as of 2026-12-31.
- Event: at least one outpatient encounter with I10 diagnosis between 2026-01-01 and 2026-06-30. After 6/30 does not establish event.
- Continuous enrolment: full year, no more than one gap of up to 45 days. Gap >45 days or two+ gaps of any length removes.
Numerator: most recent outpatient BP reading on or after date of qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. ED or inpatient readings don't count, skipped when identifying most recent reading.
Exclusions (evaluated before numerator, only for members in eligible population):
E1 ESRD N18.6 or dialysis Z99.2 any time on or before 2026-12-31.
E2 Pregnancy O00-O9A during measurement year.
E3 Hospice/palliative care during measurement year.
E4 Died during measurement year.
Member by member:
71041: DOB 1941-07-25, 85 on 2026-12-31. Age OK (18–85 inclusive). Enrolment continuous. Encounters: 2026-02-18 office visit I10 → qualifying event. 2026-05-18 inpatient R07.9 BP 159/81 (doesn't count anyway; also not I10). BP readings: 2026-02-18 office 150/72; inpatient 159/81 skipped. Most recent outpatient BP on/after 2026-02-18: only the 2026-02-18 one (the 5/18 is inpatient, skipped). 150/72 → systolic 150 ≥ 140 → non-compliant. No exclusions. → non_compliant.
71042: DOB 1940-06-12, 86 → age fails. Also two gaps (15 and 12 days) → enrolment fails. And the I10 encounters are 2026-04-05 and 2026-04-11 — wait, both within 1/1–6/30, so event OK. But age fails (86 > 85). → not_eligible.
71043: DOB 1991-01-17, 35. Continuous enrolment. Encounters: 2026-02-12 office I10 → event. BP readings: 2/12 126/73; 3/21 135/73; 5/22 119/102; 10/2 136/103. All outpatient office visits. Most recent outpatient BP on/after qualifying encounter date (2026-02-12): all four qualify (all on/after 2/12). Most recent is 2026-10-02: 136/103 → diastolic 103 ≥ 90 → non-compliant. Note: 135/73 on 3/21 would be compliant but the most recent reading governs. → non_compliant.
71044: DOB 1956-05-26, 70. Continuous. Event: 2026-04-23 office I10 → yes. Exclusion E1: N18.6 diagnosed 2024-06-20, on or before 2026-12-31 → excluded. Exclusions evaluated before numerator. → excluded.
71045: DOB 1982-06-22, 44. Enrolment starts 2026-04-05, not full measurement year → fails continuous enrolment. → not_eligible. (Encounter 5/23 I10 within window, but enrolment fails.)
71046: DOB 1991-10-18, 35. Enrolment: 1/1–4/26; 6/24–12/31. Gap = 4/27 to 6/23. Let's compute: April has 30 days, so 4/27–4/30 = 4 days; May = 31; June 1–23 = 23. Total = 4+31+23 = 58 days. One gap of 58 days > 45 → fails enrolment. → not_eligible.
71047: DOB 2008-04-06, 18. Continuous. Event: 2026-06-17 office I10 → within window (≤6/30). BP readings: 6/17 138/76; 7/25 137/73; 11/21 inpatient 118/88 (skipped). Most recent outpatient BP on/after 6/17: 7/25 137/73 → both below thresholds → compliant. Inpatient reading skipped. → compliant.
71048: DOB 1991-04-26, 35. Continuous. Event: 2026-05-15 office I10 → yes. BP 134/93 → diastolic 93 ≥ 90 → non-compliant. → non_compliant.
71049: DOB 1965-05-12, 61. Enrolment: 1/1–6/26; 7/30–12/31. Gap 6/27–7/29: June 27–30 = 4 days; July 1–29 = 29 days; total 33 days. One gap of 33 days ≤ 45 → enrolment OK. Event: I10 encounters at 2026-08-25 and 2026-12-25 — both after 6/30! Hmm. Wait — the event must be an outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30. 71049's I10 encounters: 2026-08-25 and 2026-12-25. The ED visit 11/28 R07.9 is not I10. So no qualifying event → not_eligible.
Hmm, let me double-check: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." 71049 has I10 office visits only on 8/25 and 12/25, both after 6/30. So no qualifying event. → not_eligible.
71050: DOB 1942-01-04, 84. Continuous. Event: 2026-06-23 office I10 → yes (≤6/30). BP readings: 6/23 122/84; 9/8 129/71. Most recent on/after 6/23: 9/8 129/71 → below 140/90 → compliant. → compliant.
71051: DOB 1991-04-19, 35. Enrolment gaps: 4/9–5/4 and 8/8–8/21. First gap: April 9–30 = 22 days; May 1–4 = 4; total 26. Second gap: Aug 8–21 = 14 days. Two gaps of any length → fails continuous enrolment. Also hospice 2026-10-27 (E3), but exclusion only applies to members in eligible population. Enrolment fails → not_eligible.
71052: DOB 1991-11-27, 35. Enrolment: 1/1–4/8; 5/24–12/31. Gap 4/9–5/23: April 9–30 = 22; May 1–23 = 23; total 45 days. One gap of up to 45 days → OK ("no more than one gap of up to 45 days"). 45 days is allowed. Event: 2026-04-08 office I10 → yes. BP readings: 4/8 121/76; 6/4 149/73; 7/13 127/73; 7/16 ED 119/89 (skipped). Most recent outpatient BP on/after 4/8: 7/13 127/73 → below thresholds → compliant. → compliant.
71053: DOB 1942-08-07, 84. Enrolment: 1/1–5/15; 6/7–12/31. Gap 5/16–6/6: May 16–31 = 16; June 1–6 = 6; total 22 days. One gap ≤45 → OK. Event: 2026-05-22 office I10 → yes. BP readings: 5/22 146/72; 6/26 133/95; 8/24 inpatient 112/84 (skipped). Most recent outpatient: 6/26 133/95 → diastolic 95 ≥ 90 → non-compliant. → non_compliant.
71054: DOB 1942-12-16, 84. Enrolment: 1/1–5/6; 6/18–12/31. Gap 5/7–6/17: May 7–31 = 25; June 1–17 = 17; total 42 days. One gap ≤45 → OK. Event: 2026-03-21 office I10 → yes. BP readings: 3/21 137/92; 5/6 138/85; 6/5 inpatient 132/76 (skipped); 10/28 office 132/95. Most recent outpatient on/after 3/21: 10/28 132/95 → diastolic 95 ≥ 90 → non-compliant. → non_compliant.
71055: DOB 1940-08-21, 86 → age fails. → not_eligible.
71056: DOB 1942-01-17, 84. Continuous. Event: 2026-01-19 office I10 → yes. BP readings: 1/19 125/88; 3/20 153/86. Most recent: 3/20 153/86 → systolic 153 ≥ 140 → non-compliant. → non_compliant.
Summary:
- compliant: 71047, 71050, 71052 → 3
- non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
- excluded: 71044 → 1
- not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Total 3+6+1+6 = 16 ✓
Denominator = compliant + non_compliant = 9. Numerator = 3. Excluded = 1. Not eligible = 6.
Rate = 3/9 × 100 = 33.333... → 33.3.
Let me double-check the gap calculations and any edge cases.
71042 gaps: 1/1–3/27; 4/12–6/29; 7/12–12/31. Gap 1: 3/28–4/11 = 4 days (March 28–31) + 11 days (April 1–11) = 15. Gap 2: 6/30–7/11 = 1 + 11 = 12. Two gaps → fails. Age 86 also fails. not_eligible. ✓
71046 gap: enrolled through 4/26, resumes 6/24. Gap 4/27–6/23. April: 27,28,29,30 = 4. May: 31. June: 1–23 = 23. 4+31+23 = 58 > 45. Fails. ✓
71049: enrolment OK (33-day gap). No I10 encounter in 1/1–6/30. not_eligible. ✓
71051: two gaps (26, 14) → fails. Hospice exclusion moot. not_eligible. ✓
71052 gap: enrolled through 4/8 (last day enrolled 4/8), resumes 5/24. Gap 4/9–5/23 = 22 + 23 = 45 days. Exactly 45 → "up to 45 days" → OK. ✓
71047: age 18 as of 2026-12-31 (born 2008-04-06 → turns 18 on 2026-04-06). "18 through 85 years as of 2026-12-31" → 18 is included. ✓
71041: age 85 exactly → included. ✓
71044: exclusion E1 N18.6 in 2024, "any time on or before 2026-12-31" → yes, excluded. ✓
Numerator checks:
- 71041: most recent outpatient BP on/after 2/18 is... the inpatient 5/18 is skipped. So most recent outpatient is 2/18: 150/72 → non-compliant. ✓
- 71043: most recent outpatient 10/2: 136/103 → diastolic fails → non-compliant. ✓ (Note the trap: 135/73 on 3/21 is compliant, but most recent governs.)
- 71047: most recent outpatient 7/25: 137/73 → compliant. Inpatient 11/21 skipped. ✓
- 71050: most recent outpatient 9/8: 129/71 → compliant. ✓
- 71052: most recent outpatient 7/13: 127/73 → compliant. ED 7/16 skipped. ✓
- 71053: most recent outpatient 6/26: 133/95 → diastolic fails. Inpatient 8/24 skipped. Non-compliant. ✓
- 71054: most recent outpatient 10/28: 132/95 → diastolic fails. Non-compliant. ✓
- 71056: most recent 3/20: 153/86 → systolic fails. Non-compliant. ✓
- 71048: 134/93 → diastolic fails. Non-compliant. ✓
Rate: 3/9 = 33.333...% → 33.3.
Now output JSON with all required keys:
- denominator: 9
- numerator: 3
- excluded: 1
- not_eligible: 6
- rate: 33.3
- compliant_members: ["71047", "71050", "71052"]
- non_compliant_members: ["71041", "71043", "71048", "71053", "71054", "71056"]
- excluded_members: ["71044"]
- not_eligible_members: ["71042", "71045", "71046", "71049", "71051", "71055"]
Only the JSON block, nothing else.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,523 tokens
Let me work through each member against the specification.
Measure: QM-CBP, measurement year 2026.
Eligible population:
- Age 18–85 as of 2026-12-31.
- At least one outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30.
- Continuous enrolment for full year, no more than one gap of up to 45 days.
Numerator: most recent outpatient BP reading on or after date of qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. ED/inpatient readings skipped.
Exclusions (evaluated before numerator, only for those in eligible population):
- E1: ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31.
- E2: pregnancy during measurement year.
- E3: hospice/palliative care during measurement year.
- E4: died during measurement year.
Now each member:
**71041**: DOB 1941-07-25, age 85 on 2026-12-31. Age OK (18–85 inclusive). Enrolment continuous. Encounters: 2026-02-18 office visit I10 (within Jan 1–Jun 30) — event OK. Exclusions: none. Numerator: readings on or after 2026-02-18, outpatient: 2026-02-18 BP 150/72 (office, counts); 2026-05-18 inpatient — skip (inpatient, and also diagnosis R07.9 but the skip rule is about setting: ED or inpatient). Most recent qualifying outpatient reading: 2026-02-18, 150/72. Systolic 150 ≥ 140 — not below. Non-compliant.
Wait — "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". The inpatient reading on 2026-05-18 is skipped. So most recent outpatient reading on/after 2026-02-18 is 2026-02-18 itself: 150/72. Not below 140/90. Non-compliant.
**71042**: DOB 1940-06-12, age 86 — over 85. Not eligible (age). Even though encounters exist. Not eligible.
Check: age 86 as of 2026-12-31. Age fails. Not eligible. Note the enrolment: gaps of 15 and 12 days — two gaps, which would also fail continuous enrolment, but a member who fails age is not_eligible regardless. Either way not_eligible.
**71043**: DOB 1991-01-17, age 35. Enrolment continuous. Encounters: 2026-02-12 office I10 — event OK (within window). Exclusions: none (E78.5 is hyperlipidemia, not pregnancy; no hospice). Numerator: readings on or after 2026-02-12: 2026-02-12 126/73 (compliant); 2026-03-21 135/73; 2026-05-22 119/102 (diastolic 102 ≥ 90); 2026-10-02 136/103 (diastolic 103 ≥ 90). Most recent outpatient reading: 2026-10-02, 136/103. Diastolic fails. Non-compliant.
**71044**: DOB 1956-05-26, age 70. Enrolment continuous. Encounter 2026-04-23 office I10 — event OK. Exclusion E1: N18.6 diagnosed 2024-06-20, "any time on or before 2026-12-31" — yes, applies. Excluded.
**71045**: DOB 1982-06-22, age 44. Enrolment: 2026-04-05 through 2026-12-31, not enrolled before 2026-04-05. Continuous enrolment requires enrolled for the full measurement year. This member is not enrolled Jan 1–Apr 4 — a gap of ~95 days (or simply not enrolled full year). Fails. Not eligible.
The gap from 2026-01-01 to 2026-04-04: that's 94 days, or if we treat start of year... Either way, not enrolled full year → not eligible.
**71046**: DOB 1991-10-18, age 35. Enrolment: one gap of 58 days (2026-04-27 to 2026-06-23). Gap longer than 45 days → fails continuous enrolment. Not eligible.
**71047**: DOB 2008-04-06, age 18 on 2026-12-31. Age 18 — within 18–85. Enrolment continuous. Encounter: 2026-06-17 office I10 — within window (Jun 17 ≤ Jun 30) — event OK. Exclusions: none. Numerator: readings on or after 2026-06-17: 2026-06-17 138/76 (compliant); 2026-07-25 137/73; 2026-11-21 inpatient — skip. Most recent outpatient: 2026-07-25, 137/73 — below 140/90. Compliant.
**71048**: DOB 1991-04-26, age 35. Enrolment continuous. Encounter 2026-05-15 office I10 — event OK. Numerator: only reading 2026-05-15, 134/93. Diastolic 93 ≥ 90 — fails. Non-compliant.
**71049**: DOB 1965-05-12, age 61. Enrolment: one gap of 33 days (2026-06-27 to 2026-07-29) — one gap up to 45 days, OK. Event: need outpatient I10 encounter between 2026-01-01 and 2026-06-30. Encounters: 2026-08-25 office I10 (after Jun 30 — doesn't establish event); 2026-11-28 ED R07.9; 2026-12-25 office I10 (after Jun 30). No qualifying encounter in the first half of the year. Not eligible (event criterion not met).
**71050**: DOB 1942-01-04, age 84. Enrolment continuous. Encounter 2026-06-23 office I10 — within window — event OK. Numerator: readings on or after 2026-06-23: 2026-06-23 122/84 (compliant); 2026-09-08 129/71 (office, J06.9 — but reading is outpatient office; the measure says most recent outpatient BP reading, diagnosis of the visit doesn't matter, only setting). Most recent outpatient: 2026-09-08, 129/71 — below 140/90. Compliant.
**71051**: DOB 1991-04-19, age 35. Enrolment: gaps of 26 and 14 days — two gaps of any length → fails continuous enrolment. Not eligible. Note hospice on 2026-10-27 would be E3 exclusion, but member is not in eligible population, so not_eligible takes precedence ("a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented").
**71052**: DOB 1991-11-27, age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. Gap: 2026-04-09 to 2026-05-23. Let me count: April 9 to May 23. April has 30 days: Apr 9–30 = 22 days; May 1–23 = 23 days. Total 45 days. Stated as "One gap of 45 days." Rule: no more than one gap of up to 45 days. One gap of 45 days is allowed ("up to 45 days"). So enrolment OK.
Event: 2026-04-08 office I10 — within window (≤ Jun 30) — event OK. The qualifying encounter is 2026-04-08 (the first one; actually any I10 encounter in the window; here 2026-04-08 is the only one on or before Jun 30? Wait, 2026-06-04 and 2026-07-13 are also I10 office visits. 2026-06-04 is on or before 2026-06-30, so it also qualifies. The event criterion is met if at least one. The qualifying hypertension encounter date — for the numerator, "taken on or after the date of the qualifying hypertension encounter". If multiple qualifying encounters, presumably the earliest qualifying one establishes the event? The spec says "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30". For the numerator, the "qualifying hypertension encounter" — ambiguous whether it's the first or last. In NCQA HEDIS CBP, the numerator uses BP readings on or after the first qualifying encounter date... Actually HEDIS: "A BP reading on or after the diagnosis date of the qualifying encounter" — the qualifying encounter is typically the first eligible encounter. But if multiple, readings after any qualifying encounter... Let's consider both: qualifying encounters 2026-04-08 and 2026-06-04. Readings on or after 2026-04-08 (outpatient): 2026-04-08 121/76; 2026-06-04 149/73; 2026-07-13 127/73; 2026-07-16 ED — skip. Most recent outpatient: 2026-07-13, 127/73 — compliant either way. Even if we used the earliest qualifying encounter (Apr 8), most recent outpatient reading is Jul 13, 127/73, compliant. If we used latest qualifying encounter (Jun 4), most recent outpatient on/after Jun 4: 2026-07-13, 127/73 — still compliant. So 71052 is compliant regardless.
**71053**: DOB 1942-08-07, age 84. Enrolment: one gap of 22 days — OK. Event: 2026-05-22 office I10 — within window — OK. Numerator: readings on or after 2026-05-22 (or qualifying encounter — only one I10 encounter on/before Jun 30, which is 2026-05-22): 2026-05-22 146/72; 2026-06-26 133/95; 2026-08-24 inpatient — skip. Most recent outpatient: 2026-06-26, 133/95. Diastolic 95 ≥ 90 — fails. Non-compliant.
**71054**: DOB 1942-12-16, age 84. Enrolment: one gap of 42 days — OK. Event: 2026-03-21 office I10 — OK; also 2026-05-06 office I10 (within window). Numerator: readings on or after qualifying encounter (earliest 2026-03-21): 2026-03-21 137/92 (diastolic 92 fails); 2026-05-06 138/85 (compliant); 2026-06-05 inpatient — skip; 2026-10-28 132/95 (diastolic 95 fails). Most recent outpatient: 2026-10-28, 132/95 — diastolic fails. Non-compliant.
**71055**: DOB 1940-08-21, age 86 — over 85. Not eligible.
**71056**: DOB 1942-01-17, age 84. Enrolment continuous. Event: 2026-01-19 office I10 — OK. Numerator: readings on or after 2026-01-19: 2026-01-19 125/88 (compliant); 2026-03-20 153/86 (systolic fails). Most recent: 2026-03-20, 153/86 — fails. Non-compliant.
Now tally:
Compliant: 71047, 71050, 71052 → 3
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 → 6
Excluded: 71044 → 1
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055 → 6
Total: 3+6+1+6 = 16 ✓
Denominator = compliant + non_compliant = 3 + 6 = 9.
Numerator = 3.
Rate = 3/9 × 100 = 33.333... → 33.3.
Double-check each not-eligible:
- 71042: age 86 → not eligible. ✓ (also two gaps)
- 71045: not enrolled full year (starts Apr 5) → not eligible. ✓
- 71046: gap 58 days > 45 → not eligible. ✓
- 71049: no I10 outpatient encounter Jan 1–Jun 30 (first I10 is Aug 25) → not eligible. ✓
- 71051: two gaps (26 and 14) → not eligible. ✓ (hospice would be exclusion but not_eligible takes precedence)
- 71055: age 86 → not eligible. ✓
Excluded: 71044 (N18.6 in 2024, E1 applies any time on or before 2026-12-31). ✓
Verify 71047's event: encounter 2026-06-17 — "on or between 2026-01-01 and 2026-06-30" — yes, June 17 is within. Age 18 as of 2026-12-31 (DOB 2008-04-06 → 18th birthday 2026-04-06) — within 18–85. ✓
Verify 71050 numerator: most recent outpatient on/after 2026-06-23: 2026-09-08 office J06.9, BP 129/71. Setting is outpatient (office visit) so it counts. 129 < 140, 71 < 90. Compliant. ✓
Verify 71041: qualifying encounter 2026-02-18. Readings on/after: 2026-02-18 office 150/72; 2026-05-18 inpatient (skip). Most recent outpatient = 150/72 → non-compliant. ✓
Verify 71043: most recent outpatient on/after 2026-02-12 = 2026-10-02, 136/103 → diastolic fails. Non-compliant. ✓
Verify 71048: 134/93 diastolic fails. Non-compliant. ✓
Verify 71053: most recent outpatient = 2026-06-26, 133/95 fails. Non-compliant. ✓
Verify 71054: most recent outpatient = 2026-10-28, 132/95 fails. Non-compliant. ✓
Verify 71056: most recent = 2026-03-20, 153/86 fails. Non-compliant. ✓
Rate: 3/9 = 33.333...% → 33.3.
Output JSON with required keys only.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Hunyuan 4 · Tencent200.6s · 13,133 out | 230.5s · 13,816 out | 229.4s · 13,896 out
Reasoning · 12,984 tokens
We need answer JSON only, one fenced code block. Need evaluate 16 members against QM-CBP.
We need carefully apply measure spec. Let's restate.
Measurement year 2026-01-01 through 2026-12-31.
Eligible population (denominator):
- Age: 18 through 85 years as of 2026-12-31.
- Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish event.
- Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes from denominator.
Important: "enrolled for the full measurement year with no more than one gap of up to 45 days." Need parse: They say continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. That means coverage from 2026-01-01 through 2026-12-31, but allowed gaps? Wait, "full measurement year" but "no more than one gap of up to 45 days" means if member had one gap <=45 days, still considered continuous enrolled? The examples: 71042 enrolment: 2026-01-01 through 2026-03-27; 2026-04-12 through 2026-06-29; 2026-07-12 through 2026-12-31. Gaps of 15 and 12 days. They have two gaps, so removes. Yes.
71052: Enrolment 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days. It says one gap of 45 days. Allowed up to 45 days: allowed, so continuous enrolment met.
What about gap of exactly 45 is "up to 45 days" includes 45. Good.
71046: one gap of 58 days. Longer than 45, removes.
71049: one gap of 33 days, allowed.
71053: one gap of 22 days, allowed.
71054: one gap of 42 days, allowed.
71045: enrolled 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05. Is that "enrolled for full measurement year"? It is not enrolled 2026-01-01 to 2026-04-04. That is a gap from Jan 1 to Apr 5? Wait, if enrolment starts 2026-04-05, that's not a gap within coverage? Continuous enrolment: enrolled for full measurement year. Starting late means not enrolled for full year, and there is an initial gap before enrollment of more than 45 days? The period 2026-01-01 through 2026-04-04 is 94 days not enrolled. It says "enrolled for the full measurement year with no more than one gap of up to 45 days." A late start is not enrolled for full year; the gap before 2026-04-05 is from 2026-01-01 to 2026-04-04 inclusive? Let's count days: Jan 1 to Apr 4 = 31+28+31+4 = 94 days. That's a gap longer than 45 days. So removes from denominator. Indeed member 71045 not eligible? Let's verify: Not enrolled before 2026-04-05. So not_eligible due to enrolment (not full year). However maybe if the enrolment start is considered a gap? The spec says continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days removes. Late start is effectively a gap of >45 days at the beginning. So not eligible. We'll mark not_eligible.
Age: 18 through 85 as of 2026-12-31. Need compute ages:
- 71041 DOB 1941-07-25. On 2026-12-31, age = 2026-1941 = 85 if birthday passed. Birthday July 25, 2026, so on Dec 31 2026, turned 85 on 2026-07-25. Age 85. Allowed 18-85 inclusive. Yes, 85 eligible.
- 71042 DOB 1940-06-12, age on 2026-12-31: turned 86 on 2026-06-12. Age 86. Not eligible (over 85). Also enrolment two gaps, but not_eligible due age first? Status: not_eligible. Even if multiple fail, list not_eligible.
- 71043 DOB 1991-01-17, age 35. Eligible age.
- 71044 DOB 1956-05-26, age 70. Eligible age.
- 71045 DOB 1982-06-22, age 44. Age eligible but enrolment fails. not_eligible.
- 71046 DOB 1991-10-18, age 35. Age eligible, enrolment fails (gap 58). not_eligible.
- 71047 DOB 2008-04-06, age 18 on 2026-12-31? Birthday April 6, 2026. On Dec 31, turned 18. Allowed 18 through 85 inclusive, so age 18 eligible. Yes.
- 71048 DOB 1991-04-26, age 35. Eligible.
- 71049 DOB 1965-05-12, age 61. Eligible.
- 71050 DOB 1942-01-04, age on 2026-12-31: turned 84 on 2026-01-04. Age 84. Eligible.
- 71051 DOB 1991-04-19, age 35. Eligible.
- 71052 DOB 1991-11-27, age 35 (birthday Nov 27, 2026, so 35). Eligible.
- 71053 DOB 1942-08-07, age on 2026-12-31: birthday Aug 7, turned 84. Age 84.
- 71054 DOB 1942-12-16, age on 2026-12-31: birthday Dec 16, turned 84. Age 84.
- 71055 DOB 1940-08-21, age on 2026-12-31: turned 86 on 2026-08-21. Age 86. Not eligible (over 85). Wait DOB 1940-08-21. In 2026, 2026-1940=86. Birthday Aug 21, 2026, so yes age 86 as of Dec 31. Not eligible. The record says "so 86 years old on 2026-12-31." (It says female, age 86). So not_eligible due age. Wait check: 71055 is in roster: Date of birth 1940-08-21, so 86 years old on 2026-12-31. Yes 86. Not eligible.
- 71056 DOB 1942-01-17, age on 2026-12-31: birthday Jan 17, turned 84. Age 84. Eligible.
Wait 71041 record says Date of birth 1941-07-25, so 85 years old on 2026-12-31. Yes eligible.
Double-check 71042: DOB 1940-06-12, so 86 years old, not eligible. Yes record says 86.
71055 DOB 1940-08-21, so 86, not eligible.
Event: At least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. The encounter must be outpatient. Office visits are outpatient. Inpatient admission is not outpatient. Emergency department? The event requires outpatient encounter with I10. Are ED visits outpatient? Usually emergency department is not outpatient? In HEDIS, outpatient includes ED? Need check measure spec: "outpatient encounter" - they listed encounter types: Office visit, Inpatient admission, Emergency department visit. In the numerator they say "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." This implies ED and inpatient are not outpatient? Wait, they say for numerator: A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. So ED is a setting where readings are not counted for numerator. For the event: "at least one outpatient encounter with a hypertension diagnosis (I10)". The encounter entries labelled "Office visit" are outpatient. "Emergency department visit" is not called outpatient? It is an ED visit. "Inpatient admission" is inpatient. So qualifying event encounter must be Office visit with I10 in period Jan 1-Jun 30. If only ED or inpatient with I10, not outpatient. Let's inspect each member's encounters:
We'll list each member, check age, enrolment, event, exclusions, numerator.
Need numerator: most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both must be below threshold. "Below 140" means <140 (139 or less). "Below 90" means <90 (89 or less). Reading taken in ED or inpatient admission does not count and is skipped when identifying the most recent reading. So when finding most recent reading, we consider only readings from outpatient (office visit?) that are on/after the qualifying encounter date and <=2026-12-31. Wait: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". It says outpatient blood pressure reading. Then: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." This clarifies that ED and inpatient readings are not outpatient readings and are skipped. So only office visit readings count? What about other outpatient settings? All encounters listed are Office visit, Inpatient admission, Emergency department visit. So only Office visit readings count for numerator. Inpatient and ED are skipped. And the reading must be on/after the date of the qualifying hypertension encounter. If multiple qualifying encounters? The qualifying hypertension encounter is the one that establishes event: at least one outpatient encounter with I10 between Jan 1 and Jun 30. The date of the qualifying hypertension encounter is that encounter's date. If there are multiple outpatient I10 encounters in that period, the earliest? Or the one that qualifies? It says "the date of the qualifying hypertension encounter". The event is at least one outpatient encounter with I10 in period. If more than one, which date? Usually the earliest qualifying encounter? Let's parse: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." Then numerator: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". If there are multiple outpatient I10 encounters, the "qualifying hypertension encounter" could be the first one? Or any? In HEDIS, the event is the earliest eligible encounter? Actually for blood pressure control, the qualifying event is an outpatient encounter with hypertension diagnosis during the first 6 months. The BP reading must be taken during the measurement year on or after the date of the eligible encounter. If multiple eligible encounters, the most recent BP reading must be on or after the date of the earliest? Wait, typical HEDIS CBP: "The most recent BP reading during the measurement year. The BP reading must occur on or after the date of the encounter that qualifies for the event (i.e., the earliest qualifying outpatient encounter with hypertension?)" Let's recall: In HEDIS, CBP denominator: patients 18-85 with essential hypertension who had an outpatient encounter with a diagnosis of hypertension during the first 6 months (or two visits in the first 6 months? Actually CBP is: one or more outpatient encounters with hypertension diagnosis in the first 6 months of the measurement year; or at least two outpatient encounters on different dates in the first 6 months?). Wait the spec here simplifies: at least one outpatient encounter with hypertension diagnosis (I10) on or between Jan 1 and Jun 30. The numerator: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before Dec 31 is <140/<90. If multiple qualifying encounters, the date of the qualifying hypertension encounter is the date of that encounter (likely the first/earliest? Actually if any qualifying encounter exists, the event date is the date of the encounter. If there are multiple, the earliest encounter date would be the initial qualifying encounter. But the numerator says "the date of the qualifying hypertension encounter" singular. If there are multiple, which one? It might be the encounter that establishes the event; if multiple, the earliest date among them? Let's examine member examples to infer.
Example member 71043:
Age 35, continuous enrolment.
Encounters:
2026-02-12 Office visit, diagnosis I10. BP 126/73. (Qualifying encounter date 2026-02-12, I10 in period)
2026-03-21 Office visit, I10. BP 135/73. (Another qualifying encounter)
2026-05-22 Office visit, diagnosis E78.5 (hyperlipidemia, not I10). BP 119/102. (This is an office visit, BP reading, date after Feb 12, but diagnosis not I10; reading counts for numerator as outpatient BP reading on/after qualifying date)
2026-10-02 Office visit, diagnosis E78.5. BP 136/103. (Most recent office visit reading: 136/103. On/after Feb 12. Systolic 136 <140, diastolic 103 is NOT <90. So not numerator. If there were no other readings, most recent is 136/103 -> diastolic 103, fails. So member non_compliant? Wait check 2026-10-02 BP 136/103: diastolic 103 >90, so fails. The earlier 2026-05-22 has diastolic 102 >90. 2026-03-21 BP 135/73: systolic 135 <140, diastolic 73 <90, passes, but is it the most recent? Most recent outpatient reading is 2026-10-02, which fails, so member does not meet numerator. Because most recent reading is 136/103 (diastolic high). Yes non_compliant. No exclusions. Continuous enrolment ok. Age 35. So 71043 is in denominator, not excluded => non_compliant.
Need be careful: Are readings with diagnosis other than I10 from office visits counted for numerator? Yes, "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". It doesn't require the reading encounter to have I10 diagnosis. It just says outpatient blood pressure reading. So any office visit reading counts.
Now member 71041:
DOB 1941-07-25 age 85. Enrolment continuous. Encounters:
2026-02-18 Office visit, diagnosis I10. BP 150/72. (Qualifying encounter date 2026-02-18, in period.)
2026-05-18 Inpatient admission, diagnosis R07.9. BP 159/81. (Inpatient reading skipped)
No hospice, alive.
Exclusions? None. ESRD? No. Pregnancy? Female age 85, no.
Need numerator: most recent outpatient BP reading on/after 2026-02-18 and <=2026-12-31. Outpatient readings: only the office visit on 2026-02-18 itself (BP 150/72). Inpatient reading skipped. Are there any other office visits? No. So most recent (and only) outpatient reading is 150/72, taken on the same date as qualifying encounter. It is on/after 2026-02-18. Systolic 150 is NOT <140. Diastolic 72 <90. Both must be below: systolic fails. So not numerator. Thus compliant? No, non_compliant. Wait is there any BP reading after? No. So member 71041 non_compliant. But check age: 85 is eligible. Yes denominator. Not excluded. So non_compliant.
Member 71042:
DOB 1940-06-12 age 86. Not eligible (age). Also enrolment two gaps. Status not_eligible. Even though has I10 encounters etc. Not_eligible.
Member 71043: analyzed, non_compliant (denominator, no exclusion). Let's verify: Age 35 eligible. Enrolment continuous. Event: office visit I10 on 2026-02-12 (and 03-21) within Jan-Jun. Yes denominator. Exclusions: none. Numerator: most recent outpatient reading: office visits: 2026-10-02 BP 136/103 (E78.5). Skipped? It's office visit, outpatient, on/after 2026-02-12. Most recent overall is that. 136 systolic <140, diastolic 103 not <90, fails. Could there be later? No. So non_compliant.
Member 71044:
DOB 1956-05-26 age 70. Enrolment continuous. Encounters: 2026-04-23 Office visit, diagnosis I10. BP 152/76. Qualifying event date 2026-04-23 (within Jan-Jun). Other history: 2024-06-20 Diagnosis N18.6, end stage renal disease. Exclusion E1: ESRD (N18.6) any time on or before 2026-12-31. Yes, documented 2024-06-20. So meets exclusion E1. Therefore excluded (not in denominator). Even if BP? Doesn't matter. Status excluded. Check also numerator? Not needed. Exclusions evaluated before numerator. So excluded_members includes 71044. No not_eligible. Age ok. Enrolment ok. Event ok. Excluded.
Member 71045:
DOB 1982-06-22 age 44. Enrolment: 2026-04-05 through 2026-12-31, not enrolled before. Age eligible. Event: 2026-05-23 Office visit, diagnosis I10. This is an outpatient encounter with I10, but is it on/between Jan 1 and Jun 30? Yes, 2026-05-23 is within period. However, continuous enrolment fails: not enrolled for full measurement year; gap from Jan 1 to Apr 5 >45 days (94 days). So not_eligible. Also note event encounter occurs after enrolment started, but enrolment requirement is separate. So not_eligible. Status not_eligible.
Member 71046:
DOB 1991-10-18 age 35. Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days (from Apr 27 to Jun 23? Let's count: after Apr 26, next start Jun 24. Gap days: Apr 27-30 =4, May=31, Jun 1-23=23, total 58). Longer than 45 days. So continuous enrolment fails. Not_eligible. Age ok. Event? Has office visit I10 on 2026-03-08 (qualifying) and 2026-05-11 (within period). But enrolment removes. So not_eligible.
Member 71047:
DOB 2008-04-06 age 18 (eligible). Enrolment continuous. Encounters:
2026-06-17 Office visit, diagnosis I10. BP 138/76. Qualifying encounter date 2026-06-17 (within Jan-Jun, yes before Jun 30).
2026-07-25 Office visit, diagnosis I10. BP 137/73. (Outpatient reading after event)
2026-11-21 Inpatient admission, diagnosis I10. BP 118/88. (Inpatient reading skipped)
No hospice, alive. Exclusions none. Numerator: most recent outpatient BP reading on/after 2026-06-17 and <=2026-12-31. Outpatient (office) readings: 2026-06-17 BP 138/76; 2026-07-25 BP 137/73. The 2026-11-21 inpatient skipped. So most recent outpatient is 2026-07-25 BP 137/73. Systolic 137 <140, diastolic 73 <90. Both below. Meets numerator! So compliant. Status compliant. Check age 18 inclusive yes. So 71047 compliant.
Wait: Need to check if 2026-07-25 office visit had diagnosis I10, BP 137/73. Yes. So compliant. No ED/inpatient count. Good.
Member 71048:
DOB 1991-04-26 age 35. Enrolment continuous. Encounter: 2026-05-15 Office visit, diagnosis I10. BP 134/93. Qualifying event date 2026-05-15. Only reading is same date, outpatient (office). Most recent outpatient reading = 134/93. Systolic 134 <140, diastolic 93 is NOT <90 (needs 89 or lower). Fails diastolic. So non_compliant. No exclusions. So denominator, non_compliant.
Member 71049:
DOB 1965-05-12 age 61. Enrolment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days (Jun 27 to Jul 29 = 33 days? Let's count: Jun 27-30=4, Jul 1-29=29, total 33). Allowed (<=45, one gap). So continuous enrolment met. Encounters:
2026-08-25 Office visit, diagnosis I10. BP 116/86. Wait, this office visit is on 2026-08-25, which is AFTER 2026-06-30. Event requires outpatient encounter with I10 on or between Jan 1 and Jun 30. This encounter is Aug 25, not within period.
2026-11-28 Emergency department visit, diagnosis R07.9. BP 124/82. (ED, not outpatient, and diagnosis not I10)
2026-12-25 Office visit, diagnosis I10. BP 138/87. (Office visit I10, but date Dec 25, after Jun 30).
Is there any outpatient encounter with I10 in Jan-Jun? No. The only I10 encounters are Aug 25 and Dec 25, both after Jun 30. So Event NOT met. Therefore not in denominator => not_eligible? Wait status definitions: not_eligible = never enters the eligible population (age, event, or enrolment). Yes, fails event, so not_eligible. Age and enrolment ok, but event fails. So 71049 not_eligible. Good catch. Let's double-check: There is no encounter in first half with I10. Yes. So not_eligible.
Member 71050:
DOB 1942-01-04 age 84. Enrolment continuous. Encounters:
2026-06-23 Office visit, diagnosis I10. BP 122/84. Date Jun 23, within Jan-Jun. Qualifying event date 2026-06-23.
2026-09-08 Office visit, diagnosis J06.9. BP 129/71. (Outpatient reading after event, diagnosis not I10)
No hospice, alive. Exclusions none. Numerator: most recent outpatient reading on/after 2026-06-23. Readings: 2026-06-23 BP 122/84; 2026-09-08 BP 129/71. Most recent is 2026-09-08: systolic 129 <140, diastolic 71 <90. Both below. Meets numerator! Compliant. So 71050 compliant.
Member 71051:
DOB 1991-04-19 age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps: first gap Apr 9 to May 4: 26 days. second gap Aug 8 to Aug 21: 14 days. Two gaps of any length. Removes from denominator (continuous enrolment fails). So not_eligible. Also exclusion? Other history: 2026-10-27 Hospice election. That is E3 hospice during measurement year, would be excluded if in denominator. But enrolment fails first, so not_eligible (never enters eligible population). The instructions: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So 71051 not_eligible, not excluded. Good.
Member 71052:
DOB 1991-11-27 age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days (Apr 9 to May 23 inclusive? Let's count: Apr 9-30 =22, May 1-23=23, total 45). Allowed up to 45. So enrolment met. Encounters:
2026-04-08 Office visit, diagnosis I10. BP 121/76. (Qualifying event, date Apr 8, within Jan-Jun.)
2026-06-04 Office visit, diagnosis I10. BP 149/73. (Outpatient reading after event)
2026-07-13 Office visit, diagnosis I10. BP json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 13,666 tokens
We need answer JSON for measure population. Need process each member.
We have measure QM-CBP. Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
- Age 18 through 85 as of 2026-12-31. Inclusive? "18 through 85 years". Need interpret. As of 2026-12-31. Ages given. 85 qualifies? "through 85" inclusive, yes. 86 does not. Need check ages: member 71041 is 85, qualifies (if inclusive). 71042 is 86, fails. 71055 is 86 fails. 71050 is 84 qual. 71053 84 qual. 71054 84 qual. 71056 84 qual. 71044 70 qual. etc.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event. Qualifying encounter must be outpatient (office visit likely outpatient; ED? emergency department visit is not outpatient? Measure says outpatient encounter; ED is not outpatient? Need parse. It says later: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." For event: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between...". Does ED count as outpatient encounter? Typically in HEDIS, ED visits are not outpatient. The spec explicitly says outpatient encounter, and later says readings in ED do not count for numerator. Also "Inpatient admission" clearly not outpatient. ED visit – in HEDIS, emergency department is a separate setting; not outpatient. The measure text for eligible population says "outpatient encounter" with hypertension diagnosis. Later numerator says "most recent outpatient blood pressure reading taken... A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." It doesn't explicitly say ED encounters don't count as event, but event requires outpatient encounter; ED visit is not an outpatient encounter (it's emergency department). So ED visit with I10 (none? let's check) would not establish event. In our roster, are there ED visits with I10? 71046 ED visit diagnosis S52.501A, not I10. 71049 ED visit diagnosis R07.9, not I10. 71051 ED visit diagnosis S52.501A, not I10. So no issue. Outpatient encounters are "Office visit" and maybe others? The roster lists "Office visit" as outpatient. Inpatient admission is not outpatient. Emergency department visit is not office/outpatient. Good.
- Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes member from denominator. Need apply carefully: "no more than one gap of up to 45 days" means either continuous, or one gap <=45 days. If two or more gaps of any length => not eligible. If one gap >45 days => not eligible. If gap exactly 45 days? "up to 45 days" includes 45? Probably yes. Need compute gap lengths as days between end of one enrollment period and start of next? Or number of days not enrolled? Example: enrolment 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days. Let's verify: from 2026-04-27 to 2026-06-23 inclusive? 04-27 to 06-23. April has 30 days: 27-30 = 4 days (27,28,29,30). May 31 days. June 1-23 = 23 days. Total 4+31+23=58. Yes, gap length 58 days. They say one gap of 58 days. So gap length computed as number of days not enrolled inclusive of days between end+1 and start-1. If start next day after end? e.g., end 04-08, next 05-05. April 9-30: 22 days? Wait 30-8=22 days (9 through 30 inclusive is 22). May 1-4 = 4 days. Total 26. They said gap of 26 and 14 days for 71051: periods: 01-01 to 04-08; 05-05 to 08-07; 08-22 to 12-31. Gap1: 04-09 to 05-04: April 9-30 = 22 days; May 1-4 = 4 days => 26. Yes. Gap2: 08-08 to 08-21: 14 days (8 through 21 inclusive = 14). Good. So our day calculation matches inclusive of non-enrolled days. Good.
Now numerator: Most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both below threshold: systolic <140 and diastolic <90. Strictly below? "below 140 systolic AND below 90 diastolic" means <140 and <90. If reading equals 140 or 90 not below. Check values: need systolic <=139 and diastolic <=89 to meet. If no qualifying reading exists (because no outpatient BP reading after qualifying encounter, or all readings are in ED/inpatient skipped, or no qualifying BP after encounter date?), member in denominator not numerator.
Required exclusions evaluated before numerator, only if in eligible population. Exclusions:
E1 ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31.
E2 Pregnancy (O00-O9A) during measurement year.
E3 Hospice or palliative care at any time during measurement year.
E4 Died during measurement year.
All members alive at year end except maybe none died? All say alive at year end. No deaths. E4 none.
E2 pregnancy: none documented? No O codes. Unless not listed. Roster no O codes. So no E2.
E3 hospice: 71051 has hospice election on 2026-10-27 during year -> exclusion E3. Others No hospice. Good.
E1 ESRD: 71044 has 2024-06-20 diagnosis N18.6 any time on or before 2026-12-31 -> exclusion E1. Note: diagnosis date 2024, before year, qualifies "any time on or before 2026-12-31". Yes. Others? No N18.6 or Z99.2.
Now need classify each of 16 members.
Let's list members with DOB age, enrollment, event, exclusions, numerator.
Member IDs: 71041 to 71056. Need all 16.
Let's go one by one.
First, define qualifying hypertension encounter: outpatient encounter (office visit) with diagnosis I10 between 2026-01-01 and 2026-06-30 inclusive. Need find first or any. It says at least one. Date of qualifying encounter used as start for BP reading window: reading must be on or after the date of the qualifying hypertension encounter. Which qualifying encounter? Probably the event date (the outpatient I10 encounter). If multiple qualifying encounters, the earliest? It says "the date of the qualifying hypertension encounter" singular. If multiple, the one that establishes event maybe the earliest within Jan-Jun? Typically the event is the encounter; if multiple, perhaps the earliest qualifying? HEDIS usually the event/diagnosis is the earliest? Let's examine: Numerator: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31. If there are multiple I10 outpatient encounters in first half, any establishes denominator. The qualifying encounter date might be the earliest one? Or the one that qualifies? The text: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." That encounter is a qualifying hypertension encounter. If multiple, each is a qualifying encounter; but the phrase "the date of the qualifying hypertension encounter" maybe refers to that encounter (the one that made them eligible). If multiple, using the earliest? Need decide. Let's inspect members with multiple I10 office visits in first half: 71042 (04-05 and 04-11 both I10), 71043 has none after? Actually 71043: 2026-02-12 I10 and 2026-03-21 I10, both office visits with I10 in first half. 71046: 2026-03-08 I10 (office) and 2026-05-11 I10 (office) – wait 71046: 03-08 office I10, 05-11 office I10. Both in first half (by 06-30). 71047: 06-17 office I10; 07-25 is after Jun 30 so not event. 71052: 04-08 I10, 06-04 I10, 07-13 after half. 71053: 05-22 I10, 06-26 I10 (both first half). 71054: 03-21 I10, 05-06 I10 (05-06 within first half). 71056: 01-19 I10, 03-20 I10. Many have multiple. For numerator, if we choose the earliest qualifying encounter date, the window for BP starts earlier (includes more readings). If choose the latest qualifying encounter in first half? The phrase "the date of the qualifying hypertension encounter" singular. The event is the encounter with I10; if multiple, perhaps any one qualifies, but to determine the most recent BP reading on or after the date of the qualifying hypertension encounter, we need a specific date. In HEDIS, for Blood Pressure Control (CBP), the numerator: "Most recent BP reading during the measurement year, taken during an outpatient visit, on or after the date of the qualifying encounter." The qualifying encounter is the earliest encounter with hypertension during the first 6 months? Let's recall HEDIS CBP: Eligible population: members 18-85 with essential hypertension (I10) and an outpatient encounter during the first 6 months of the measurement year (or prior year? Actually the hypertension diagnosis must be during the first 6 months? Wait HEDIS CBP: Two encounters with hypertension, one of which is during the first 6 months? Let's not rely. In this harness measure, event is at least one outpatient encounter with I10 between Jan 1 and Jun 30. So qualifying encounter is that encounter. If multiple, I think the qualifying encounter date is the date of the encounter that qualifies, but since at least one, maybe the earliest such encounter? Let's see if ambiguity affects classification. In most cases, the BP readings after the earliest vs latest might differ only if there is a reading between the two I10 encounters that would be excluded if after earliest but before latest? Wait window start is on or after the date of the qualifying encounter. If we use earliest, window includes readings after earliest; if we use latest, window starts later, potentially excluding some readings between earliest and latest. For members with multiple I10 visits in first half, are there BP readings at those visits? The BP at the I10 office visits themselves are readings. The most recent outpatient BP reading on or after the qualifying encounter date: If we take earliest I10 encounter date, then the BP at that encounter and subsequent qualify. If we take latest I10 encounter (within first half), then the BP at earlier I10 encounter (if earlier date) would be before the qualifying encounter date and thus not count, but later readings (including at latest encounter and after) count. Since we need the MOST RECENT reading before year end meeting criteria, using earliest includes more readings, but the most recent reading is the last one before year end anyway (unless the last reading is skipped ED/inpatient and earlier ones count). The difference matters if there is a reading between the earliest and latest I10 encounter, and all readings after latest are non-qualifying (e.g., skipped or not below). Then using earliest would allow the intermediate reading (which is after earliest) to be considered; using latest would exclude it. Let's inspect members where this could matter.
Take 71043: I10 encounters 02-12 and 03-21 (both first half). BP readings: 02-12 BP 126/73 (at first I10), 03-21 BP 135/73 (at second I10), 05-22 BP 119/102 (office, after both), 10-02 BP 136/103 (office, after both). The most recent outpatient BP is 10-02: 136/103. Diastolic 103 >=90, not below. So not compliant regardless. No issue.
71046: I10 encounters 03-08 and 05-11. BP readings: 03-08 137/82 (at first), 05-11 119/85 (at second), 08-20 138/68 (office, after both), 09-18 ED 130/69 (ED skipped). Most recent outpatient (non-ED/inpatient) reading: 08-20 office BP 138/68. Systolic 138 <140, diastolic 68 <90 -> compliant. Using earliest (03-08) or latest (05-11) both before 08-20, so 08-20 is after both. Compliant. Wait also 05-11 BP 119/85 also compliant, but most recent is 08-20. So compliant.
71052: I10 encounters 04-08, 06-04. BP readings: 04-08 121/76 (at first), 06-04 149/73 (at second, systolic 149 not below), 07-13 127/73 (office, after both, compliant), 07-16 ED 119/89 (ED skipped). Most recent outpatient (non-ED) reading is 07-13: 127/73 <140/90 -> compliant. (07-16 ED skipped, so 07-13 is most recent qualifying). Compliant.
71053: I10 encounters 05-22, 06-26. BP: 05-22 146/72, 06-26 133/95 (diastolic 95 not below), 08-24 inpatient 112/84 (inpatient skipped). Most recent outpatient BP after qualifying encounter: The only outpatient readings are 05-22 and 06-26 (both office). 08-24 is inpatient, skipped. The most recent outpatient reading is 06-26: 133/95 -> diastolic 95 not <90, so not compliant. (If use earliest 05-22, still most recent outpatient is 06-26). So non-compliant.
71054: I10 encounters 03-21, 05-06. BP: 03-21 137/92, 05-06 138/85, 06-05 inpatient 132/76 (skipped), 10-28 office 132/95 (diagnosis E78.5, office visit outpatient, after qualifying encounter). Most recent outpatient non-inpatient reading is 10-28: 132/95 diastolic 95 not <90 -> non-compliant. Note 10-28 is after both I10 encounters. So non-compliant.
71056: I10 encounters 01-19, 03-20. BP: 01-19 125/88 (diastolic 88 <90, systolic 125 <140, actually compliant), 03-20 153/86 (systolic 153 not). Most recent outpatient reading is 03-20 (since no later office visits): 153/86 -> systolic not <140 -> non-compliant. No later readings.
71047: I10 encounter 06-17 (only one in first half). BP: 06-17 138/76 (at encounter, systolic 138 <140, diastolic 76 <90 => compliant if this is most recent outpatient reading). Later 07-25 office visit I10 BP 137/73 (after qualifying encounter, office, compliant). 11-21 inpatient admission I10 BP 118/88 (inpatient, skipped). Most recent outpatient non-inpatient reading: 07-25 office BP 137/73 -> compliant. Wait check: 06-17 BP 138/76, 07-25 BP 137/73. Most recent outpatient is 07-25 (since 11-21 inpatient skipped). Both <140/90, so compliant. Yes.
71041: Age 85 (qualifies, since 18 through 85 inclusive). Enrollment continuous. Event: 2026-02-18 Office visit I10 (between Jan-Jun) qualifies. BP readings: 02-18 office BP 150/72 (systolic 150 not <140). 05-18 inpatient admission BP 159/81 (inpatient, skipped, and also diagnosis R07.9). No other outpatient readings after 02-18? Only 02-18 and 05-18 inpatient. So the only qualifying outpatient BP reading on or after 02-18 is the 02-18 reading itself: 150/72 -> systolic 150, not below 140. No later outpatient reading. Most recent (and only) qualifying outpatient reading is 02-18: not compliant. Wait is there an outpatient reading after? No. So member in denominator, not numerator (non_compliant). No exclusions (alive, no hospice, no ESRD, no pregnancy). So non_compliant.
71042: Age 86 -> fails age (18 through 85, 86 >85). So not_eligible, regardless of enrollment gaps etc. Also event? but age fails. Not eligible.
71043: Age 35 qualifies. Enrollment continuous. Event: I10 office visits on 02-12 and 03-21 (both in first half). Qualifies. Exclusions? none. Numerator: Need most recent outpatient BP reading on or after date of qualifying encounter. Let's compute. Outpatient readings (office visits) all year: 02-12 BP 126/73; 03-21 BP 135/73; 05-22 BP 119/102 (office visit, diagnosis E78.5, but still outpatient BP reading? It says "outpatient blood pressure reading". The encounter is an Office visit; diagnosis E78.5 not hypertension, but reading counts? The numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". It doesn't require the reading encounter to have hypertension diagnosis, just outpatient BP reading. So yes, 05-22 is an office visit, outpatient, BP 119/102. 10-02 office visit BP 136/103. All are outpatient (office). Most recent is 10-02: BP 136/103. Systolic 136 <140, diastolic 103 NOT <90. So fails diastolic. Therefore not compliant. non_compliant.
Check if 05-22 diastolic 102 also fail. 03-21 135/73 would be compliant but not most recent. Most recent 10-02 fails. So non-compliant.
71044: Age 70 qualifies. Enrollment continuous. Event: 2026-04-23 Office visit I10 (first half) qualifies. Exclusion E1: 2024-06-20 diagnosis N18.6 (ESRD) any time on or before 2026-12-31 -> meets exclusion E1. Therefore excluded (since in eligible population before numerator). Note: even if numerator? BP 152/76 not compliant anyway, but exclusion takes precedence: excluded. So status excluded, in excluded_members. Denominator after exclusions excludes her.
71045: DOB 1982-06-22 age 44 qualifies. Enrolment: 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05. Continuous enrolment requirement: enrolled for the full measurement year with no more than one gap of up to 45 days. Here member is not enrolled from 01-01 to 04-04 (a gap at start of year). Does that count as a gap? The enrolment periods: only one period 04-05 to 12-31. There is a gap at the beginning of the measurement year (not enrolled for part of year). The spec: "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator." Usually continuous enrollment means enrolled the entire year except allowed gap(s). If not enrolled for the full measurement year, they aren't enrolled for full year. The gap from 01-01 to 04-04: length? From Jan 1 to Apr 4. January 31 days? Wait start of year: not enrolled 2026-01-01 through 2026-04-04 inclusive? Let's compute days not enrolled before start: Jan has 31 days (Jan 1-31), Feb 28 (2026 not leap), Mar 31, Apr 1-4 = 4 days. Total = 31+28+31+4 = 94 days gap. That's a gap of 94 days at start of year. This is one gap, but longer than 45 days. Also not enrolled for full measurement year. The rule: "enrolled for the full measurement year with no more than one gap of up to 45 days." If member has a gap of 94 days, that's one gap >45 days, so removes from denominator. Also they weren't enrolled for full year. So not eligible due to enrolment. Also event? 2026-05-23 office visit I10 (within first half? Yes, 05-23 is between Jan 1 and Jun 30). But enrolment fails (not enrolled before 04-05, gap >45). So not_eligible. Wait check: The enrolment says "2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05." That's a single enrollment period. Is the time before 04-05 considered a gap? In HEDIS continuous enrollment, if a member is not enrolled on Jan 1, they have a gap in coverage at the beginning of the year; the allowable gap is measured between enrollment segments. If they first enroll on Apr 5, the gap is from Jan 1 to Apr 4 (94 days). Since >45, not continuously enrolled. So not_eligible. Also note there is no second segment; it's one gap (the initial non-enrollment). It's longer than 45 days, so fails. Good.
71046: Age 35 qualifies. Enrolment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days (as given). Since one gap >45 days, fails continuous enrolment. Removes from denominator. Also event: office visit I10 on 03-08 (and 05-11? Wait 05-11 is within second enrollment? Let's see: second period starts 06-24, so 05-11 encounter occurs during gap? Actually 05-11 is between 04-26 and 06-24, during the gap when not enrolled. The encounter exists but member not enrolled; does event require enrolment? Eligible population requires continuous enrolment; if not met, not eligible. So not_eligible. Wait, but also 05-11 encounter date is in gap, but 03-08 I10 was during enrollment. However enrolment fails due to gap >45. So not_eligible. The given says "One gap of 58 days." 58 >45, so not eligible. Yes.
71047: Age 18 (DOB 2008-04-06, as of 2026-12-31 is 18). Qualifies (18 through 85 inclusive). Enrollment continuous. Event: 2026-06-17 office visit I10 (by Jun 30) qualifies. Exclusions none. Numerator: as discussed, most recent outpatient non-inpatient BP after 06-17: 07-25 office BP 137/73 (inpatient 11-21 skipped). Systolic 137 <140, diastolic 73 <90 -> compliant. So compliant.
71048: DOB 1991-04-26 age 35 qualifies. Enrollment continuous. Event: 2026-05-15 office visit I10 (within first half) qualifies. BP reading: 2026-05-15 office BP 134/93. Need check: systolic 134 <140, diastolic 93 NOT <90 (93 > 90). So not compliant. Any later readings? No. So nonjson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 13,745 tokens
We need evaluate each member per measure QM-CBP. Need output JSON with denominator, numerator, excluded, not_eligible, rate, and lists.
Let's parse the specification carefully.
Measurement year 2026-01-01 through 2026-12-31.
Eligible population (denominator) requires:
- Age: 18 through 85 years as of 2026-12-31. So age must be >=18 and <=85 on that date. Age 85 allowed? "18 through 85 years as of 2026-12-31" inclusive? It says 18 through 85, so 85 is included. 86 is not eligible. Need compute age.
- Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event. So must have an outpatient encounter (office visit qualifies) with diagnosis I10 in first half of year (Jan 1 to Jun 30). If only I10 encounter after Jun 30, no event -> not eligible? Actually event is required for denominator. If no event, not_eligible (never enters eligible population). "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between..." So need both outpatient encounter and diagnosis I10 and date within Jan-Jun 30. Note outpatient: office visit is outpatient. Emergency department? The numerator excludes ED/inpatient readings. For event, "outpatient encounter" likely includes office visits. ED is not outpatient? Usually emergency department is not outpatient encounter? In HEDIS, outpatient encounters include office visits, etc. ED visits are not outpatient. Here event must be outpatient encounter with hypertension diagnosis I10. We need see if ED visits count as outpatient? The numerator says reading in ED or inpatient admission does not count and is skipped. For event, they say outpatient encounter. In the roster, all hypertension events are office visits with I10, except maybe some. So okay.
- Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator. Need interpret: "enrolled for the full measurement year with no more than one gap of up to 45 days." This implies continuous enrolment from Jan 1 to Dec 31, but allowed one gap up to 45 days. Wait: "with no more than one gap of up to 45 days" means you can have one gap whose length is <=45 days; if gap >45 days, not continuous. Also two or more gaps of any length removes. Also if not enrolled full year? The phrase "enrolled for the full measurement year with no more than one gap of up to 45 days." Means member must be enrolled for full year, but gaps allowed: at most one gap, and that gap must be <=45 days. If a member has enrolment periods with a gap, they are not enrolled during gap; if gap <=45 and only one, it's okay (still considered continuous enrolment for measure). But if they are not enrolled at start or end? E.g., Member 71045: Enrolment 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05. That is not enrolled for full measurement year (missing Jan 1 - Apr 4). That removes from denominator: not_eligible. Similarly any gap >45 or two+ gaps -> not_eligible. If one gap of exactly 45 days? Allowed? "up to 45 days" means <=45. Member 71052 has one gap of 45 days. Allowed. Need check gap lengths: We'll calculate: enrolment periods are inclusive? Need compute gap days between end of one period and start of next. If end date is day before start? Example: Enrolment 2026-01-01 through 2026-04-08; next 2026-05-24 through... Gap from Apr 9 to May 23 inclusive? Need compute number of days not enrolled. The gap length is typically number of days between coverage periods. If coverage ends Apr 8 and resumes May 24, days not covered: Apr 9 through May 23. Let's count: Apr has 30 days. From Apr 9 to Apr 30 = 22 days (30 - 8 = 22). May 1 to May 23 = 23 days. Total = 45 days. Yes, gap of 45 days. Allowed (up to 45). Good.
Member 71049: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. Gap: Jun 27 to Jul 29. June 27-30 = 4 days (30-26=4). July 1-29 = 29 days. Total 33 days. Allowed.
Member 71053: Jan 1 - May 15; Jun 7 - Dec 31. Gap: May 16 to Jun 6. May 16-31 = 16 days (31-15=16). Jun 1-6 = 6 days. Total 22 days. Allowed.
Member 71054: Jan 1 - May 6; Jun 18 - Dec 31. Gap: May 7 to Jun 17. May 7-31 = 25 days (31-6=25). Jun 1-17 = 17 days. Total 42 days. Allowed.
Member 71046: Jan 1 - Apr 26; Jun 24 - Dec 31. Gap: Apr 27 to Jun 23. April 27-30 = 4 days (30-26=4). May full = 31 days. Jun 1-23 = 23 days. Total = 4+31+23 = 58 days. Gap >45 -> not_eligible.
Member 71042: Enrolment: Jan 1 - Mar 27; Apr 12 - Jun 29; Jul 12 - Dec 31. Gaps: first gap Mar 28 to Apr 11. March 28-31 = 4 days (31-27=4). April 1-11 = 11 days. Total = 15 days. Allowed? But there are two gaps: second gap Jun 30 to Jul 11. June 30 = 1 day (30-29=1). July 1-11 = 11 days. Total = 12 days. Two gaps of any length -> removes member. So not_eligible. Also age 86 -> not eligible anyway (86 >85). But we must place every member in exactly one list. For not_eligible, reason can be age or enrolment or event. We'll just assign not_eligible.
Member 71051: Enrolment: Jan 1 - Apr 8; May 5 - Aug 7; Aug 22 - Dec 31. Gaps: first Apr 9 to May 4. April 9-30 = 22 days. May 1-4 = 4 days. Total 26 days. Second gap Aug 8 to Aug 21. Aug 8-21 = 14 days. Two gaps -> not_eligible. Also has hospice election (E3) exclusion anyway. But enrolment fails first: two gaps -> not_eligible. Wait: Exclusions are evaluated before numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. So Member 71051 has two gaps thus not_eligible regardless of hospice. We must put in not_eligible list. Hospice is an exclusion, but since fails enrolment, not_eligible. Important: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So 71051 goes to not_eligible, not excluded. Good.
Member 71044: Age 70, enrolment continuous, event? Office visit 2026-04-23 diagnosis I10, within Jan-Jun 30, outpatient. Yes event. Exclusion E1: history 2024-06-20 Diagnosis N18.6 ESRD any time on or before 2026-12-31. Yes, ESRD -> excluded. So excluded.
Member 71047: Age 18 on 2026-12-31 (DOB 2008-04-06; on Dec 31 2026, turns 18 on Apr 6 2026, so age 18). Yes eligible age. Enrolment continuous. Event: Office visit 2026-06-17 diagnosis I10. That's on or before Jun 30? June 17, yes within first half. Outpatient. So event established. Later 2026-07-25 office visit I10 BP 137/73 (outpatient, after event). Also 2026-11-21 Inpatient admission diagnosis I10 BP 118/88 (inpatient, reading does not count, skipped). Need numerator: most recent outpatient blood pressure reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31, below 140 systolic AND below 90 diastolic. Both components must be below threshold. Skipped ED/inpatient readings when identifying most recent reading. So we need find most recent qualifying reading: outpatient (office visit) readings after event date (2026-06-17). Candidate readings: 2026-06-17 office visit BP 138/76 (but is that after/on event date? yes same day as event, on/after date of qualifying encounter). 2026-07-25 office visit BP 137/73 (outpatient, after). 2026-11-21 inpatient BP 118/88 skipped (inpatient). So most recent *qualifying* outpatient reading is 2026-07-25 BP 137/73 (since inpatient skipped, the next most recent non-skipped is 07-25). Check if there is any later outpatient? No later office visit. So most recent qualifying reading = 137/73. Systolic 137 < 140, diastolic 73 < 90. Both below. So compliant. Wait: The reading on 06-17 is 138/76: systolic 138 <140, diastolic 76 <90, also compliant. Most recent is 07-25 137/73. Compliant. Note: Inpatient reading 118/88 would be systolic 118<140 but diastolic 88<90 also would be compliant but it's skipped. Anyway compliant. Any exclusion? No ESRD, pregnancy, hospice, death. So compliant.
Member 71041: DOB 1941-07-25, age on 2026-12-31: 2026 - 1941 = 85, birthday Jul 25, so on Dec 31 2026 is 85 years old (turned 85 in July 2026). Age 85 allowed (18-85). Continuous enrolment. Event: Office visit 2026-02-18 diagnosis I10, within Jan-Jun 30. Yes event. Numerator: readings: 2026-02-18 Office visit BP 150/72 (outpatient, on/after event date? event date is 2026-02-18, reading same day). Then 2026-05-18 Inpatient admission BP 159/81 (inpatient, skipped). No other readings. Most recent outpatient reading after event: The 02-18 reading is outpatient office visit BP 150/72. Is there any later outpatient? No. The 05-18 is inpatient skipped. So most recent qualifying reading = 150/72 from 02-18. Systolic 150 is NOT <140 (it's above). So not compliant (non_compliant). Both components? Actually need both below. 150 >=140, so fails. No exclusion. So non_compliant.
Check age: 85 exactly, allowed. Yes.
Member 71043: DOB 1991-01-17, age 35. Continuous enrolment. Event: Office visit 2026-02-12 I10 (within first half). Yes event. Also 2026-03-21 I10 office visit (another event). Numerator: readings after event date(s). Qualifying encounter date: The earliest? Actually event is at least one outpatient encounter with I10 in first half. The qualifying hypertension encounter: For numerator, "taken on or after the date of the qualifying hypertension encounter". Which encounter is the qualifying one? Usually the event that establishes eligibility can be any; but we need the date of the qualifying hypertension encounter. If there are multiple I10 encounters, the "qualifying" one likely the one that meets the event (first one? or the one that establishes denominator). It says "the date of the qualifying hypertension encounter". The event is "at least one outpatient encounter with a hypertension diagnosis (I10) on or between...". So any such encounter is a qualifying hypertension encounter. For numerator, reading must be on or after the date of the qualifying hypertension encounter. If multiple, presumably the earliest such encounter (the one that established eligibility) or any? Need decide. The phrase "the date of the qualifying hypertension encounter" singular, referring to the encounter that qualifies the member for the denominator (the event). In HEDIS, the hypertension encounter is the event/diagnosis; the BP reading must be during the measurement year, and the most recent BP reading during the measurement year (or after the event? Actually CBP: Most recent BP reading during the measurement year, if the member had an outpatient visit with hypertension diagnosis during the first 6 months? Let's recall HEDIS controlling high blood pressure: Denominator: members 18-85 with hypertension diagnosis (from outpatient encounter or other) and at least one outpatient encounter? Actually measure: "Members 18-85 years of age who had a visit and a diagnosis of hypertension..." The numerator: "The member's most recent BP reading (both systolic and diastolic) during the measurement year was <140/90. The BP reading must occur on or after the date of the hypertension diagnosis?" Wait HEDIS CBP: The most recent BP reading during the measurement year. The BP must be from an outpatient, non-ED, non-inpatient? Actually HEDIS says: "The most recent blood pressure reading during the measurement year, where the reading is systolic and diastolic. Blood pressure readings from the following are excluded: ... inpatient, ED, etc." And the BP must be on or after the date of the initial hypertension diagnosis? Let me check: In HEDIS MY2023 CBP: "The most recent BP reading during the measurement year. The BP reading must be taken on or after the date of the hypertension diagnosis (the earliest diagnosis of hypertension during the measurement year or year prior? Actually denominator requires diagnosis of hypertension in the first 6 months? Let's read our spec: Event: at least one outpatient encounter with hypertension diagnosis I10 on or between Jan 1 and Jun 30. An encounter after Jun 30 does not establish event. Numerator: The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before Dec 31 is below 140/90. Both components must be below. A reading taken in ED or inpatient does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, member in denominator not numerator."
Thus the "qualifying hypertension encounter" is the outpatient encounter with I10 that establishes the event, i.e., the first (or the one) that occurs in Jan-Jun. The date of that qualifying encounter is the date of the first I10 outpatient encounter in that window? If there are multiple, the earliest one (e.g., 02-12) is the qualifying one that made them eligible; later I10 encounters are also events but the qualifying encounter date is probably the first one. But all their I10 office visits are before Jun 30: 02-12 and 03-21 both I10. Both are within first half. The qualifying encounter could be the first one (02-12). Then readings on or after 02-12. We'll use earliest I10 encounter date as the qualifying encounter date. For member 71043: earliest I10 encounter 2026-02-12. Subsequent readings:
- 2026-02-12 Office visit BP 126/73 (outpatient, on/after 02-12, compliant itself)
- 2026-03-21 Office visit BP 135/73 (outpatient, compliant)
- 2026-05-22 Office visit diagnosis E78.5 BP 119/102 (outpatient, diastolic 102 not <90, fails)
- 2026-10-02 Office visit diagnosis E78.5 BP 136/103 (outpatient, diastolic 103 fails)
Most recent outpatient reading before Dec 31 is 2026-10-02 (since later than 05-22). It is an office visit (outpatient), not ED/inpatient. BP 136/103. Systolic 136 <140, diastolic 103 NOT <90. Fails. So non_compliant. Wait check: 119/102 systolic 119<140, diastolic 102>=90 fails. Most recent is 136/103, diastolic fails. So non_compliant.
No exclusion. So non_compliant.
Member 71048: DOB 1991-04-26, age 35. Continuous enrolment. Event: Office visit 2026-05-15 I10, within Jan-Jun 30. Yes event. Numerator: reading: 2026-05-15 Office visit BP 134/93. That's outpatient, on/after event date (same day). Most recent (only) reading: 134/93. Systolic 134 <140, diastolic 93 NOT <90. Fails. No exclusion. So non_compliant.
Member 71049: DOB 1965-05-12, age 61. Enrolment: Jan 1 - Jun 26; Jul 30 - Dec 31. One gap of 33 days. Allowed (<=45). So continuous enrolment per spec (one gap up to 45 days). Wait is member enrolled for full measurement year? They have gap; the spec says "enrolled for the full measurement year with no more than one gap of up to 45 days." That means allowed. So enrolment okay (one gap 33 days). Event: Need outpatient encounter with I10 on/between Jan 1 and Jun 30. Encounters:
- 2026-08-25 Office visit I10: date Aug 25, after Jun 30, does not establish event.
- 2026-11-28 Emergency department visit R07.9: ED, not outpatient? and after Jun 30 anyway.
- 2026-12-25 Office visit I10: after Jun 30, does not establish event.
There is NO outpatient I10 encounter on/before Jun 30. The only I10 encounters are in Aug and Dec, after Jun 30. The event must be on or between Jan 1 and Jun 30. So no event. Therefore not_eligible (fails event). Wait: The 2026-08-25 is office visit I10, but after Jun 30, does not establish event. So denominator not entered. Thus not_eligible, regardless of enrolment (which was okay) or BP readings (which we might look at but not needed). Also note ED visit 11-28 BP 124/82 (ED skipped) and office 12-25 BP 138/87. But no event, so not_eligible. Also check age okay, enrolment okay, but event missing => not_eligible. So member 71049 goes to not_eligible. Need be careful: The numerator says "most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter". If no qualifying encounter (no event), no qualifying reading exists; but they are not in denominator at all. So not_eligible.
Member 71050: DOB 1942-01-04, age on 2026-12-31: 84 (since birthday Jan 4 2026, turns 84). Eligible age (<=85). Continuous enrolment (no gaps). Event: Office visit 2026-06-23 diagnosis I10. Jun 23 is on or before Jun 30, yes. Outpatient. Event established. Numerator: readings after 2026-06-23:
- 2026-06-23 Office visit BP 122/84 (outpatient, on event date). Compliant? 122<140, 84<90 yes.
- 2026-09-08 Office visit J06.9 BP 129/71 (outpatient, later). Compliant: 129<140, 71<90.
Most recent outpatient reading is 2026-09-08 BP 129/71 (since no later). It's below thresholds. So compliant. No exclusion. So compliant.
Member 71052: DOB 1991-11-27, age 35 (on Dec 31 2026, birthday Nov 27, so age 35). Enrolment: Jan 1 - Apr 8; May 24 - Dec 31. One gap of 45 days (allowed). So enrolment okay. Event: Office visit 2026-04-08 I10. April 8 is within Jan-Jun 30. Outpatient. Event date = 2026-04-08. (Note: enrolment ends Apr 8, then gap, resumes May 24. The encounter on Apr 8 is while enrolled? The enrolment period is through Apr 8 inclusive, yes.) Also 2026-06-04 I10 office visit, but after gap, when enrolled? Enrolment resumes May 24, so Jun 4 is enrolled. Both I10 encounters in first half. Qualifying encounter date is earliest: 2026-04-08. Numerator: readings on/after 2026-04-08, outpatient, skip ED/inpatient:
- 2026-04-08 Office visit BP 121/76 (outpatient, on/after event). Compliant.
- 2026-06-04 Office visit BP 149/73 (outpatient, later). Systolic 149 NOT <140. So fails.
- 2026-07-13 Office visit BP 127/73 (outpatient, later). Compliant (127<140,73<90).
- 2026-07-16 Emergency department visit BP 119/89 (ED, skipped).
Most recent *qualifying* (non-ED, outpatient) reading: Let's list outpatient readings in chronological order:
04-08: 121/76
06-04: 149/73
07-13: 127/73
Then 07-16 ED skipped.
So most recent non-skipped reading is 07-13 BP 127/73. This is after 06-04. So the most recent qualifying outpatient reading is 127/73 (since ED 07-16 is skipped). Check: 127/73: systolic 127 <140, diastolic 73 <90. Both below. So compliant! Wait, is 121/76 compliant too, but most recent is 127/73, which is compliant. Yes. So compliant.
Need verify gap enrolment: one gap of exactly 45 days allowed. The spec: "no more than one gap of up to 45 days." "up to 45 days" includes 45. So allowed. Good.
Member 71053: DOB 1942-08-07, age on 2026-12-31: 84 (birthday Aug 7, turns 84 in 2026). Eligible. Enrolment: Jan 1 - May 15; Jun 7 - Dec 31. One gap 22 days allowed. Event: Office visit 2026-05-22 I10. Wait, is May 22 within Jan-Jun 30? Yes. But check enrolment: enrolment ended May 15, resumed Jun 7. The encounter on May 22 is during the gap! Is the member enrolled on May 22? No, the gap is May 16 - Jun 6. The office visit on 2026-05-22 occurs when member is NOT enrolled. Does that matter? The event must be an outpatient encounter with I10 during Jan 1-Jun 30. The encounter occurred, but was the member enrolled at that time? The eligible population requires continuous enrolment for the full measurement year (with allowed gap). The event simply requires an encounter; HEDIS usually requires the encounter to be during enrolment? Actually the denominator requires continuous enrolment; the event is a clinical event. The member had a gap; during the gap they were not enrolled. If they had an encounter on May 22 while not enrolled, does it count as an outpatient encounter for the measure? Typically services must be received while enrolled? The measure says "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." It does not explicitly say the encounter must be on a date of enrolment, but continuous enrolment is a separate criterion for the denominator. However, if the encounter happened during a gap (not enrolled), is that allowed? Let's think. The denominator requires "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days." This means they can be enrolled with a gap; durijson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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}100Qwen3.8 Flash · Alibaba68.2s · 7,524 out | 164.4s · 9,483 out | 67.3s · 7,835 out
Reasoning · 7,273 tokens
We need answer with JSON only. Need analyze measure QM-CBP for 16 members. Need compute denominator, numerator, excluded, not_eligible, rate, lists. Must be careful with age, event, enrolment, exclusions, numerator.
Need parse each member.
Definitions:
- Measurement year: 2026-01-01 to 2026-12-31.
Eligible population denominator:
Age 18 through 85 as of 2026-12-31. Need inclusive. They provide ages. If 86 => not eligible. 18 => eligible. 85 => eligible.
Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event. Need outpatient office visit? They say office visit = outpatient likely. ED/inpatient not outpatient. Need I10 diagnosis on outpatient encounter in Jan-Jun. If only after Jun 30 not eligible. Need if encounter is during enrollment gap? The event must be an encounter; likely claims? The encounter date maybe outside enrollment? For eligibility continuous enrolment separately. For event maybe encounter itself? We'll use as recorded. If encounter occurs during gap? Not typical; but not relevant maybe? Need consider enrolment gaps. Continuous enrolment: enrolled full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes member from denominator. This applies after age/event? Eligible population (denominator) includes all three criteria. If fails age/event/enrolment => not_eligible. Exclusions evaluated only for members who are in eligible population? The prompt: Exclusions evaluated before numerator, and only for members who are in eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. A member who meets both an exclusion and numerator is excluded. So order: determine eligible population = age+event+continuous enrolment. Then apply required exclusions E1-E4 to remove from denominator. The excluded list contains those in eligible pop but with exclusion. non_compliant = denominator minus numerator after exclusions? Specifically denominator = members in eligible population after exclusions removed (compliant+non_compliant). numerator compliant. Excluded count = eligible pop with exclusion. not_eligible = fail age/event/enrollment. Good.
Numerator: The most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components below. ED/inpatient does not count and is skipped when identifying most recent reading. If no qualifying reading => denominator not numerator.
Need determine "qualifying hypertension encounter" date: at least one outpatient encounter I10 between Jan-Jun. If multiple qualifying encounters? The wording: most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter. Could be event date perhaps first qualifying? HEDIS CBP numerator uses most recent BP measurement on or after onset date? Usually measurement period is year; most recent systolic <140 and diastolic <90 after initial hypertension diagnosis during measurement period? Here simplified. Need decide if multiple I10 outpatient Jan-Jun encounters, use earliest or latest qualifying? "the date of the qualifying hypertension encounter" singular. Could be the encounter that establishes event. If there is at least one outpatient encounter I10 Jan-Jun. Which one? Could choose earliest date within period? Need consistent with likely expected: qualifying event date could be any encounter satisfying event; numerator most recent outpatient BP on/after the date of the qualifying hypertension encounter. In practice event date = date of diagnosis encounter (maybe first/earliest I10 in Jan-Jun?). Let's analyze members where this matters.
Members with multiple I10 encounters in Jan-Jun: 71043 (Feb, Mar), 71042 (Apr I10 twice), 71054 (Mar, May), 71056 (Jan, Mar), 71051 (Mar, Apr), 71052 (Apr 8), etc. Using earliest vs latest could affect inclusion of readings after latest? But readings after event are considered; later qualifying I10 has higher date, so readings between earliest and latest could be excluded if latest used. The numerator uses most recent after qualifying encounter; if multiple readings after latest, same most recent overall after earliest if it is after latest. If most recent reading is between earliest and latest, and latest is after it, then using latest would skip earlier most recent, potentially no qualifying reading after latest. Need decide.
HEDIS CBP: Numerator: patient's blood pressure measurement is systolic <140 and diastolic <90 on most recent BP reading from outpatient setting (or non-inpatient?) during measurement year after initial diagnosis date? For CBP, if hypertension diagnosis during year, most recent systolic <140 and diastolic <90 at any time during measurement year? Let's recall: NCQA CBP numerator: For members 18+ with diagnosis of HTN, most recent systolic BP <140 and diastolic <90 during measurement year, from outpatient, etc. If initial diagnosis? It might use most recent BP after diagnosis? They often require most recent blood pressure reading during measurement year and after index hypertension diagnosis? In some implementations, numerator uses most recent blood pressure measurement on or after onset date of index hypertension diagnosis. Index event is earliest outpatient diagnosis? Let's follow prompt exactly: qualifying hypertension encounter: at least one outpatient I10 Jan-Jun. It doesn't say earliest/latest. "the date of the qualifying hypertension encounter" if multiple, could mean the encounter used to establish eligibility. Usually use the date of the encounter. But for population, any such encounter qualifies. To be defensible, if multiple qualifying encounters, the event date could be earliest qualifying encounter because that's the first time in measurement year they meet event; numerator readings after that. This seems common: after diagnosis date (index event). If use latest, might omit readings after earlier diagnosis. Also "An encounter after 2026-06-30 does not establish the event" but doesn't say after 6/30 can't count for numerator. So numerator readings from after qualifying encounter through year end. For multiple qualifying encounters, choose earliest? Need infer from test design. They may expect most recent outpatient BP overall (excluding ED/inpatient) that is after qualifying event. They likely pick earliest qualifying encounter in H1. Let's examine data.
Need classify each member.
List members:
71041:
DOB 1941-07-25 age 85 on 2026-12-31. Female. Enrollment full continuous. Event: 2026-02-18 Office I10 BP150/72. After Jan-Jun yes. Enrolment good. Exclusions: no ESRD? only inpatient R07.9 no ESRD, no pregnancy, hospice, death. Eligible. Numerator: most recent outpatient BP on/after Feb: only Feb office 150/72 (inpatient May skipped? inpatient does not count). 150 not <140 => non_compliant. So non_compliant.
71042:
DOB age 86 -> fails age. Not eligible even event. Not eligible list. Enrollment has two gaps (15 and 12) also fails, age enough. Encounters not matter. not_eligible.
71043:
Age 35. Enroll full. Event: 2026-02-12 office I10; 2026-03-21 office I10. Eligible. Exclusions none. Numerator: most recent outpatient BP on/after qualifying encounter. Outpatient readings: 2/12 126/73; 3/21 135/73; 5/22 office E78.5 119/102; 10/2 office E78.5 136/103. Diagnosis on later visits doesn't matter for numerator? It says most recent outpatient blood pressure reading taken on/after date of qualifying HTN encounter. Doesn't require HTN diagnosis. So most recent is 10/02 136/103. Systolic 136 <140, diastolic 103 not <90 => non_compliant. If using earliest event same. If latest event 3/21 same.
71044:
Age 70. Enroll full. Event: 2026-04-23 office I10 BP152/76. Eligible. Exclusion E1: 2024-06-20 N18.6 before 12/31 => excluded. Even numerator fails, excluded. Excluded list.
71045:
Age 44. Enrollment: not enrolled before 2026-04-05, enrolled 4/5 to 12/31 continuous. Continuous enrolment: enrolled for full measurement year? They miss Jan-Apr 4; fails enrolment. Not eligible. Even if one gap from start >45 days? Fails. Event: 2026-05-23 office I10 (in H1) but fails enrolment. not_eligible.
71046:
Age 35. Enroll: 1/1-4/26; 6/24-12/31. One gap of 58 days >45 => fails enrolment. Event: 3/8 office I10; 5/11 office I10? Need note 5/11 after gap (not enrolled? gap 4/27-6/23, yes 5/11 not enrolled). Does that matter? Fails enrolment regardless. not_eligible. Encounters after? no need. Even numerator? no.
71047:
Age 18 (2008-04-06, turns 18 on 2026-04-06; age as of 12/31 is 18). Eligible age. Enroll full continuous. Event: 2026-06-17 office I10 BP138/76; 2026-07-25 office I10 BP137/73; 2026-11-21 inpatient I10 BP118/88. Event date 6/17. Exclusions none. Numerator: most recent outpatient reading on/after 6/17: office 6/17 138/76; office 7/25 137/73; inpatient skipped. Most recent 7/25 137/73 <140/<90 => compliant. If use later qualifying encounter 7/25 also compliant. So compliant.
71048:
Age35. Enroll full. Event: 2026-05-15 office I10 BP134/93. Eligible. Numerator most recent after event = same 134/93; diastolic 93 not <90 => non_compliant.
71049:
Age61. Enroll: 1/1-6/26; 7/30-12/31. One gap of 33 days <=45 => passes? Wait continuous enrolment enrolled for full measurement year with no more than one gap of up to 45 days. They are enrolled except gap; gap length 33; passes. Event: Need outpatient I10 encounter Jan-Jun. Encounters: 2026-08-25 office I10 after Jun; 11/28 ED after; 12/25 office I10 after. No encounter Jan-Jun. Therefore fails event => not_eligible. Even though numerator if eligible would maybe 12/25 138/87, but not eligible. not_eligible.
71050:
Age84. Enroll full. Event: 2026-06-23 office I10 BP122/84. Eligible. Exclusions none. Numerator: most recent outpatient after event: 6/23 122/84; 9/8 office J06.9 BP129/71. Most recent 9/8 129/71 => compliant (both below). Even if require HTN? prompt not. So compliant.
71051:
Age35. Enroll: 1/1-4/08; 5/5-8/7; 8/22-12/31. Gaps 26 and 14 days => two or more gaps => fails enrolment. Not eligible. Additionally hospice election 2026-10-27, but not eligible because fails enrolment. Prompt: a member who fails age/event/enrolment is not_eligible even if exclusion documented. So not_eligible. Note age/event? Event 3/21 office I10; yes. But fails enrolment. not_eligible.
71052:
Age35. Enroll: 1/1-4/8; 5/24-12/31. One gap of 45 days. Gap length? Need count. They state one gap of 45 days. Pass (up to 45). Event: encounters: 2026-04-08 office I10 BP121/76 (on or before Jun and during enrolled? enrolled ends 4/8. likely outpatient encounter). 2026-06-04 office I10 BP149/73 (during gap? gap 4/9-5/23? Actually 5/24 start, so 6/4 after gap and enrolled yes? gap ends 5/23? They say gap 45 days from 4/9 to 5/23? 45 days? start 5/24. Anyway 6/4 enrolled? yes). 7/13 office I10; 7/16 ED skipped. Eligible age/enrollment/event. Exclusions none. Numerator: qualifying encounter date? If earliest 4/08, most recent outpatient after 4/08: 6/04 149/73; 7/13 127/73 (office). ED skipped. Most recent 7/13 127/73 => compliant. If latest qualifying encounter 6/04, most recent outpatient after 6/04: 7/13 127/73 => compliant. Good.
71053:
Age84. Enroll: 1/1-5/15; 6/7-12/31. One gap 22 days passes. Event: 2026-05-22 office I10 BP146/72. But 5/22 occurs during gap? Enrollment 1/1-5/15 and 6/7-12/31. The record says office visit diagnosis I10 on 5/22. It is after Jan-Jun. Does event require enrolled? Continuous enrollment separately; event does not say encounter must occur during enrollment? It should be an encounter with I10; a visit during gap perhaps could happen, but plan enrollment? The measure event often requires encounter during measurement year, not necessarily during enrollment? Usually denominator includes event and continuous enrollment; the event can occur any time in measurement year, but claims likely only when enrolled. But here they gave encounter during gap. Need decide. If event encounter date is 5/22 but during gap; still on/between Jan-Jun and outpatient I10. Continuous enrollment criterion passes. If they intended to test event during gap? Hmm. Eligibility for numerator: most recent outpatient BP reading taken on/after date of qualifying encounter. Encounters: 5/22 office 146/72; 6/26 office 133/95; 8/24 inpatient skipped. Most recent outpatient 6/26 133/95; systolic <140 but diastolic 95 not <90 => non_compliant. If use event date 5/22, includes 6/26. If use qualifying encounter 6/26? Actually 6/26 office I10 also before Jun30, another qualifying encounter! Yes 6/26 office I10 within Jan-Jun. So event established by 6/26 as well. Numerator most recent after 6/26 is 6/26 133/95. Same non_compliant. Good.
Check if event on 5/22 during gap: If need encounter during enrollment, 5/22 invalid, but 6/26 is within enrollment (after 6/7) and before Jun30. So event passes anyway. Eligible. Non_compliant.
71054:
Age84. Enroll: 1/1-5/6; 6/18-12/31. One gap 42 days passes. Event: 2026-03-21 office I10 BP137/92; 2026-05-06 office I10 BP138/85 (last day enrollment before gap? 5/6 included); 2026-06-05 inpatient after gap? not relevant; 2026-10-28 office E78.5 BP132/95. Eligible. Numerator: most recent outpatient after qualifying encounter. Need if event date earliest 3/21: outpatient readings: 3/21 137/92, 5/6 138/85, 10/28 132/95. Most recent 10/28 132/95 -> diastolic 95 not <90 => non_compliant. If use latest qualifying 5/6, most recent 10/28 same. Good.
71055:
Age86 -> not eligible. Event 2/18 I10 144/79, but fails age. not_eligible.
71056:
Age84. Enroll full. Event: 2026-01-19 office I10 BP125/88; 2026-03-20 office I10 BP153/86. Eligible. Exclusions none. Numerator most recent after qualifying: if earliest 1/19: readings 1/19 and 3/20. Most recent 3/20 153/86 => systolic 153 not <140 -> non_compliant. If latest qualifying 3/20: same 153/86 -> non_compliant. Good. So non_compliant.
Need verify all statuses:
Eligible population before exclusions = those pass age+event+enrollment.
Let's list:
71041 eligible, no exclusion, non_compliant.
71043 eligible, non_compliant.
71044 eligible, excluded E1.
71047 eligible, compliant.
71048 eligible, non_compliant.
71050 eligible, compliant.
71052 eligible, compliant.
71053 eligible, non_compliant.
71054 eligible, non_compliant.
71056 eligible, non_compliant.
Maybe 71049 fails event. 71051 fails enrolment; excluded hospice but not eligible. 71042 fails age/enroll. 71045 fails enroll. 71046 fails enroll. 71055 fails age.
Need count: total 16.
Excluded: 71044 only? Check any E2/E3/E4? 71051 hospice but not eligible. No deaths. No pregnancy. ESRD only 71044. yes excluded count 1.
Denominator = eligible after exclusions: compliant + non_compliant = members: 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056. Count 9. Numerator compliant: 71047, 71050, 71052 count 3. Non_compliant: 6? 71041, 71043, 71048, 71053, 71054, 71056 = 6. 3+6=9. Excluded=1, not_eligible=6? 71042,71045,71046,71049,71051,71055 = 6. Total 9+1+6=16. Rate = 3/9*100=33.333... rounded half up to one decimal = 33.3. Need JSON number 33.3.
But need ensure numerator for 71043: There are later E78.5 readings (high diastolic 102, 103). Should they count? Prompt says most recent outpatient BP reading taken on/after qualifying encounter, not necessarily diagnosis. So yes. But maybe numerator should only use BP readings from encounters with hypertension? Let's re-read: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." It doesn't limit to I10 encounters; all outpatient BP readings. It specifically says ED/inpatient skipped, not non-HTN. So use all outpatient. Good.
Need ensure "outpatient encounter" includes office visit only. Yes. Emergency department and inpatient do not count for numerator and probably not for event. Event requires outpatient encounter with I10; 71049 has no outpatient before Jun; 71046 ED after etc. 71042 has after gap 4/11 office, but fails age/enroll.
Need ensure gaps count: Continuous enrollment: enrolled for full measurement year with no more than one gap of up to 45 days. They give gap lengths; we trust. But check 71052 gap of 45 days. Pass. If count inclusive? It says gap of 45 days pass. Fine.
71045 not enrolled before Apr 5: Is that a gap from start? It is not full measurement year. Fails. Could it be considered one gap of 94 days >45? yes. not_eligible.
71046 one gap 58 >45 fails.
71051 two gaps fails; not eligible even exclusion. Good.
Need check 71042 age 86 not eligible; event maybe after gap but no matter. Also two gaps fail.
Potential ambiguity: Exclusions evaluated before numerator and only for members who are in eligible population. Could a member with hospice but not eligible due to enrolment be excluded? Prompt says no, not_eligible. 71051 is not_eligible. Good.
Potential ambiguity: Denominator after exclusions; if a member is eligible and also has no qualifying reading? denominator but not numerator. All have readings. Good.
Potential ambiguity: ESRD exclusion any time on/before 2026-12-31: 71044 has N18.6 2024, yes exclude.
Need consider 71041: Inpatient admission May with BP 159/81. Does it count as outpatient? No. If inpatient skipped, most recent outpatient Feb 150/72. If only BP after event? yes.
Need consider 71047: inpatient November 118/88, if skipped, most recent outpatient Jul 25 137/73. Good. If inpatient counted, most recent Nov 118/88 also compliant anyway. No effect.
Need consider 71052: ED July 16 119/89 skipped; outpatient July13 127/73 before ED. If ED counted, most recent ED 119/89 also compliant, no effect. Fine.
Need consider 71053: Inpatient Aug 24 112/84 skipped; outpatient Jun26 133/95 before. If inpatient counted, compliant; but prompt says skip, so non_compliant. Good.
Need consider 71054: Inpatient Jun5 132/76 skipped? But after qualifying? Event date 3/21 or 5/6. Most recent outpatient Oct28 132/95 non_compliant. If inpatient counted, maybe Oct28 still most recent outpatient; no effect. If no outpatient after event? yes Oct28. If use only HTN outpatient, latest I10 5/6 138/85 non_compliant. Same.
Need consider 71056: 1/19 125/88 compliant, 3/20 153/86 not; most recent non_compliant. If event date first and need most recent after event includes 3/20; yes non.
Need consider 71050: 9/8 J06.9 BP129/71; if only HTN reading after event? 6/23 122/84, also compliant. no effect.
Need consider 71043 if only HTN reading? 3/21 135/73 compliant if ignore non-HTN readings, but using all outpatient gives non_compliant due to high diastolic on later E78.5. This is likely a test. Good.
Need consider event qualification for 71043: later E78.5 high diastolic. If non-HTN readings count, non_compliant. If not, compliant. Need prompt explicitly: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter" Not "hypertension reading." It is a blood pressure reading, not necessarily diagnosis. So yes count all outpatient readings. The inclusion of E78.5 BP with high diastolic likely tests counting all outpatient BPs, and skip ED/inpatient. Good.
Need consider if most recent outpatient reading must be after date of qualifying encounter and on/through Dec31. 71043's 10/02 office E78.5 is after. yes.
Need maybe exclude BP readings from encounters that occur during non-enrollment gaps? Continuous enrollment criterion doesn't require numerator readings in enrolled periods? Typically numerator reading must be during measurement year, not necessarily enrolled after? But if member has a gap, numerator readings during gap? For eligible members, gaps allowed. Could numerator BP readings during gap count? For 71052, no BP dujson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
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"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
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],
"got": [
"71041",
"71043",
"71048",
"71053",
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 9,232 tokens
We need answer JSON only fenced. Need evaluate each member against QM-CBP. Need be careful.
Need parse spec.
Eligible denominator:
- Age 18 through 85 as of 2026-12-31. It says 18 through 85 years inclusive likely <=85, >=18. Given ages.
- Event: at least one outpatient encounter with I10 on/between 2026-01-01 and 2026-06-30. An encounter after Jun30 does not establish event. Outpatient encounter likely office visit, not ED/inpatient? Event says outpatient encounter with hypertension diagnosis. Need identify qualifying encounter. ED and inpatient do not count for numerator and event? It explicitly says outpatient encounter for event. So only office visit with I10 in H1. If office visit after H1 with I10 no event if no H1 I10. Need ensure. Inpatient admission diagnosis I10 after H1 doesn't establish event. ED? no.
- Continuous enrolment: enrolled for full measurement year with no more than one gap up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes member from denominator. Need not enrolled before start means? 71045 enrolment starts Apr 5, not full year. Does that count as gap? yes removes. If no start at Jan1, not enrolled for full measurement year => not eligible. Need evaluate if one gap up to 45. Given gap lengths. Note gap from end date to start date maybe not include enrolled dates. Provided gap days. Need use. Two or more gaps any length removes. But age fail means not eligible before exclusion; event fail also not eligible. Exclusions remove from denominator before scoring for eligible population.
Numerator:
- The most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components below threshold. ED or inpatient reading does not count and is skipped when identifying most recent reading. If no qualifying reading exists, in denominator not numerator.
Need decide if qualifying reading must be after qualifying hypertension encounter date inclusive. "on or after date of qualifying hypertension encounter" so same day qualifies? Yes on or after date.
Outpatient BP reading: likely from office visit. What about outpatient encounter with diagnosis other than I10 but after qualifying encounter? Does any outpatient reading count? Most recent outpatient BP reading taken on or after date of qualifying hypertension encounter. It doesn't require diagnosis. So office visit with any diagnosis after qualifying encounter can count as outpatient reading. But numerator is blood pressure control in hypertension; typically read from encounter after index date, any BP reading from outpatient encounter? Spec says most recent outpatient blood pressure reading. Could include office visit with E78.5. It says outpatient reading, ED/inpatient skipped. Need include all office visits after qualifying encounter (maybe even if not I10). Need check examples: 71042 qualifying encounters Apr5 and Apr11. Then May1 office E78.5 BP167/83 after Apr11: most recent outpatient reading after qualifying encounter is May1, fail, even though Apr11 139/82 passes. Is that intended? The numerator: most recent outpatient BP reading taken on or after date of qualifying hypertension encounter. If multiple qualifying encounters, on or after date of qualifying hypertension encounter; probably most recent qualifying hypertension encounter? HEDIS CBP: index event date earliest qualifying encounter; numerator is most recent BP reading after index date. It may include non-HI? Actually "most recent outpatient blood pressure reading after the date of the index event" where index event is earliest encounter with HTN. Reading from any outpatient setting. If later non-HTN reading, counts. So yes. But careful: qualifying hypertension encounter date likely earliest qualifying event? "the date of the qualifying hypertension encounter" singular. Event is at least one outpatient encounter with I10 in Jan-Jun. If multiple, choose earliest? Usually index event date is earliest qualifying encounter. For numerator, most recent after index date. Need apply: For each with qualifying I10 in H1, use earliest qualifying date as index. Then consider all outpatient BP readings on/after index date, skip ED/inpatient. If none, not numerator. Need see if that changes.
Alternative: choose latest qualifying encounter? The text: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter" If event is at least one, could be qualifying encounter maybe earliest? It doesn't specify multiple; but measure design likely earliest date. Need infer from given cases to see intended. Let's evaluate both and see differences.
Let's enumerate each member.
Member 71041: DOB 1941-07-25 age 85. Enrol continuous. Outpatient I10 2026-02-18 BP150/72 in H1 => eligible event, enrol ok. Exclusions? none. Numerator: qualifying encounter date 2026-02-18. Outpatient readings after date: 2026-02-18 150/72; 2026-05-18 inpatient skip. Most recent qualifying outpatient is 2/18 150/72 fail sys not <140. Non_compliant. If latest qualifying same. So 71041 NC.
71042: DOB 1940-06-12 age 86. Age fail (not 18-85). Even with gaps etc not eligible. not_eligible.
71043: age35. continuous. Event: 2026-02-12 office I10, 2026-03-21 office I10. index 2/12 or 3/21. Outpatient readings: 2/12 126/73 pass; 3/21 135/73 pass; 5/22 office E78.5 BP119/102 fail (dia not <90); 10/2 office E78.5 BP136/103 fail. Most recent outpatient after index = 10/2 136/103 fail. If latest qualifying index 3/21, most recent after index still 10/2 fail. If only readings from I10 encounters, then latest 3/21 pass -> compliant. Need decide. The text says most recent outpatient BP reading, not diagnosis restricted. So likely fail. Important. Let's examine other members where non-I10 outpatient readings affect result. 71046 2026-08-20 office J06.9 BP 138/68; if counted as outpatient reading, passes; latest outpatient reading after qualifying (if after 8/20 passes 138<140 and 68<90 -> compliant). If only I10 readings, 5/11 119/85 passes too compliant. 71050 2026-09-08 office J06.9 129/71; if counted pass; if not, qualifying 6/23 pass? 122/84 pass anyway. 71052: outpatient readings: 4/8 I10 121/76, 6/4 I10 149/73, 7/13 I10 127/73; if index earliest 4/8 most recent outpatient 7/13 pass; if latest qualifying 6/4 7/13 pass; if only I10 7/13 pass; ED skipped. Compliant. 71053: event? Outpatient I10 5/22 pass? 146/72 fail; 6/26 I10 133/95 fail; 8/24 inpatient skip. Nonqual? If latest index 6/26, most recent outpatient after index 6/26 fail. Noncompliant. 71054: outpatient I10 3/21 137/92 fail (dia not <90), 5/6 138/85 pass, then 6/5 inpatient skip, 10/28 office E78.5 132/95 fail. If all outpatient readings after earliest index 3/21, most recent outpatient 10/28 fail -> NC. If latest qualifying index 5/6, most recent after 5/6? 10/28 fail -> NC. If only I10 readings, latest 5/6 pass -> compliant. So important.
Need infer from intended. In HEDIS CBP numerator: "The most recent systolic and diastolic blood pressure readings taken after or on the date of the index event and during the measurement year from a qualifying setting are both below 140/90." Qualifying settings include outpatient, home, etc. It does not require HTN diagnosis. So any outpatient reading counts. Thus 71043 NC, 71054 NC, maybe 71042 etc. Need consider home readings? only office visits given. So yes any office visit.
Need also check if ED/inpatient readings can count as outpatient BP reading if inpatient not. They are skipped when identifying most recent reading. Good.
71043 eligible denominator NC. Need confirm age/enrol/event/exclusions no. 71043 most recent outpatient reading after date of qualifying encounter? index earliest 2/12. 10/2 office E78.5 136/103 fail. NC.
71044: age70 continuous, event 4/23 I10 152/76. Exclusion E1 N18.6 on/before 2026-12-31 (2024) => excluded. Not in denom. Excluded.
71045: age44. Enrol starts 4/5 not continuous full year => not eligible. Also event 5/23 I10, but fail enrolment. Status not_eligible (enrolment). Exclusions none.
71046: age35, enrolment: Jan1-Apr26; Jun24-Dec31. One gap 58 days >45 => not eligible (even event). not_eligible.
71047: age18, continuous. Event: office visit 6/17 I10 within H1. 7/25 after no. 11/21 inpatient not event. Exclusions none. Numerator: index 6/17. Outpatient readings after/on date: 6/17 138/76 pass (both <140 and <90). 7/25 137/73 pass. 11/21 inpatient skip. Most recent outpatient = 7/25 137/73 pass. Compliant.
71048: age35 continuous. Event 5/15 I10 BP134/93 fail dia. Numerator: most recent outpatient after/on = same 134/93 fail. NC.
71049: age61. Enrolment Jan1-Jun26; Jul30-Dec31 one gap 33 <=45? Continuous enrolled for full measurement year with no more than one gap up to 45 days. If starts Jan1 ends Dec31, gap 33 okay. Event: needs outpatient I10 Jan1-Jun30. They have 8/25 office I10 after Jun30; 12/25 after; 11/28 ED not outpatient. No H1 I10. So not eligible event. not_eligible. Even if numerator would fail? not eligible.
71050: age84 continuous. Event: 6/23 office I10 (on or before 6/30) yes. 9/8 office J06.9 later. Numerator: index 6/23. Outpatient readings: 6/23 122/84 pass; 9/8 129/71 pass. Most recent 9/8 pass. Compliant. If index 6/23. yes.
71051: age35. Enrolment: Jan1-Apr8; May5-Aug7; Aug22-Dec31. Gaps 26 and 14 days => two or more gaps any length removes denominator. But also hospice Oct27 exclusion E3. Status: exclusions evaluated before numerator but only for members who are in eligible population. If fails enrolment (two gaps) -> not_eligible even if exclusion. Need age ok, event: outpatient I10 Mar21 Apr6. Apr6 date Jan1-Jun30 yes. But enrolment fails. Therefore not_eligible. However note enrolment gaps: maybe if they are not enrolled Jan1-Apr8? they are enrolled Jan1-Apr8, gap Apr8-May5 26; then gap Aug7-Aug22 14. Two gaps any length removes. not_eligible.
71052: age35. Enrolment Jan1-Apr8; May24-Dec31. One gap 45 days. The wording "up to 45 days" includes 45. so eligible. Event: outpatient I10 Apr8 (date within H1? Apr8 yes). Also Jun4 I10; Jul13. Numerator: index earliest Apr8? Qualifying encounter Apr8. Outpatient readings after/on Apr8: 4/8 121/76 pass; 6/4 149/73 fail; 7/13 127/73 pass. Most recent outpatient = 7/13 pass. ED skip. Compliant. If latest qualifying index 6/4 most recent 7/13 pass. Either. So C.
71053: age84. Enrolment Jan1-May15; Jun7-Dec31. One gap 22 ok. Event: office I10 May22? Wait enrolment gap ended Jun7. May22 is within gap? It says encounters 2026-05-22 Office visit I10. But member not enrolled 2026-05-16 through 2026-06-06? Actually enrolment Jan1-May15 and Jun7-Dec31, gap 22 days. May22 encounter occurs during gap? Event eligibility may require encounter? It says at least one outpatient encounter with I10 between Jan1-Jun30; not explicitly must be during enrolment? Continuous enrolment separate. In real measure, event must be during enrollment? Usually index event must occur during measurement year and maybe continuous enrollment? If encounter occurs during gap, does it count? Need think. The eligible population has event and continuous enrolment criteria; a member with gap can have an encounter in gap? It might be allowed? Usually encounters are services while enrolled; if not enrolled, maybe not considered? The spec doesn't say encounter must occur while enrolled. But could be a trap.
Member 71053 has qualifying I10 5/22 during gap; 6/26 after re-enrol. If 5/22 counts event, eligible (one gap 22 ok), numerator: most recent outpatient after 5/22 includes 6/26 I10 133/95 fail and 8/24 inpatient skip => NC. If 5/22 doesn't count due gap, 6/26 still event and NC. So status unchanged NC. But need if 6/26 index pass/fail? 133/95 fail. So 71053 NC.
71054: age84. Enrolment Jan1-May6; Jun18-Dec31. One gap 42 <=45. Event: outpatient I10 3/21 (while enrolled) and 5/6 (last day enrolled before gap). Numerator index earliest 3/21 or latest 5/6. Outpatient readings after earliest: 3/21 fail (137/92), 5/6 pass, 10/28 office E78.5 fail. Most recent outpatient = 10/28 fail -> NC. If index 5/6, 10/28 fail. NC.
71055: age86 not eligible. Not_eligible.
71056: age84 continuous. Event: outpatient I10 1/19 BP125/88 pass; 3/20 BP153/86 fail. Numerator: index earliest 1/19, most recent outpatient after/on 1/19 = 3/20 153/86 fail (sys fail). If latest qualifying index 3/20, reading fail. NC.
Now need categorize all.
C: 71047, 71050, 71052.
NC: 71041, 71043, 71048, 71053, 71054, 71056.
Excluded: 71044 (ESRD). Also any exclusions among eligible: 71051 not eligible due enrolment, so not excluded. 71044 excluded. No other pregnancy? No death/hospice among eligible. Check 71045 starts Apr 5 no event? fails enrol not eligible even if maybe pregnancy no. 71049 not eligible. 71042 not eligible. 71046 not eligible. 71055 not eligible.
not_eligible: 71042 age86; 71045 enrol not full; 71046 gap >45; 71049 no H1 I10 event; 71051 two gaps; 71055 age86. Also any age? 71041 85 eligible inclusive. 71047 exactly 18 eligible inclusive. Need age 85 on 12/31? 1941-07-25 => 85 at 12/31 yes. Eligible age 18-85 inclusive.
Denominator = C+NC = 3 + 6 = 9. Excluded 1. not_eligible 6. Numerator 3.
Rate = 3/9*100 = 33.333 -> 33.3 (round half up one decimal).
Lists:
compliant_members ["71047","71050","71052"]
non_compliant ["71041","71043","71048","71053","71054","71056"]
excluded ["71044"]
not_eligible ["71042","71045","71046","71049","71051","71055"]
Need double-check every member.
Let's scrutinize spec nuances.
MEASURE QM-CBP Blood Pressure Control in Hypertension.
Eligible population:
Age 18 through 85 years as of 2026-12-31. So 85 yes, 86 no.
Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between Jan1 and Jun30. An encounter after Jun30 does not establish event.
Continuous enrolment: enrolled for full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes member from denominator.
Does "full measurement year with no more than one gap" mean can start not Jan1 but still full? No if enrolled not full measurement year. For gap definition, starts Jan1 and ends Dec31 likely. 71045 not eligible. Could there be an interpretation that a gap from Jan1-Apr5 is 95 days => >45, not eligible. yes.
Exclusions evaluated before numerator but only if in eligible population. "Required Exclusions (remove from denominator before scoring)" E1 any time on or before Dec31. 71044 ESRD. E4 death. none.
Numerator: The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before Dec31 is below 140 AND below 90. Both components below threshold. A reading taken in ED or on inpatient admission does not count and is skipped when identifying most recent reading. If no qualifying reading exists...
Ambiguity: What qualifies as "qualifying hypertension encounter" for date if there are multiple? The event only at least one, but date of qualifying encounter could be any qualifying? In measure, index event date is first qualifying encounter. Need check if there is a possible scenario where choosing earliest vs latest alters status. Need inspect all with multiple qualifying I10.
- 71043: earliest 2/12, latest 3/21. Most recent outpatient after either is 10/2 fail, so no diff if any outpatient reading counts. If only I10 readings, latest pass, earliest latest pass too? 3/21 pass, then no I10 after 3/21. diff no.
- 71047: earliest 6/17, latest 7/25 (after H1 no qualifying). Most recent after earliest includes 7/25 pass; after latest pass; no diff.
- 71052: earliest 4/8 (I10), latest 6/4. most recent 7/13 pass; diff no.
- 71053: earliest 5/22, latest 6/26. most recent 6/26 fail; diff no? If earliest includes 6/26 fail; latest 6/26 fail. no diff.
- 71054: earliest 3/21, latest 5/6. Most recent after earliest includes 10/28 non-I10 fail. If latest after 5/6 includes 10/28 fail. If only I10 readings latest pass; but if any outpatient fail. no diff earliest vs latest.
- 71056: earliest 1/19, latest 3/20. Most recent after earliest includes 3/20 fail; latest fail. no diff.
Thus earliest/latest not issue here.
Need ensure non-I10 outpatient readings count. The phrase "The most recent outpatient blood pressure reading" not "from a qualifying hypertension encounter". Yes count. If intended only outpatient BP reading after qualifying encounter, regardless diagnosis. So 71043, 71054 NC due later non-I10. What about 71046? Not eligible anyway. If not eligible due gap. OK.
Could office visit with diagnosis E78.5 after qualifying be considered outpatient? yes. What about 71042? not eligible age but if age didn't fail would 4/5 146/88, 4/11 139/82 pass, 5/1 E78.5 167/83 fail, so NC. Age excludes.
Need ensure age and event failure status: not_eligible, not excluded even if exclusion documented. 71051 has hospice election but two gaps => not_eligible. 71042 age fail but not exclusion. 71049 no event but no exclusion. 71045 enrol fail. 71046 gap >45. 71055 age. Good.
Could 71049 event? No I10 outpatient before Jun30. It has one gap 33 days, age61 continuous? Jan1-Jun26, Jul30-Dec31. Could office 8/25 I10 be after qualifying date? event doesn't establish. So not_eligible. Need not numerator.
Could 71051 hospice election Oct27; if it had eligible? no due two gaps. If two gaps but hospice E3 remove denominator before scoring? no, not eligible. The status definitions: not_eligible never enters eligible population. A member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. So not_eligible.
Need counts sum: 3+6+1+6=16. Rate 33.3.
Double-check gap definitions for 71052: one gap of 45 days. Is gap 45 from Apr8 to May24? Let's calculate: Apr8 end to May24 start. Days gap maybe April 9-23? If Apr8 included end day, May24 start day. Difference Apr8 to May24 =46 days inclusive? They state gap of 45 days. Use given. Up to 45 okay.
71054 gap 42 days, ok. 71053 22, ok. 71049 33 but event fail. 71051 two gaps.
71046: one gap 58 >45; not eligible. Note they also have ED reading on 9/18 skipped. If eligible? not due gap.
Could 71050 office 9/8 J06.9 after event, counts. If not, 6/23 pass. Compliant anyway. But if numerator most recent after qualifying encounter and only before Dec31, yes 9/8 pass. Good.
Potential pitfall: For numerator threshold "below 140 systolic AND below 90 diastolic." Need both strictly below. 139/82 passes; 140/89 fails; 139/90 fails. Values:
71047: 137/73 pass (both <140 <90). 138/76 pass. Good.
71050: 129/71 pass. 122/84 pass. Good.
71052: 127/73 pass. 121/76 pass. Good.
Noncompliant:
71041: 150/72 fail sys.
71043: 136/103 fail dia.
71048: 134/93 fail dia.
71053: 133/95 fail dia.
71054: 132/95 fail dia (and maybe 137/92 fail dia) most recent 10/28 fail.
71056: 153/86 fail sys.
Any borderline pass: 71042 139/82 pass but age fail. 71043 E78 119/102 fail; 136/103 fail. If only HTN diag: would pass 135/73. But no. Need ensure no hidden exclusion/pregnancy? None. 71044 ESRD on 2024-06-20. Exclusion says any time on or before 2026-12-31. Yes. It is removed from denominator even if event. Not excluded if not eligible? 71044 eligible age/enrol/event so excluded.
Potential issue: "Age: 18 through 85 years as of 2026-12-31." Some might mean 18-84? "through 85" inclusive. The record says 85 years old for 71041, likely included. If not, 71041 not_eligible, denominator 8 numerator 3 rate 37.5. Need confirm. "18 through 85" inclusive; and HEDIS ages 18-85? Some measures 18-85? Yes. 71041 likely tests 85 included. Good.
Potential issue: "Date of birth 1941-07-25, so 85 years old on 2026-12-31." At Dec31 2026, born Jul25 1941 => 85. Good.
Potential issue: 71047 exactly 18 at 12/31. Included. Good.
Potential issue: Enrolment full measurement year with no more than one gap of up to 45 days. For 71051, two gaps any length remove. Good.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,584 tokens
We need answer JSON only. Need solve measure population. Need analyze every member carefully.
We need determine for each member: eligible population denominator before exclusions? Then exclusions removed. Status definitions:
- not_eligible: fails age, event, or enrolment. Even if exclusion documented, not_eligible wins.
- excluded: in eligible population but meets required exclusion. Removed from denominator.
- denominator: members in eligible population after exclusions removed (compliant + non_compliant)
- numerator: compliant.
Status: compliant if in denominator (eligible no exclusion) and numerator meets; non_compliant if in denom not numerator.
Need report lists counts.
Measure details:
Eligible:
Age 18 through 85 as of 2026-12-31. Note inclusive. So 18<=age<=85. DOBs provided ages. Those 86 not eligible; age 18 eligible; 85 eligible.
Event: at least one outpatient encounter with HTN diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 06-30 does not establish event. Need outpatient? Records: office visit outpatient? ED/inpatient? Qualifying encounter must be outpatient encounter with I10. Office visits are outpatient. ED/inpatient with I10? If inpatient admission diagnosis I10 does not establish outpatient encounter? likely no. Event after 6/30 no. Also what about if I10 encounter during gap? For event? It says at least one outpatient encounter... probably encounter can be during enrolled? But enrolment condition separate.
Continuous enrolment: enrolled full measurement year no more than one gap of up to 45 days. Gap longer than 45 or two or more gaps any length removes from denominator.
Need parse gaps. Given "Gaps of 15 and 12 days" etc. Need trust provided lengths? Some maybe inclusive? We should consider as stated. Continuous full measurement year? Enrolment segments may include dates. Need check if segment starts/ends. The task gives explicit gaps. Use those. But we might need calculate if ambiguous:
- 71042: two gaps 15 and 12 -> not eligible.
- 71045: not enrolled before 04-05 -> gap >45? Not eligible.
- 71046: one gap 58 days -> not eligible.
- 71049: one gap 33 -> eligible if age event.
- 71051: gaps 26 and 14 -> not eligible.
- 71052: one gap 45 -> eligible (up to 45 inclusive).
- 71053: one gap 22 -> eligible.
- 71054: one gap 42 -> eligible.
Others continuous.
Need age:
71042 86 -> not eligible. Even event? also gaps.
71055 86 -> not eligible.
All others <=85.
Event: Need at least one outpatient I10 in 1/1-6/30.
Evaluate all.
71041: age 85 eligible age, enrolment continuous, event 2026-02-18 office I10 qualifies. Exclusions? none (alive, no hospice, no pregnancy, no ESRD mentioned). In denom. Numerator: most recent outpatient BP reading taken on/after qualifying encounter date and before 12/31, skipping ED/inpatient. Readings: 2026-02-18 office BP 150/72; 2026-05-18 inpatient admission BP 159/81 skipped. No later outpatient. Most recent qualifying outpatient is 150/72. systolic not below 140, so non_compliant. Note if threshold: below 140 AND below 90. 150/72 fails sys.
71042: age 86 and enrolment 2 gaps -> not_eligible.
71043: age 35, continuous, event 2/12 office I10 (also 3/21). No exclusions. In denom. Numerator: most recent outpatient BP on/after qualifying date. Need consider BP readings at encounters with non-HTN diagnosis? Rule: The most recent outpatient blood pressure reading taken on or after date of qualifying hypertension encounter and on/before 12/31. It doesn't require encounter diagnosis I10. So all outpatient BP readings after qualifying encounter, skipping ED/inpatient. 5/22 office E78.5 BP 119/102, 10/2 office E78.5 BP 136/103. Most recent 136/103: sys <140 yes, dia <90? 103 no. non_compliant. Earlier 135/73 would compliant? Most recent fails. Need no other exclusion.
71044: age 70, continuous, event 4/23 office I10. Exclusion E1: history 2024-06-20 N18.6 on/before 12/31, so excluded. Even though numerator? not relevant. excluded_members.
71045: age 44, enrolment not full (starts 04/05, gap before >45). not_eligible. Even event 5/23 office I10 after enrolment but event within 1/1-6/30? Yes, but fails continuous. not_eligible.
71046: age 35, enrolment gap 58 -> not_eligible. Has event 3/8 etc but not eligible. not_eligible.
71047: age 18, continuous, event 6/17 office I10 qualifies. Exclusions none. In denom. Numerator: readings after qualifying date: 7/25 office I10 137/73; 11/21 inpatient skipped. Most recent outpatient 137/73 both below -> compliant. Note inpatient skipped. The 6/17 reading 138/76 qualifies too, but most recent outpatient 7/25. compliant.
71048: age 35, continuous, event 5/15 office I10. Numerator: only 5/15 134/93. sys <140 but dia >=90, fails -> non_compliant. No exclusions.
71049: age 61, one gap 33 -> eligible. Event? Need at least one outpatient I10 on/before 6/30. Encounters: 8/25 office I10 after 6/30; 11/28 ED; 12/25 office I10. None in 1/1-6/30. So fails event -> not_eligible, even though enrolment OK age OK. Exclusions? none. not_eligible. Need consider if office during gap? no event before.
71050: age 84, continuous, event 6/23 office I10 qualifies. In denom. Numerator: most recent outpatient after qualifying: 9/8 office J06.9 BP 129/71. Both below -> compliant. No exclusions.
71051: age 35, enrolment gaps two -> not_eligible. Even has hospice exclusion but not_eligible wins. not_eligible.
71052: age 35, one gap 45 eligible. Event 4/8 office I10 qualifies. In denom. Numerator: readings after 4/8: 4/8 same date? "on or after date of qualifying encounter". Most recent outpatient BP on/after 4/8. Need consider same encounter: 4/8 BP 121/76; 6/4 office 149/73; 7/13 office 127/73; 7/16 ED skip. Most recent outpatient 7/13 127/73 -> compliant. If 6/4 failed but later 7/13 passes. Most recent qualifies.
71053: age 84, one gap 22 eligible. Event 5/22 office I10 qualifies (also 6/26). Numerator: outpatient readings after qualifying: 5/22 146/72; 6/26 133/95; 8/24 inpatient skipped. Most recent outpatient 6/26 133/95: sys<140 yes but dia>=90 fails. Non_compliant. Note if same date qualifying? Yes. No exclusions.
71054: age 84, one gap 42 eligible. Event 3/21 office I10; 5/6 office I10 qualifies. Numerator: after qualifying (earliest? date of qualifying HTN encounter? If multiple, most recent outpatient BP taken on or after the date of the qualifying hypertension encounter. Which qualifying encounter? Typically event date could be first? Need decide if multiple. If at least one; for numerator, use most recent BP after date of the qualifying encounter. If multiple encounters within event period, which? Usually the denominator event date? Could be the most recent? The spec: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". If there are multiple qualifying HTN encounters, "the" maybe any? In single member tasks, likely use earliest or first? Need careful. For 71054: I10 encounters 3/21, 5/6, inpatient 6/5 skipped, 10/28 office E78.5. If qualifying encounter 3/21: readings after: 3/21 137/92; 5/6 138/85; 6/5 inpatient skip; 10/28 office 132/95. Most recent outpatient 132/95 -> dia 95 fails non_compliant. If qualifying encounter 5/6: readings after: 5/6 138/85; 10/28 132/95 -> fails. Non_compliant. If somehow most recent qualifying? still fails. no change.
71055: age 86 not_eligible (despite event). not_eligible.
71056: age 84, continuous, event 1/19 office I10 qualifies (and 3/20). Numerator: most recent outpatient after qualifying: 1/19 125/88; 3/20 153/86. Most recent 153/86 fails sys -> non_compliant.
Need exclusions for eligible population members before numerator.
List all statuses:
71041 non_compliant
71042 not_eligible
71043 non_compliant
71044 excluded (ESRD)
71045 not_eligible
71046 not_eligible
71047 compliant
71048 non_compliant
71049 not_eligible (no event in first half)
71050 compliant
71051 not_eligible (two gaps; hospice irrelevant)
71052 compliant
71053 non_compliant
71054 non_compliant
71055 not_eligible (age)
71056 non_compliant
Count denominator = compliant + non_compliant = 71041,71043,71047,71048,71050,71052,71053,71054,71056 = 9. numerator = 3. excluded = 1. not_eligible = 71042,71045,71046,71049,71051,71055 = 6. Total 9+1+6=16 yes.
Rate = 3/9*100 = 33.333... rounded half up to one decimal -> 33.3. Need output number 33.3.
Compliant_members [71047,71050,71052]
Non_compliant_members [71041,71043,71048,71053,71054,71056]
Excluded [71044]
Not_eligible [71042,71045,71046,71049,71051,71055]
Need ensure member IDs strings numbers after MEMBER, e.g. "71041". Any order.
Check all edge cases.
Let's scrutinize measure language and potential interpretations.
Eligible population continuous enrolment: enrolled full measurement year with no more than one gap of up to 45 days.
What is a gap? The dates provided: For 71046: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days. 4/26 to 6/24 difference? April 27-May 31 (35 days?) + June 1-23 (23) = 58, yes. Good. 71052 gap: 4/8 to 5/24. Provided 45 days. Let's calculate: 4/9-5/23 = 45 days. up to 45 inclusive.
71049 gap: 6/26 to 7/30: 6/27-7/29 = 33 days. good.
71054 gap: 5/6 to 6/18: 5/7-6/17 = 42? 25+17=42. good.
71053: 5/15 to 6/7: 5/16-6/6 = 22. good.
71042 gap: 3/27 to 4/12: 3/28-4/11 = 15; 6/29 to 7/12: 6/30-7/11=12.
71051: 4/8 to 5/5: 4/9-5/4=26; 8/7 to 8/22: 8/8-8/21=14. OK.
Age inclusive: DOB given ages on 2026-12-31. For 71041 born 1941-07-25 -> 85 (turns 85 on 7/25). Eligible 18 through 85. 71047 born 2008-04-06 -> 18; eligible. 71055 86 not.
Pregnancy: 71041 female but no pregnancy code. None O00-O9A. No mention pregnant. 71043 etc no. So only 71044 exclusion? ESRD N18.6 2024-06-20 (any time on or before 2026-12-31). Yes. 71051 hospice but not eligible due gaps, status not_eligible. If age/event eligible? no due gaps, and exclusion evaluated only in eligible population, so not_eligible.
Event: Need outpatient encounter with hypertension diagnosis I10 between 1/1 and 6/30. What about 71043: yes. 71050: 6/23 yes. 71047: 6/17 yes. 71041 yes. 71048 yes. 71052 yes. 71053 yes. 71054 yes. 71056 yes. 71045 yes? 5/23 office I10, but not eligible due enrollment. 71046 yes (3/8). 71049 no. What if 71049 has no I10 in first half; 8/25 after. Not eligible.
Numerator details:
- "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading. If no qualifying reading exists, the member is in the denominator and not in the numerator."
Need interpret "qualifying hypertension encounter" if multiple. Could be the encounter establishing event; if multiple in event period perhaps choose most recent qualifying encounter? Or earliest? Need infer from scoring? We have cases where might differ. Let's find any member where different event date changes numerator? 71041: only one event. 71043: I10 events 2/12 and 3/21; most recent outpatient reading is 10/02 regardless after any event, fails. If using 2/12 or 3/21 same most recent 10/2. 71047: events 6/17 and 7/25 (second after 6/30, not qualifying). Most recent after 6/17 is 7/25 (also I10) compliant. If using only qualifying event 6/17 same. 71052: events 4/8; later 6/4,7/13. Most recent after 4/8 is 7/13 compliant. If using 6/4? 6/4 not qualifying because after 6/30? It's 6/4? wait 71052 events: 4/8 I10, 6/4 I10 (office), 7/13 I10 (office), 7/16 ED. Qualifying encounters in first half: 4/8 and 6/4. If using date of qualifying encounter as the later qualifying 6/4: most recent outpatient after 6/4: 6/4 BP 149/73 (fails if only 6/4? But 7/13 is after 6/4, 127/73 compliant) same. If using earliest: same most recent 7/13. So no difference. 71053: qualifying encounters 5/22, 6/26. If using earliest 5/22 most recent outpatient after: 6/26 133/95 fails. If using latest qualifying 6/26 most recent after or same: 6/26 133/95 fails. No difference. 71054: qualifying 3/21, 5/6. If earliest, 10/28 132/95 fail; if latest 5/6, 10/28 fail. 71056: events 1/19,3/20; most recent after either 3/20? If earliest, most recent 3/20 153/86 fail; if latest, 3/20 fail. No difference. So robust.
Need consider reading on same date as qualifying encounter. It says on or after date, so yes. 71041 if qualifying 2/18 and reading same day considered. 71047 if 6/17 reading same day and later 7/25; most recent after includes 7/25. 71052 includes 7/13. If same date qualifies. OK.
Need consider BP readings from encounters without diagnosis? Yes all records are BP readings at encounters. Some E78.5 office visits. Count as outpatient BP readings. 71043 non-HTN E78.5 readings count. 71050 J06.9 reading count. 71054 E78.5 reading count. Good.
Need consider 71043 5/22 BP 119/102 and 10/2 BP 136/103 both fail diastolic. Most recent 10/2 fails. 71048 diastolic 93 fails.
Need consider 71041 inpatient BP 159/81 skipped. If not skipped, same date after qualifying but inpatient doesn't count. If only reading inpatient skipped, there is qualifying outpatient reading. If no qualifying reading? If only inpatient after and no outpatient, denominator non-compliant. Not relevant.
Potential edge: 71047 inpatient admission diagnosis I10 11/21 BP 118/88 is inpatient skipped. Could there be another outpatient reading after 11/21? no. Most recent outpatient 7/25 137/73 compliant. If the inpatient reading counted? 118/88 compliant anyway, same. But skipping is OK.
Potential edge: 71053 8/24 inpatient 112/84 skipped; most recent outpatient 6/26 133/95 fails. If counted, compliant; so important. Correct skip.
Potential edge: 71052 7/16 ED 119/89 skipped; most recent outpatient 7/13 127/73 compliant. If counted ED before outpatient? ED date after outpatient, would be most recent 119/89 compliant anyway. no difference. 71054 6/5 inpatient 132/76 skipped; most recent outpatient 10/28 fail. If counted before 10/28, 10/28 still later fail. no difference. 71046 not eligible. 71049 not eligible.
Potential edge: exclusion E3 hospice: 71051 has hospice election 10/27, but not eligible due two gaps. Rule says not_eligible even if exclusion documented. Yes. If it were eligible would excluded.
Potential edge: ESRD/dialysis any time on or before 2026-12-31 includes history before measurement year? "any time on or before 2026-12-31". Yes 2024. 71044 excluded. Even if no numerator.
Potential edge: "Required exclusions (remove from denominator before scoring) E1... any time on or before 2026-12-31." This includes before event? yes. For 71044 event 4/23 in eligible; E1 removed.
Potential edge: "not_eligible never enters eligible population (age, event, or enrolment)" Could a member fail enrolment and age? not_eligible. OK.
Need final output exactly one fenced JSON code block. No extra text. Need include required keys only. Could include integer and number and arrays. Ensure JSON valid. Use double quotes. Need no markdown outside? They say reply with exactly one fenced JSON code block and nothing else. So final:
```json
{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
```
Double-check counts: 9 denominator, numerator 3 => 33.3. Lists sum: denom lists 3+6=9, excluded 1, not 6 total 16. Good.
Need maybe rate should be number one decimal; 33.3 exactly. Good.
Let's think if any member with age event could be excluded due pregnancy? None. Could gender and age female 35 but no O code. None.
Could 71043 BP 119/102 with high diastolic, maybe if most recent outpatient reading must be at HTN encounter? It says blood pressure reading, no diagnosis requirement. So count E78.5. Good. If only at I10, most recent I10 outpatient 3/21 135/73 compliant? But spec doesn't limit. Need decide. It says most recent outpatient blood pressure reading taken on or after date of qualifying HTN encounter, not only HTN encounter. And examples? Usually HEDIS BP control numerator uses most recent BP in denominator period, regardless of encounter diagnosis. So count all outpatient readings. Good.
Could 71050 reading 9/8 office J06.9 count? Yes. If only HTN, no later I10, then 6/23 122/84 compliant anyway. Same result. 71043 result differs if only I10: most recent I10 outpatient 3/21 135/73 compliant; but with E78.5 10/2 fail. We chose fail. Need be sure measure language: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". Doesn't say BP reading must be at HTN encounter. Thus all outpatient readings. So 71043 non-compliant. This likely intentional to test count non-HTN readings. 71054 has E78.5 10/28; if only I10, most recent I10 5/6 138/85 compliant (sys<140 dia<90) but with E78.5 132/95 fail. Also likely intentional. Need consider "blood pressure reading" at E78.5 office visits; yes reading from claim record? We have diagnoses and BP. It is an outpatient blood pressure reading. So count. Good.
Could 71041 inpatient admission with R07.9 not count; skipped. Good.
Could 71053 inpatient R07.9 not count; skipped.
Could 71047 inpatient I10 not count, even diagnosis I10, because inpatient admission. skipped. Good.
Could ED J06/S52 not count. skipped. Good.
Need consider if BP reading on inpatient admission date 2026-05-18 71041 is after qualifying encounter; skipped. If all outpatient readings before are 2/18, most recent outpatient 2/18 fail. good.
Potential edge: "measurement year: 2026-01-01 through 2026-12-31". Numerator readings on or after qualifying encounter and on or before 2026-12-31. Qualifying encounter could be 2026-04-08 71052. BP on 4/8 qualifies (same date). Then later. good.
Potential edge: "at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." It doesn't say encounter must be within enrollment. Usually denominator event occurs during continuous enrollment period? If member has encounter during gap, does that establish event? For 71052: qualifying encounters 4/8 during enrollment, no issue. 71054: 3/21 and 5/6 during enrollment. 71045 starts 4/5 and event 5/23 during enrollment. 71046: 3/8 during enrollment. 71049 no. 71043 event continuous. 71041 continuous. 71042 gaps, event 4/5 during enrollment after gap? Actually 71042 enrolled 1/1-3/27 then gap; event 4/5 during gap, and 4/11 office I10 during gap? Enrollment 4/12-6/29. But not eligible due age and gaps. If event during gap might fail? Not relevant. But rule only event and enrolment separate. If enrolment fails due gaps, not eligible. Good.
Need think if 71053 has I10 office 5/22 during gap? Enrollment: 1/1-5/15; 6/7-12/31. 5/22 is during gap. But 6/26 office I10 during enrollment after gap. Event qualifies. Numerator reading on 5/22 is during gap but after qualifying date 6/26? Wait if the earliest qualifying event is 6/26? Actually event in first half: only 5/22 and 6/26. 5/22 during gap? But enrollment gap 5/16-6/6; 5/22 during gap. Event says at least one outpatient encounter with I10 on/between 1/1-6/30. It doesn't explicitly require during enrollment? Usually denominator condition is event during continuous enrollment period? But here separate. Continuous enrolment full year with one gap. If encounter during gap? Does that count as event? If enrolment says full measurement year with gap up to 45 days; event can occur during gap? HEDIS typically requires continuous enrollment during denominator period and the condition event; events occurring during enrollment gap? But if they have claim, mighjson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": [
"71047",
"71050",
"71052"
],
"non_compliant_members": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"excluded_members": [
"71044"
],
"not_eligible_members": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K2.6 · Moonshot42.3s · 8,095 out | 26.5s · 6,456 out | 65.5s · 12,526 out
Reasoning · 6,835 tokens
We need to apply measure QM-CBP to each of 16 members. Determine for each: not_eligible, excluded, compliant, non_compliant.
First, parse measure spec carefully.
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population (denominator):
- Age: 18 through 85 years as of 2026-12-31.
- Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does NOT establish event.
- Continuous enrollment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member.
Numerator:
- Most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both must be below thresholds.
- Reading taken in ER or inpatient does not count and is skipped when identifying the most recent reading.
- If no qualifying reading exists, denominator and not numerator (non-compliant).
Exclusions (evaluated before numerator; only for members eligible):
- E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31.
- E2. Pregnancy (any O00-O9A code) during the measurement year.
- E3. Enrolled in hospice or receiving palliative care at any time during the measurement year.
- E4. Died during the measurement year.
Important ordering: Age, event, enrollment first. If fail any, not_eligible, even if exclusion also applies. Then check exclusions for those eligible. Then numerator.
Now let's go member by member.
MEMBER 71041.
DOB 1941-07-25. Age as of 2026-12-31: 85. (2026-1941=85, month 07<12, so 85). Age 18-85 inclusive? "18 through 85 years" includes 85. So age eligible.
Enrollment: 2026-01-01 through 2026-12-31 continuous, no gaps. Good.
Event: need outpatient encounter with I10 between 2026-01-01 and 2026-06-30.
- 2026-02-18 Office visit, dx I10. This is outpatient, within date range. So event met.
Thus eligible.
Exclusions: No ESRD, no pregnancy, no hospice (no), not died.
Now numerator: Need most recent OUTPATIENT BP reading on or after date of qualifying hypertension encounter (2026-02-18) and on or before 2026-12-31, below 140/90. Skip ER/inpatient.
Encounters:
- 2026-02-18 Office visit, BP 150/72. Outpatient. Counts.
- 2026-05-18 Inpatient admission, BP 159/81. Inpatient is skipped.
Any other? No.
Most recent qualifying reading is 2026-02-18 BP 150/72. Systolic 150 NOT <140. So not numerator.
Non-compliant.
MEMBER 71042.
DOB 1940-06-12. Age as of 2026-12-31: 86. (2026-1940=86). Age >85. So fails age.
Thus not_eligible (even if other things).
Check: not_eligible regardless of exclusions.
Double-check enrollment: gaps 15 and 12 days. That's two gaps. But not needed since already not eligible due to age.
Not_eligible.
MEMBER 71043.
DOB 1991-01-17. Age: 35. Good.
Enrollment: continuous full year, no gaps. Good.
Event: outpatient encounter with I10 between 2026-01-01 and 2026-06-30.
- 2026-02-12 Office visit, dx I10. Yes.
- 2026-03-21 Office visit, dx I10. Yes.
So eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after qualifying encounter date. Qualifying encounter date is earliest? Actually "taken on or after the date of the qualifying hypertension encounter" — if multiple qualifying encounters, any of them? Need to interpret: The member has at least one qualifying encounter. The reading must be on or after the date of that encounter. If multiple, probably the reading must be on or after the date of the qualifying encounter used to establish event. But since any qualifying encounter works, and the reading must be on or after the date of the qualifying hypertension encounter, I think it means on or after the earliest qualifying encounter? Or perhaps "the" qualifying encounter implies the one used, but if multiple, any reading after the first such encounter would be after "a" qualifying encounter. However, typically in HEDIS style, it's "on or after the date of the first qualifying encounter" or just "on or after the date of the qualifying encounter". Let's read carefully: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31". If there are multiple qualifying encounters, does "the qualifying hypertension encounter" refer to each? Usually in measure specs, if multiple events, the numerator reading must be on or after the date of the first qualifying event? Actually, for continuity, the reading just needs to be after the encounter that established the denominator. Since any qualifying encounter establishes denominator, the reading must be on or after the date of that encounter. But if there are multiple, the reading must be on or after the date of the qualifying encounter? It might mean on or after the date of the qualifying encounter that establishes the event. In many measures, if there are multiple encounters, the reading must be on or after the earliest qualifying encounter? Or on or after any of them? Typically, the measure wants the most recent reading after the diagnosis/encounter. If you have an encounter on Feb 12 and another on Mar 21, a reading on Feb 15 is after the Feb 12 encounter. The phrase "the qualifying hypertension encounter" is ambiguous, but generally we should treat it as any qualifying encounter: the reading must be on or after at least one qualifying encounter. But practically, we should look at all qualifying encounters and consider the reading must be on or after the earliest date? Let's think. Suppose a member has a qualifying encounter on Jan 5. Then later a non-qualifying encounter on Dec 1. The most recent reading is on Dec 1. That's after Jan 5, so qualifies. If there are multiple qualifying encounters, the earliest one sets the starting point. For example, a reading on Feb 15 is after the Feb 12 encounter. Is it "on or after the date of the qualifying hypertension encounter"? If the encounter used to satisfy the event is the Mar 21 one, then Feb 15 is before that and wouldn't count. But the spec doesn't say we pick a specific encounter; it says "at least one outpatient encounter". So there isn't a single designated encounter. Therefore, I think the reading must be on or after the date of ANY qualifying hypertension encounter, i.e., if there is at least one qualifying encounter on date X, the reading must be >= X? But which X? The earliest possible X? Because if it must be on or after "the" date, and there are multiple, the most natural reading is that the reading must be on or after the date of the first qualifying encounter (since that establishes the event). However, some measures treat it as on or after the date of the first qualifying encounter. Let's examine typical HEDIS Controlling High Blood Pressure measure. In HEDIS, the numerator is the most recent BP reading taken after the second diagnosis and during the year, with a specific threshold. But this measure is custom. Let's see if any readings are before the first qualifying encounter; none likely matter.
Let's proceed carefully per member.
71043:
Qualifying encounters: 2026-02-12 (I10) and 2026-03-21 (I10).
Readings:
- 2026-02-12 BP 126/73. This is on the same date as a qualifying encounter. Is it "on or after"? Yes, on the date. So qualifies. Outpatient.
- 2026-03-21 BP 135/73. On the date.
- 2026-05-22 BP 119/102. Outpatient, but after.
- 2026-10-02 BP 136/103. Outpatient, after.
The most recent outpatient reading (skipping inpatient/ER; none here) is 2026-10-02 BP 136/103. Systolic 136 < 140. Diastolic 103 NOT < 90. So fails numerator.
Are there any readings taken before the qualifying encounter? No.
Thus non-compliant.
MEMBER 71044.
DOB 1956-05-26. Age: 70. Good.
Enrollment: continuous full year. Good.
Event: 2026-04-23 Office visit, dx I10. BP 152/76. This is between Jan 1 and Jun 30. So eligible.
Exclusions: Other history: 2024-06-20 Diagnosis N18.6, end stage renal disease. E1: ESRD any time on or before 2026-12-31. Yes. Excluded.
Excluded.
MEMBER 71045.
DOB 1982-06-22. Age: 44. Good.
Enrollment: 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05. So not enrolled for the full measurement year. The measurement year starts 2026-01-01. Therefore fails continuous enrollment requirement. Not_eligible.
Check: "Enrolled for the full measurement year with no more than one gap of up to 45 days." Since not enrolled from Jan 1 to Apr 4, that's a gap from Jan 1 to Apr 4? Actually not enrolled at all before Apr 5. So they are not enrolled for the full year. The requirement is "enrolled for the full measurement year". This phrase can mean they must be enrolled from the start to the end, but the next clause says "with no more than one gap of up to 45 days." That implies the baseline is full-year enrollment, allowing a small gap. Not being enrolled at the start is effectively a gap of 94 days? But more fundamentally, they are missing the first part. Usually if they don't start until Apr 5, they are not eligible. So not_eligible.
MEMBER 71046.
DOB 1991-10-18. Age: 35. Good.
Enrollment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days. The gap is from Apr 27 to Jun 23 inclusive? Let's calculate: Apr 26 is last enrolled day. Next enrolled is Jun 24. Gap length: days from Apr 27 to Jun 23. That's 58 days (Apr has 30, so Apr 27-30 is 4 days; May is 31; Jun 1-23 is 23; total 4+31+23=58). Since gap >45 days, fails continuous enrollment. Not_eligible.
Even though there's only one gap, it's longer than 45 days. So not_eligible.
MEMBER 71047.
DOB 2008-04-06. Age as of 2026-12-31: 18. (2026-2008=18). Born in April, as of Dec 31 age 18. "18 through 85 years" includes 18. Good.
Enrollment: continuous, full year. Good.
Event: outpatient encounter with I10 between Jan 1 and Jun 30.
- 2026-06-17 Office visit, dx I10. Outpatient, within window. Good.
- 2026-07-25 Office visit, dx I10. After Jun 30, doesn't establish event but is an encounter.
- 2026-11-21 Inpatient admission, dx I10. Inpatient, doesn't establish event, and also after Jun 30.
So eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after date of qualifying encounter (2026-06-17) and on or before 2026-12-31. Skip inpatient/ER.
Readings:
- 2026-06-17 Office visit, BP 138/76. Outpatient. Qualifying. Systolic 138 < 140, diastolic 76 < 90. Good.
- 2026-07-25 Office visit, BP 137/73. Outpatient. Good.
- 2026-11-21 Inpatient admission, BP 118/88. Inpatient, skip.
The most recent qualifying reading is 2026-07-25 (since inpatient is skipped). BP 137/73. Both < thresholds. So numerator = compliant.
Wait: Is the reading on 2026-07-25 "on or after the date of the qualifying hypertension encounter"? The qualifying encounter is 2026-06-17. Yes. So it counts. Most recent outpatient reading is 2026-07-25. So compliant.
MEMBER 71048.
DOB 1991-04-26. Age: 35. Good.
Enrollment: continuous full year. Good.
Event: 2026-05-15 Office visit, dx I10. Outpatient, within window. Eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after 2026-05-15.
Readings:
- 2026-05-15 BP 134/93. Outpatient. Diastolic 93 NOT < 90. So fails.
Any other readings? No. So non-compliant.
MEMBER 71049.
DOB 1965-05-12. Age: 61. Good.
Enrollment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days. Jun 27 to Jul 29 inclusive? Let's calculate: Jun 27-30 is 4 days; Jul 1-29 is 29 days; total 33 days. That's <=45 days and only one gap. So continuous enrollment satisfied.
Event: need outpatient I10 encounter between Jan 1 and Jun 30.
Encounters:
- 2026-08-25 Office visit, dx I10. After Jun 30. Does not establish event.
- 2026-12-25 Office visit, dx I10. After Jun 30. Does not establish event.
- 2026-11-28 Emergency department visit, dx R07.9. Not I10, and ED.
No qualifying encounter in Jan-Jun. So fails event. Not_eligible.
MEMBER 71050.
DOB 1942-01-04. Age: 84. Good.
Enrollment: continuous full year. Good.
Event: 2026-06-23 Office visit, dx I10. Outpatient, within window. Eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after 2026-06-23.
Readings:
- 2026-06-23 BP 122/84. Outpatient. Systolic 122 <140, diastolic 84 <90. Good.
- 2026-09-08 Office visit, dx J06.9. BP 129/71. Outpatient. Also good.
Most recent outpatient reading is 2026-09-08 BP 129/71. Both < thresholds. Compliant.
MEMBER 71051.
DOB 1991-04-19. Age: 35. Good.
Enrollment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days. Two gaps. "Two or more gaps of any length, removes the member." So fails continuous enrollment. Not_eligible.
But let's check exclusions anyway? Order says exclusions only for eligible population. Since not eligible due to enrollment, not_eligible. Even though hospice election on 2026-10-27 would be exclusion. But not eligible first.
Not_eligible.
MEMBER 71052.
DOB 1991-11-27. Age: 35. Good.
Enrollment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days? Let's calculate: Apr 9 to May 23 inclusive. Apr 9-30 = 22 days; May 1-23 = 23 days; total 45 days. Exactly 45 days. Spec says "up to 45 days." So 45 is allowed. And only one gap. So continuous enrollment satisfied.
Event: need outpatient I10 encounter between Jan 1 and Jun 30.
Encounters:
- 2026-04-08 Office visit, dx I10. Outpatient. Date is Apr 8, within window. Good.
- 2026-06-04 Office visit, dx I10. Outpatient, within window. Good.
- 2026-07-13 Office visit, dx I10. After Jun 30, doesn't establish event.
So eligible.
Exclusions: none (no hospice, etc.).
Numerator: Most recent outpatient BP on or after date of qualifying encounter (which is 2026-04-08 or 2026-06-04; reading must be on or after at least one? We'll assume after earliest; all readings are after both anyway).
Readings (skip ER/inpatient):
- 2026-04-08 Office visit, BP 121/76. Outpatient.
- 2026-06-04 Office visit, BP 149/73.
- 2026-07-13 Office visit, BP 127/73.
- 2026-07-16 Emergency department visit, BP 119/89. ED, skip.
Most recent outpatient reading (not skipped) is 2026-07-13 BP 127/73. Both < thresholds. Compliant.
MEMBER 71053.
DOB 1942-08-07. Age: 84. Good.
Enrollment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days. <=45 and one gap. Good.
Event: need outpatient I10 encounter between Jan 1 and Jun 30.
Encounters:
- 2026-05-22 Office visit, dx I10. Outpatient, but date May 22 is within window? Yes, Jan 1 - Jun 30. Good.
- 2026-06-26 Office visit, dx I10. Outpatient, within window? Jun 26 <= Jun 30. Yes. Good.
So eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after date of qualifying encounter. All readings after.
Readings:
- 2026-05-22 BP 146/72.
- 2026-06-26 BP 133/95.
- 2026-08-24 Inpatient admission, BP 112/84. Inpatient, skip.
Most recent outpatient reading is 2026-06-26 BP 133/95. Diastolic 95 NOT < 90. So non-compliant.
MEMBER 71054.
DOB 1942-12-16. Age: 84. Good.
Enrollment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days? Let's calculate: May 7 to Jun 17 inclusive. May has 31, so May 7-31 = 25 days. Jun 1-17 = 17 days. Total = 42. <=45 and one gap. Good.
Event: need outpatient I10 encounter between Jan 1 and Jun 30.
Encounters:
- 2026-03-21 Office visit, dx I10. Outpatient, within window. Good.
- 2026-05-06 Office visit, dx I10. Outpatient, within window. Good.
- 2026-06-05 Inpatient admission, dx S52.501A. Inpatient, also not I10. Doesn't matter.
- 2026-10-28 Office visit, dx E78.5. Not I10. Doesn't matter.
So eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after date of qualifying encounter (2026-03-21 or 2026-05-06).
Readings:
- 2026-03-21 BP 137/92. Outpatient.
- 2026-05-06 BP 138/85. Outpatient.
- 2026-06-05 Inpatient admission, BP 132/76. Inpatient, skip.
- 2026-10-28 Office visit, BP 132/95. Outpatient.
Most recent outpatient reading is 2026-10-28 BP 132/95. Diastolic 95 NOT < 90. So non-compliant.
Wait, what about 2026-05-06 reading 138/85? That is lower. But most recent is Oct 28. So non-compliant. Good.
MEMBER 71055.
DOB 1940-08-21. Age as of 2026-12-31: 86. (2026-1940=86). Age >85. Fails age. Not_eligible.
MEMBER 71056.
DOB 1942-01-17. Age: 84. Good.
Enrollment: continuous full year. Good.
Event: 2026-01-19 Office visit, dx I10. Within window. 2026-03-20 Office visit, dx I10. Within window. So eligible.
Exclusions: none.
Numerator: Most recent outpatient BP on or after date of qualifying encounter.
Readings:
- 2026-01-19 BP 125/88. Systolic 125 <140, diastolic 88 <90. Good.
- 2026-03-20 BP 153/86. Systolic 153 not <140.
Most recent outpatient reading is 2026-03-20 BP 153/86. Systolic fails. Non-compliant.
Note: The reading on 2026-01-19 is earlier. The most recent is Mar 20. So non-compliant.
Wait, is the reading on Jan 19 "on or after the date of the qualifying hypertension encounter"? It IS the qualifying encounter. So yes. But most recent is Mar 20. So non-compliant.
Let's double-check all members for any nuance.
List of members with status:
71041: Age 85 (eligible), event yes, enrollment yes, no exclusions. Numerator? Most recent outpatient BP after event: Feb 18 (150/72) and May 18 inpatient skip. So 150/72 => non-compliant.
71042: Age 86 => not_eligible.
71043: Age 35, event yes, enrollment yes. Most recent outpatient BP Oct 2 (136/103) => non-compliant.
71044: Age 70, event yes, enrollment yes, excluded (N18.6). Excluded.
71045: Enrollment starts Apr 5 => not full year => not_eligible.
71046: One gap 58 days => not_eligible.
71047: Age 18, event yes (Jun 17), enrollment yes. Most recent outpatient BP after Jun 17 is Jul 25 (137/73) => compliant.
71048: Event May 15. Most recent outpatient BP May 15 (134/93) => diastolic 93 > 90 => non-compliant.
71049: No qualifying event (I10 only after Jun 30). Not_eligible.
71050: Event Jun 23. Most recent outpatient BP Sep 8 (129/71) => compliant.
71051: Two gaps => not_eligible.
71052: One gap 45 days allowed. Event Apr 8. Most recent outpatient BP Jul 13 (127/73) => compliant.
71053: Event May 22. Most recent outpatient BP Jun 26 (133/95) => diastolic 95 > 90 => non-compliant.
71054: Event Mar 21. Most recent outpatient BP Oct 28 (132/95) => diastolic 95 > 90 => non-compliant.
71055: Age 86 => not_eligible.
71056: Event Jan 19. Most recent outpatient BP Mar 20 (153/86) => systolic > 140 => non-compliant.
Now let's count.
Denominator = eligible after exclusions (compliant + non_compliant).
Excluded = 1 (71044).
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055. That's 6.
Total members = 16. So denominator = 16 - 1 - 6 = 9.
Let's verify denominator members: 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056. That's 9.
Compliant among these: 71047, 71050, 71052. That's 3.
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056. That's 6.
Excluded: 71044. 1.
Not eligible: 71042, 71045, 71046, 71049, 71051, 71055. 6.
Check 9+1+6=16. Yes.
Rate = numerator / denominator * 100 = 3/9 * 100 = 33.333... Round half up to one decimal place: 33.3.
Wait, is 3/9 exactly 33.333... rounded to one decimal: 33.3.
Now ensure member IDs as strings: "71041" etc.
Let's double-check each case for any hidden issues.
71041: Age 85 on 12/31/2026. DOB 1941-07-25. On 2026-07-25 turns 85. On 2026-12-31, is 85. "18 through 85 years as of 2026-12-31." Usually if you turn 85 during the year, as of 12/31 you are 85. So included. Good.
71041 enrollment: continuous, no gaps. Good.
71041 event: Feb 18 office visit I10. Good. Numerator: reading on Feb 18 is 150/72. Systolic not <140. Non-compliant. Could there be a reading after May 18? Inpatient admission, skip. No other readings. So correct.
71042: Age 86. Not eligible. Even though he has qualifying event on Apr 5. Age rules out. Also enrollment has two gaps. But age alone suffices.
71043: Event on Feb 12. All readings are outpajson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,730 tokens
Let me meticulously apply the measure specification to each of the 16 members.
**Measure QM-CBP — Blood Pressure Control in Hypertension**
Measurement Year: 2026-01-01 through 2026-12-31.
**Eligible Population (Denominator):**
1. Age: 18 through 85 years as of 2026-12-31 (inclusive).
2. Event: at least one outpatient encounter with diagnosis I10 on or between 2026-01-01 and 2026-06-30.
3. Continuous enrollment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member.
**Numerator:**
The most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below. ED/inpatient readings do not count and are skipped when identifying the most recent reading. If no qualifying reading exists, denominator and not numerator.
**Exclusions (evaluated only for those in eligible population):**
E1. ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31.
E2. Pregnancy (O00-O9A code) during measurement year.
E3. Hospice or palliative care at any time during measurement year.
E4. Died during the measurement year.
---
**MEMBER 71041**
- DOB: 1941-07-25. Age on 2026-12-31: 85 years old. **Age eligible** (18-85 inclusive).
- Enrollment: 2026-01-01 to 2026-12-31, continuous, no gaps. **Enrollment eligible**.
- Event: 2026-02-18 office visit, dx I10. This is on or between 2026-01-01 and 2026-06-30. **Event eligible**.
- Check exclusions:
- E1: No N18.6/Z99.2.
- E2: No pregnancy.
- E3: No hospice.
- E4: Alive.
- **Not excluded**.
- Numerator: Need most recent outpatient BP on or after 2026-02-18 and on or before 2026-12-31.
- 2026-02-18 office visit BP 150/72. Outpatient. Systolic 150 >= 140, so not controlled.
- 2026-05-18 inpatient admission BP 159/81. Inpatient - does not count.
- Most recent qualifying reading: 150/72. Systolic 150 is NOT below 140. **Non-compliant**.
**MEMBER 71042**
- DOB: 1940-06-12. Age on 2026-12-31: 86 years old. **Age NOT eligible** (must be <=85).
- Since age fails, **not_eligible** regardless of other criteria or exclusions. Note the instruction: "A member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
- So: **not_eligible**.
**MEMBER 71043**
- DOB: 1991-01-17. Age on 2026-12-31: 35. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-12-31, continuous. **Enrollment eligible**.
- Event: 2026-02-12 office visit, dx I10. Within Jan 1 - Jun 30. **Event eligible**.
- Exclusions: None noted. Not excluded.
- Numerator: Most recent outpatient BP on or after 2026-02-12.
- 2026-02-12: 126/73. Outpatient. (<140 and <90).
- 2026-03-21: 135/73. Outpatient. (<140 and <90).
- 2026-05-22: 119/102. Outpatient. Diastolic 102 >=90. Not controlled.
- 2026-10-02: 136/103. Outpatient. Diastolic >=90.
- The most recent outpatient BP is 2026-10-02: 136/103. Since diastolic 103 is NOT below 90. **Non-compliant**.
**MEMBER 71044**
- DOB: 1956-05-26. Age on 2026-12-31: 70. **Age eligible**.
- Enrollment: continuous full year. **Enrollment eligible**.
- Event: 2026-04-23 office visit, dx I10. Within Jan 1 - Jun 30. **Event eligible**.
- Exclusions: E1 history: 2024-06-20 diagnosis N18.6. ESRD any time on or before 2026-12-31. Meets E1. **Excluded**.
**MEMBER 71045**
- DOB: 1982-06-22. Age on 2026-12-31: 44. **Age eligible**.
- Enrollment: 2026-04-05 through 2026-12-31. Not enrolled from Jan 1 to Apr 4. Not full measurement year. Enrollment says "enrolled for the full measurement year with no more than one gap of up to 45 days". This isn't a gap; it's missing the beginning. So **not enrolled for the full measurement year**. **Enrollment NOT eligible**.
- Since enrollment fails: **not_eligible**.
**MEMBER 71046**
- DOB: 1991-10-18. Age on 2026-12-31: 35. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-04-26; 2026-06-24 to 2026-12-31. One gap: Apr 27 to Jun 23.
- Apr 27 to Jun 23 inclusive? Let's calculate gap length. The enrollment ends 2026-04-26. Next starts 2026-06-24.
- Gap: Apr 27, 28, 29, 30 (4 days). May (31 days). Jun 1 through Jun 23 (23 days). Total = 4 + 31 + 23 = 58 days.
- The rule says "no more than one gap of up to 45 days". This gap is 58 days (>45). So **Enrollment NOT eligible**.
- **not_eligible**.
Wait, let me double-check gap calculation. If coverage ends on 2026-04-26 and resumes on 2026-06-24, the gap is the days without coverage: April 27 to June 23 inclusive? Usually in these rules, the gap is measured as the days between the end date and start date. But the wording says "enrolled for the full measurement year with no more than one gap of up to 45 days". Does the gap length count the endpoint?
Standard interpretation: if enrolled through 04-26 and from 06-24, the gap is (06-24 minus 04-26) minus 1 day? Or just the difference?
04-26 to 05-26 is 30 days. 05-26 to 06-24 is 29 days. Wait.
Let's count carefully: April has 30 days.
After 04-26, uncovered days in April: 27, 28, 29, 30 = 4 days.
May: 31 days.
June before 06-24: 1 through 23 = 23 days.
Total uncovered = 4 + 31 + 23 = 58 days.
So gap is 58 days. Too long. Not eligible.
**MEMBER 71047**
- DOB: 2008-04-06. Age on 2026-12-31: 18. **Age eligible** (18 through 85 inclusive).
- Enrollment: continuous full year. **Enrollment eligible**.
- Event: 2026-06-17 office visit, dx I10. Within Jan 1 - Jun 30. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-06-17.
- 2026-06-17: 138/76. Outpatient. (<140 and <90).
- 2026-07-25: 137/73. Outpatient. (<140 and <90).
- 2026-11-21: Inpatient admission BP 118/88. Inpatient - skipped.
- Most recent qualifying outpatient reading: 2026-07-25 at 137/73. Both below thresholds. **Compliant**.
**MEMBER 71048**
- DOB: 1991-04-26. Age: 35. **Age eligible**.
- Enrollment: continuous full year. **Enrollment eligible**.
- Event: 2026-05-15 office visit, dx I10. Within period. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-05-15.
- 2026-05-15: 134/93. Outpatient. Diastolic 93 >= 90. Not controlled.
- No later readings.
- Most recent qualifying is 134/93. Diastolic not below 90. **Non-compliant**.
**MEMBER 71049**
- DOB: 1965-05-12. Age: 61. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-06-26; 2026-07-30 to 2026-12-31. One gap.
- June 27 to July 29 inclusive? Ends 06-26. Starts 07-30.
- June 27, 28, 29, 30 = 4 days.
- July 1-29 = 29 days.
- Total = 33 days.
- 33 days <= 45. Only one gap. **Enrollment eligible**.
- Event: Need at least one outpatient encounter with I10 on or between 2026-01-01 and 2026-06-30.
- 2026-08-25 office visit, dx I10. This is after June 30. Does NOT establish event.
- 2026-12-25 office visit, dx I10. After June 30. Does NOT establish event.
- Are there any other encounters? The ED visit on 2026-11-28 is dx R07.9, not I10.
- There is no qualifying event before 2026-06-30. **Event NOT eligible**.
- **not_eligible**.
**MEMBER 71050**
- DOB: 1942-01-04. Age on 2026-12-31: 84. **Age eligible**.
- Enrollment: continuous full year. **Enrollment eligible**.
- Event: Need outpatient encounter with I10 by 2026-06-30.
- 2026-06-23 office visit, dx I10. Within period. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-06-23.
- 2026-06-23: 122/84. Outpatient. (<140 and <90).
- 2026-09-08: office visit J06.9, BP 129/71. This is outpatient (office visit). It is a BP reading on or after the qualifying encounter date. Even though diagnosis isn't I10, the numerator just looks for the most recent outpatient BP reading after the qualifying encounter. The specification doesn't say the later reading must have a hypertension diagnosis; it just says "the most recent outpatient blood pressure reading". So this counts.
- Most recent outpatient BP is 2026-09-08 at 129/71. Both below thresholds. **Compliant**.
**MEMBER 71051**
- DOB: 1991-04-19. Age: 35. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-04-08; 2026-05-05 to 2026-08-07; 2026-08-22 to 2026-12-31.
- Gaps: Apr 9 to May 4, and Aug 8 to Aug 21.
- First gap: Apr 9-30 (22 days) + May 1-4 (4 days) = 26 days? Actually April has 30 days. Apr 9,10,...,30 = 22 days. May 1,2,3,4 = 4 days. Total 26 days.
- Second gap: Aug 8-21 inclusive = 14 days? Aug 8,9,10,11,12,13,14,15,16,17,18,19,20,21 = 14 days.
- Two gaps. Rule: "no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member."
- Two gaps of any length = enrollment fails. **Enrollment NOT eligible**.
- Wait, but let me check if the member is even eligible. Since enrollment fails, **not_eligible**.
However, let me also note: other history says 2026-10-27 Hospice election. But since enrollment fails first, not_eligible. Also the event is 2026-03-21 (I10) which is within Jan 1-Jun 30. But enrollment failure overrides.
**MEMBER 71052**
- DOB: 1991-11-27. Age: 35. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-04-08; 2026-05-24 to 2026-12-31. One gap.
- Apr 9 to May 23 inclusive? Ends 04-08. Starts 05-24.
- April 9-30 = 22 days.
- May 1-23 = 23 days.
- Total = 45 days.
- The rule says "no more than one gap of up to 45 days". Is 45 days allowed? "up to 45 days" usually means <=45. So 45 is okay. It's one gap. **Enrollment eligible**.
- Event: outpatient encounter with I10 by 06-30.
- 2026-04-08 office visit dx I10. This is within Jan 1 - Jun 30. **Event eligible**.
- Exclusions: none. No hospice, alive.
- Numerator: Most recent outpatient BP on or after 2026-04-08.
- 2026-04-08: 121/76. Outpatient. (<140/<90).
- 2026-06-04: 149/73. Outpatient. (Systolic >=140).
- 2026-07-13: 127/73. Outpatient. (<140/<90).
- 2026-07-16: ED visit, dx S52... BP 119/89. ED does not count.
- Most recent qualifying outpatient BP: 2026-07-13 at 127/73. Both below thresholds. **Compliant**.
**MEMBER 71053**
- DOB: 1942-08-07. Age: 84. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-05-15; 2026-06-07 to 2026-12-31. One gap.
- May 16 to June 6 inclusive? Ends 05-15. Starts 06-07.
- May 16-31 = 16 days.
- June 1-6 = 6 days.
- Total = 22 days. <=45. **Enrollment eligible**.
- Event: outpatient encounter with I10 by 06-30.
- 2026-05-22 office visit, dx I10. Within Jan 1-Jun 30. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-05-22.
- 2026-05-22: 146/72. Outpatient. Systolic >=140.
- 2026-06-26: 133/95. Outpatient. Diastolic 95 >= 90.
- 2026-08-24: Inpatient admission BP 112/84. Inpatient - skipped.
- Most recent qualifying outpatient BP: 2026-06-26 at 133/95. Diastolic NOT below 90. **Non-compliant**.
**MEMBER 71054**
- DOB: 1942-12-16. Age: 84. **Age eligible**.
- Enrollment: 2026-01-01 to 2026-05-06; 2026-06-18 to 2026-12-31. One gap.
- May 7 to June 17 inclusive? Ends 05-06. Starts 06-18.
- May 7-31 = 25 days.
- June 1-17 = 17 days.
- Total = 42 days. <=45. **Enrollment eligible**.
- Event: outpatient encounter with I10 by 06-30.
- 2026-03-21 office visit, dx I10. Within period. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-03-21.
- 2026-03-21: 137/92. Outpatient. Diastolic 92 >=90.
- 2026-05-06: office visit, dx I10, BP 138/85. Outpatient. (<140/<90).
- 2026-06-05: inpatient admission BP 132/76. Inpatient - skipped.
- 2026-10-28: office visit, dx E78.5, BP 132/95. Outpatient. Diastolic 95 >=90.
- Most recent qualifying outpatient BP: 2026-10-28 at 132/95. Diastolic NOT below 90. **Non-compliant**.
**MEMBER 71055**
- DOB: 1940-08-21. Age on 2026-12-31: 86. **Age NOT eligible** (>85).
- **not_eligible**.
**MEMBER 71056**
- DOB: 1942-01-17. Age: 84. **Age eligible**.
- Enrollment: continuous full year. **Enrollment eligible**.
- Event: outpatient encounter with I10 by 06-30.
- 2026-01-19 office visit, dx I10. Within period. **Event eligible**.
- Exclusions: none.
- Numerator: Most recent outpatient BP on or after 2026-01-19.
- 2026-01-19: 125/88. Outpatient. (<140/<90).
- 2026-03-20: 153/86. Outpatient. Systolic >=140.
- Most recent qualifying outpatient BP: 2026-03-20 at 153/86. Systolic NOT below 140. **Non-compliant**.
---
**Summary of each member:**
- 71041: denominator, non-compliant (age ok, enrollment ok, event ok, BP 150/72 last outpatient)
- 71042: not_eligible (age 86)
- 71043: denominator, non-compliant (BP 136/103 last outpatient)
- 71044: excluded (ESRD N18.6 in history)
- 71045: not_eligible (not enrolled Jan 1 - Apr 4; not full year)
- 71046: not_eligible (gap 58 days)
- 71047: denominator, compliant (BP 137/73 last qualifying outpatient)
- 71048: denominator, non-compliant (BP 134/93 last outpatient)
- 71049: not_eligible (no qualifying event before 06/30)
- 71050: denominator, compliant (BP 129/71 last outpatient)
- 71051: not_eligible (two gaps in enrollment, >1 gap)
- 71052: denominator, compliant (BP 127/73 last qualifying outpatient)
- 71053: denominator, non-compliant (BP 133/95 last outpatient)
- 71054: denominator, non-compliant (BP 132/95 last outpatient)
- 71055: not_eligible (age 86)
- 71056: denominator, non-compliant (BP 153/86 last outpatient)
Let me double-check 71051. The prompt says:
"Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days."
Two gaps. The rule says: "A gap longer than 45 days, or two or more gaps of any length, removes the member." Thus, not_eligible. Correct.
Let me double-check 71049's event. The event must be on or between 2026-01-01 and 2026-06-30. The I10 office visits are on 2026-08-25 and 2026-12-25. Both after June 30. So no event. Not eligible. Correct.
Wait, what about 71049's enrollment gap? 33 days. That's fine. But no event.
Double-check 71043:
Encounters:
2026-02-12 office I10 BP 126/73
2026-03-21 office I10 BP 135/73
2026-05-22 office E78.5 BP 119/102
2026-10-02 office E78.5 BP 136/103
All are office visits = outpatient. The most recent outpatient BP is 136/103. Diastolic 103 >= 90. Non-compliant. Correct.
Double-check 71047:
Encounters:
2026-06-17 office I10 BP 138/76
2026-07-25 office I10 BP 137/73
2026-11-21 inpatient admission I10 BP 118/88
Most recent outpatient BP is from 2026-07-25: 137/73. Both <140 and <90. Compliant. Correct.
Double-check 71053:
Event: 2026-05-22. Last outpatient BP is 2026-06-26 at 133/95. Diastolic 95 not <90. Non-compliant. Correct.
Double-check 71054:
Event: 2026-03-21. Outpatient BPs after that date:
2026-05-06 office I10 BP 138/85 (controlled)
2026-06-05 inpatient BP 132/76 (skipped)
2026-10-28 office E78.5 BP 132/95 (diastolic 95 not <90)
Most recent outpatient BP is 2026-10-28 at 132/95. Non-compliant. Correct.
Double-check 71050:
Event: 2026-06-23. Outpatient BPs:
2026-06-23 office I10 BP 122/84 (controlled)
2026-09-08 office J06.9 BP 129/71 (controlled)
Most recent is 129/71. Compliant. Correct.
Double-check 71041:
Event: 2026-02-18. Outpatient BPs:
2026-02-18 BP 150/72 (systolic not <140)
2026-05-18 inpatient (skipped)
Most recent outpatient is 150/72. Non-compliant. Correct.
Double-check 71052:
Event: 2026-04-08. Outpatient BPs:
04-08: 121/76
06-04: 149/73
07-13: 127/73
07-16: ED (skipped)
Most recent outpatient is 07-13: 127/73. Both controlled. Compliant. Correct.
Double-check 71056:
Event: 2026-01-19. Outpatient BPs:
01-19: 125/88
03-20: 153/86
Most recent is 153/86. Systolic not <140. Non-compliant. Correct.
Double-check 71048:
Event: 2026-05-15. Outpatient BP:
05-15: 134/93. Diastolic not <90. Most recent. Non-compliant. Correct.
Double-check 71044 exclusion:
History: 2024-06-20 diagnosis N18.6. E1 says "End stage renal disease (N18.6) ... any time on or before 2026-12-31." So yes, excluded. Correct.
Counts:
not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 = 6
excluded: 71044 = 1
denominator: the rest = 16 - 6 - 1 = 9
Among denominator, compliant: 71047, 71050, 71052 = 3
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056 = 6
Check total: 3+6+1+6 = 16. Good.
Rate = numerator / denominator * 100 = 3 / 9 * 100 = 33.333...
Rounded half up to one decimal place: 33.3.
Wait, let me reconsider member 71045 enrollment. "Enrolment: 2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05." Measurement year is 2026-01-01 through 2026-12-31. The member is not enrolled for the full measurement year. So not_eligible. Correct.
Wait, is there any subtlety about what constitutes a "gap"? In some measure specs, a gap is measured only between enrollment segments, and the member must be enrolled for the full measurement year. 71045 simply isn't enrolled for part of the year. That fails continuous enrollment.
Is there any issue with 71042? Age 86 on 12/31/2026. Measure says age 18 through 85 as of 2026-12-31. So not eligible.
Let me re-verify ages:
71041: DOB 1941-07-25. 2026-12-31 minus 1941-07-25 = 85 years, 5 months, 6 days. So 85. Eligible.
71042: DOB 1940-06-12. 2026-12-31 minus 1940-06-12 = 86 years, 6 months, 19 days. So 86. Not eligible.
71055: DOB 1940-08-21. 2026-12-31 minus 1940-08-21 = 86 years, 4 months, 10 days. So 86. Not eligible.
Others are younger.
Counts:
denominator: 9
numerator: 3
excluded: 1
not_eligible: 6
rate: 33.3
Compliant members: ["71047", "71050", "71052"]
Non-compliant members: ["71041", "71043", "71048", "71053", "71054", "71056"]
Excluded members: ["71044"]
Not eligible members: ["71042", "71045", "71046", "71049", "71051", "71055"]
Order doesn't matter. I should present exactly these.
Double check 71041 age: yes, 85 on 12/31/2026. Born in 1941. 2026-1941 = 85. Birthday is July 25, which is before Dec 31. So already 85. Eligible.
One more check on 71053. The event is 2026-05-22. The reading on 2026-06-26 is 133/95. The reading on 2026-08-24 is inpatient. So the most recent qualifying outpatient reading is indeed 133/95. Diastolic 95 >= 90. Non-compliant.
One more check on 71054. The event is 2026-03-21. The reading on 2026-05-06 is 138/85 (controlled). But the most recent outpatient reading is 2026-10-28 at 132/95 (not controlled because diastolic 95 >= 90). So non-compliant. Correct.
One more check on 71048. Only one reading on 2026-05-15 at 134/93. Diastolic 93 >= 90. Non-compliant. Correct.
One more check on 71043. Most recent outpatient reading is 2026-10-02 at 136/103. Diastolic 103 >= 90. Non-compliant. Correct.
Everything looks solid.json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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"want": 9,
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{
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{
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"want": [
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"want": [
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"fabricated": false,
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}Reasoning · 10,632 tokens
We need to process 16 members against the QM-CBP measure spec. Let's parse each member.
Measure: Blood Pressure Control in Hypertension.
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population (denominator):
1. Age: 18 through 85 years as of 2026-12-31.
2. Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event.
3. Continuous enrollment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from denominator.
Numerator:
The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold.
A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading.
If no qualifying reading exists, member is denominator but not numerator.
Required Exclusions (remove from denominator before scoring):
E1. End stage renal disease (N18.6) or dependence on renal dialysis (Z99.2) any time on or before 2026-12-31.
E2. Pregnancy (any O00-O9A code) during the measurement year.
E3. Enrolled in hospice or receiving palliative care at any time during the measurement year.
E4. Died during the measurement year.
First, evaluate age as of 2026-12-31. Let's compute for each:
MEMBER 71041: DOB 1941-07-25. Age = 2026-12-31 minus 1941-07-25 = 85 years old (since birthday July 25, 2026 occurs before Dec 31). So age 85. Within 18-85 inclusive. OK.
MEMBER 71042: DOB 1940-06-12. Age = 86. Over 85. So fails age. Not eligible.
MEMBER 71043: DOB 1991-01-17. Age = 35. OK.
MEMBER 71044: DOB 1956-05-26. Age = 70. OK.
MEMBER 71045: DOB 1982-06-22. Age = 44. OK.
MEMBER 71046: DOB 1991-10-18. Age = 35. OK.
MEMBER 71047: DOB 2008-04-06. Age = 18 (since birthday April 6, 2026 occurs before Dec 31). So 18. OK.
MEMBER 71048: DOB 1991-04-26. Age = 35. OK.
MEMBER 71049: DOB 1965-05-12. Age = 61. OK.
MEMBER 71050: DOB 1942-01-04. Age = 84. OK.
MEMBER 71051: DOB 1991-04-19. Age = 35. OK.
MEMBER 71052: DOB 1991-11-27. Age = 35. OK.
MEMBER 71053: DOB 1942-08-07. Age = 84. OK.
MEMBER 71054: DOB 1942-12-16. Age = 84. OK.
MEMBER 71055: DOB 1940-08-21. Age = 86. Over 85. Not eligible.
MEMBER 71056: DOB 1942-01-17. Age = 84. OK.
So 71042 and 71055 are not_eligible due to age.
Now enrollment continuity for those who pass age:
MEMBER 71041: Enrolled 2026-01-01 through 2026-12-31 continuous no gaps. OK.
MEMBER 71043: Enrolled continuous no gaps. OK.
MEMBER 71044: Enrolled continuous no gaps. OK.
MEMBER 71045: Enrolled from 2026-04-05 through 2026-12-31. Not enrolled before 2026-04-05. So not enrolled for the full measurement year. Not eligible.
MEMBER 71046: Enrolled 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap from 2026-04-27 to 2026-06-23 inclusive? Let's calculate gap: The first segment ends 2026-04-26, next starts 2026-06-24. Gap length = days between 2026-04-27 and 2026-06-23 inclusive? Usually gap is measured as days not covered. The description says "no more than one gap of up to 45 days". From 2026-04-27 to 2026-06-23: Let's compute. April has 30 days. April 27-30 = 4 days. May 1-31 = 31 days. June 1-23 = 23 days. Total = 4+31+23 = 58 days. So gap is 58 days > 45. Not eligible.
MEMBER 71047: Enrolled continuous no gaps. OK.
MEMBER 71048: Enrolled continuous no gaps. OK.
MEMBER 71049: Enrolled 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. Gap from 2026-06-27 to 2026-07-29. June 27-30 = 4 days. July 1-29 = 29 days. Total = 33 days. One gap of 33 days <=45. So OK.
MEMBER 71050: Enrolled continuous no gaps. OK.
MEMBER 71051: Enrolled 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps: gap1 from 2026-04-09 to 2026-05-04. April 9-30 = 22 days. May 1-4 = 4 days. Total = 26 days. Gap2 from 2026-08-08 to 2026-08-21. August 8-21 = 14 days. Two gaps. Not eligible.
MEMBER 71052: Enrolled 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. Gap from 2026-04-09 to 2026-05-23. April 9-30 = 22 days. May 1-23 = 23 days. Total = 45 days. One gap of up to 45 days. The spec says "up to 45 days". Is 45 inclusive? "up to 45 days" typically includes 45. So OK.
MEMBER 71053: Enrolled 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. Gap from 2026-05-16 to 2026-06-06. May 16-31 = 16 days. June 1-6 = 6 days. Total = 22 days. One gap <=45. OK.
MEMBER 71054: Enrolled 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. Gap from 2026-05-07 to 2026-06-17. May 7-31 = 25 days. June 1-17 = 17 days. Total = 42 days. One gap <=45. OK.
MEMBER 71056: Enrolled continuous no gaps. OK.
Now event: at least one outpatient encounter with diagnosis I10 on or between 2026-01-01 and 2026-06-30.
Let's list qualifying event encounters for members still in consideration (i.e., those who passed age and enrollment). Note: outpatient encounter presumably includes office visits, but excludes inpatient and ED? The spec says "outpatient encounter". Typically office visit is outpatient. Let's see the encounter types listed: Office visit, Inpatient admission, Emergency department visit. So outpatient = office visit presumably. Also, we need diagnosis I10.
71041: Office visit 2026-02-18 I10. Date within Jan1-Jun30. Qualifying event. Yes.
71043: Office visit 2026-02-12 I10. Yes.
71044: Office visit 2026-04-23 I10. Yes.
71045: Not eligible due to enrollment.
71046: Not eligible due to enrollment.
71047: Office visit 2026-06-17 I10. Yes.
71048: Office visit 2026-05-15 I10. Yes.
71049: Has no office visit with I10 before 2026-06-30? Let's check. 2026-08-25 office visit I10 (after June 30). 2026-12-25 office visit I10 (after June 30). So no qualifying event before July 1. Thus fails event. Not eligible.
71050: Office visit 2026-06-23 I10. Yes.
71051: Office visit 2026-03-21 I10. Yes. Also 2026-04-06 office visit I10. Yes.
71052: Office visit 2026-04-08 I10. Yes.
71053: Office visit 2026-05-22 I10. Yes.
71054: Office visit 2026-03-21 I10. Yes.
71056: Office visit 2026-01-19 I10. Yes.
So not_eligible so far:
71042: age
71045: enrollment (not full year)
71046: enrollment gap >45
71049: no qualifying event
71051: enrollment (two gaps)
71055: age
Wait, check 71049: enrollment is OK (gap 33 days). But event fails. So not_eligible.
Now we have potential denominator members: 71041, 71043, 71044, 71047, 71048, 71050, 71052, 71053, 71054, 71056.
Also need to check if any of the not_eligible have exclusions? But per spec: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So we don't care about exclusions for not_eligible.
Now evaluate exclusions E1-E4 for the eligible population members.
E1: ESRD (N18.6) or dialysis (Z99.2) any time on or before 2026-12-31.
E2: Pregnancy (O00-O9A) during measurement year.
E3: Hospice or palliative care any time during measurement year.
E4: Died during measurement year.
71041: No hospice, alive. No ESRD/pregnancy mentioned. No exclusion.
71043: No exclusion.
71044: Other history: 2024-06-20 Diagnosis N18.6. That's ESRD. So E1 applies. Excluded.
71047: No exclusion.
71048: No exclusion.
71050: No exclusion.
71052: No exclusion.
71053: No exclusion.
71054: No exclusion.
71056: No exclusion.
So excluded: 71044.
Now numerator evaluation for remaining denominator members (71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056).
Numerator: The most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic.
- Outpatient reading: office visits count. Inpatient and ED readings are skipped (do not count and are skipped when identifying most recent reading).
- Qualifying hypertension encounter: the one(s) in the event window (Jan 1 - Jun 30). The spec says "taken on or after the date of the qualifying hypertension encounter". There could be multiple. We need to consider readings on or after the date of the qualifying encounter. Since any qualifying encounter in the window establishes event, the latest qualifying encounter? Actually, the numerator says "on or after the date of the qualifying hypertension encounter". If there are multiple qualifying encounters, any reading on or after the first qualifying encounter? Usually measures use the date of the first qualifying encounter? But the phrasing "the qualifying hypertension encounter" might refer to the encounter that established the event. However, if multiple, the numerator likely uses the earliest? Let's parse: "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31..." Since the event is "at least one outpatient encounter with a hypertension diagnosis (I10) on or between...", the member has at least one such encounter. The numerator requires the most recent outpatient BP reading taken on or after the date of that encounter. If multiple qualifying encounters, the reading must be on or after the date of the encounter. But which encounter? Usually in these measures, it's on or after the date of the first qualifying encounter? Actually, the logic: We want the most recent outpatient BP reading after the qualifying encounter. The qualifying encounter could be any; but if there are multiple, a reading after the first one would satisfy "on or after the date of the qualifying hypertension encounter". Wait, if the second qualifying encounter is later, a reading after the first but before the second would still be after the first qualifying encounter. But does the measure intend to restrict to readings after the most recent qualifying encounter? Let's think. The spec says "taken on or after the date of the qualifying hypertension encounter". Since there may be multiple, but the event is defined generally, I'd interpret that any reading on or after the date of any qualifying encounter? Actually, typically in HEDIS/NCQA CBP measure, the numerator looks at the most recent BP reading on or after the date of the first qualifying encounter? Let me recall HEDIS CBP (Controlling High Blood Pressure). In HEDIS, the denominator is members 18-85 with a diagnosis of hypertension. The numerator is the most recent BP reading taken during an outpatient visit or remote monitoring during the measurement year, and the reading must be <140/90. It doesn't tie the reading to the encounter date specifically. But this spec says "taken on or after the date of the qualifying hypertension encounter". That implies the reading must be after the encounter that put them in the denominator. If there are multiple qualifying encounters, perhaps any reading on or after the earliest one? Actually, if the member has a qualifying encounter on Feb 1, and another on Apr 1, and a reading on Mar 1, that's after the Feb encounter. The phrase "on or after the date of the qualifying hypertension encounter" (singular) with the event definition "at least one outpatient encounter" suggests that as long as the reading is on or after the date of any qualifying encounter? But "the qualifying hypertension encounter" could be interpreted as the encounter that satisfied the event requirement. Since any encounter works, the member is in the denominator if they have at least one. The numerator then looks for the most recent outpatient BP on or after the date of that encounter. But if there are multiple, which date is used? Usually in such custom specs, it's "on or after the date of the qualifying hypertension encounter", meaning the encounter that establishes the event. Since the event can be any one, but if there are multiple, the reading must be on or after the date of the encounter that is being considered. However, the spec says "the qualifying hypertension encounter" singular. This could be ambiguous. But a safe reading: the member has one or more qualifying encounters; any reading on or after the date of the first qualifying encounter would be valid, because that is a qualifying encounter. But what if a reading is before the first qualifying encounter? It wouldn't be on or after the date of that encounter. So we need to identify the earliest date? Actually, consider a member with a qualifying encounter on June 30 and a reading on Jan 15. That reading is before the qualifying encounter, so it shouldn't count because the encounter hasn't happened yet. But if there is another qualifying encounter on Feb 1, the reading on Jan 15 is before that encounter too. So the reading must be on or after the earliest qualifying encounter? Or after the specific encounter used? The spec doesn't specify "first" or "most recent". However, typical measure logic: once the event is established (by any encounter in the window), the numerator looks at all outpatient readings from that encounter date forward? Actually, if there are multiple qualifying encounters, a reading after any of them is after "a qualifying hypertension encounter". But the phrase "the qualifying hypertension encounter" might refer to the one that established the event; but since any could establish, the reading must be on or after the date of the encounter that we are using to establish. If we use the earliest, then more readings are eligible. If we use the latest, fewer readings are eligible. In the absence of clarification, I think the standard interpretation is: the qualifying hypertension encounter is the encounter in the event window that has diagnosis I10. Since the event requirement is satisfied by at least one, the numerator should consider readings on or after the date of any such encounter? But "the" suggests a specific one. However, usually in these synthetic harnesses, they intend the earliest qualifying encounter? Or perhaps they intend any reading on or after the earliest qualifying encounter because that's when the member entered the cohort. Let me look at the members to see if there are cases with multiple qualifying encounters and readings before some later qualifying encounter.
71041: qualifying encounter on 2026-02-18. Reading same day 150/72 (outpatient). That's after or on the date. Later inpatient on 2026-05-18 with BP 159/81 (skip). No other outpatient BP after Feb 18? No. Most recent outpatient BP is 150/72. Not <140/90. Non-compliant.
71043: qualifying encounters: 2026-02-12 (I10, BP 126/73), 2026-03-21 (I10, BP 135/73). Both before Jun 30. Then after that, on 2026-05-22 office visit E78.5 BP 119/102, and 2026-10-02 office visit E78.5 BP 136/103. The reading at 2026-05-22 is after the qualifying encounters. The most recent outpatient BP is 2026-10-02: 136/103. Systolic 136 < 140, diastolic 103 >= 90. So not controlled. Non-compliant. Note: the reading must be after the qualifying encounter. The latest reading is after both qualifying encounters, so it's fine regardless of which encounter date is used.
71047: qualifying encounter: 2026-06-17 office visit I10 BP 138/76. Later 2026-07-25 office visit I10 BP 137/73. Later 2026-11-21 inpatient admission I10 BP 118/88 (skip, inpatient). Most recent outpatient BP is 2026-07-25: 137/73. Both < thresholds. Compliant. Note: the 07-25 encounter is also a qualifying encounter? It is after Jun 30, so it does not establish the event, but it is an outpatient encounter with I10. The spec says "the most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter". The qualifying encounter is 2026-06-17. The 2026-07-25 reading is after that. It's an outpatient reading. So yes. Compliant.
71048: qualifying encounter: 2026-05-15 office visit I10 BP 134/93. Most recent outpatient BP: same day or later? No other readings. So most recent is 134/93. Diastolic 93 >= 90. Non-compliant.
71050: qualifying encounter: 2026-06-23 office visit I10 BP 122/84. Later 2026-09-08 office visit J06.9 BP 129/71. That later reading is outpatient, after the qualifying encounter. Most recent outpatient BP is 2026-09-08: 129/71. Both < thresholds. Compliant.
71052: qualifying encounter: 2026-04-08 office visit I10 BP 121/76. Later 2026-06-04 office visit I10 BP 149/73. Later 2026-07-13 office visit I10 BP 127/73. Later 2026-07-16 ED visit BP 119/89 (skip, ED). Most recent outpatient BP is 2026-07-13: 127/73. Both < thresholds. Compliant.
71053: qualifying encounter: 2026-05-22 office visit I10 BP 146/72. Later 2026-06-26 office visit I10 BP 133/95. Later 2026-08-24 inpatient admission BP 112/84 (skip). Most recent outpatient BP is 2026-06-26: 133/95. Diastolic 95 >= 90. Non-compliant.
71054: qualifying encounter: 2026-03-21 office visit I10 BP 137/92. Later 2026-05-06 office visit I10 BP 138/85. Later 2026-06-05 inpatient admission BP 132/76 (skip). Later 2026-10-28 office visit E78.5 BP 132/95. Most recent outpatient BP is 2026-10-28: 132/95. Diastolic 95 >= 90. Non-compliant.
71056: qualifying encounter: 2026-01-19 office visit I10 BP 125/88. Later 2026-03-20 office visit I10 BP 153/86. Most recent outpatient BP is 2026-03-20: 153/86. Systolic 153 >=140. Non-compliant.
Wait, check if any readings are from ED or inpatient. Skipped for numerator but do we also skip them when identifying the most recent reading? The spec says: "A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading." So we should ignore ED/inpatient readings entirely. I did that for 71041 (inpatient skipped), 71047 (inpatient skipped), 71052 (ED skipped), 71053 (inpatient skipped), 71054 (inpatient skipped). Good.
Now check 71043: The reading on 2026-05-22 is E78.5, office visit, outpatient. Is it on or after the qualifying hypertension encounter? Qualifying encounters are 2026-02-12 and 2026-03-21. Yes, 2026-05-22 is after both. So it's a valid reading. The most recent outpatient reading is 2026-10-02: 136/103. Diastolic >=90 -> non-compliant. Could there be any reading after the qualifying encounter but before the most recent that is lower? Doesn't matter; we need the most recent. So non-compliant.
Check 71050: qualifying encounter 2026-06-23. Later outpatient reading 2026-09-08. Most recent. Good.
Check 71054: qualifying encounter 2026-03-21. Later outpatient reading 2026-10-28. Diastolic 95. Non-compliant.
Now check 71041: qualifying encounter 2026-02-18. Most recent outpatient reading is same day 150/72. Inpatient reading on 05-18 is skipped. No later outpatient. So non-compliant.
Now check exclusions for the eligible members: Already did. 71044 excluded.
Now check if any denominator members have exclusions that I missed.
71041: No.
71043: No.
71047: No.
71048: No.
71050: No.
71052: No.
71053: No.
71054: No.
71056: No.
Now check if any not_eligible members could be excluded? No, exclusions only for eligible. So excluded count = 1 (71044). Denominator = eligible - excluded = 9 - 1 = 8 members. Actually eligible population before exclusion: the 10 members (71041, 71043, 71044, 71047, 71048, 71050, 71052, 71053, 71054, 71056). After excluding 71044, denominator = 9? Wait, count: 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056. That's 9 members. Yes. Denominator = 9.
Compliant members: those with most recent outpatient BP <140 and <90.
71041: 150/72 -> no.
71043: 136/103 -> no.
71047: 137/73 -> yes.
71048: 134/93 -> no.
71050: 129/71 -> yes.
71052: 127/73 -> yes.
71053: 133/95 -> no.
71054: 132/95 -> no.
71056: 153/86 -> no.
So compliant: 71047, 71050, 71052. That's 3.
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056. That's 6.
Check: 3+6 = 9 denominator. Good.
Rate = numerator / denominator * 100 = 3 / 9 * 100 = 33.333...%. Rounded json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
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{
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{
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{
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{
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{
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{
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{
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"ok": true,
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],
"fabricated": false,
"abstained": false
}100DeepSeek V4 Pro · DeepSeek428.8s · 8,784 out | 168.6s · 11,006 out | 117.4s · 7,814 out
Reasoning · 8,639 tokens
We need answer as JSON only. Need compute measure population for 16 members. Need carefully apply spec. We need determine for each member: eligible population, exclusions, numerator. Need output denominator numerator excluded not_eligible rate lists.
Let's restate spec.
Measurement year 2026.
Eligible:
- Age 18 through 85 as of 2026-12-31.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish event.
- Continuous enrollment: enrolled full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps any length, removes.
Numerator:
- most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic.
- Both components below threshold.
- ED or inpatient reading doesn't count and skipped when identifying most recent reading.
- If no qualifying reading exists, denominator not numerator.
Exclusions:
E1 ESRD N18.6 or dialysis Z99.2 any time on/before 2026-12-31.
E2 Pregnancy (O00-O9A) during measurement year.
E3 Hospice or palliative care at any time during measurement year.
E4 Died during measurement year.
Need evaluate each roster.
We need parse each member.
I'll create table.
Member 71041:
DOB 1941-07-25 -> age on 2026-12-31: 85 (turns 85 2026-07-25, yes 85). Age eligible.
Enrollment continuous full year no gaps. OK.
Event: outpatient office 2026-02-18 diagnosis I10 within first half. Qualifying.
Exclusions: no hospice alive; no ESRD/preg. likely none. Not excluded.
Most recent outpatient BP on/after qualifying encounter (2026-02-18) and <= year end. Encounters:
2026-02-18 office BP 150/72 qualifies? reading on qualifying encounter, outpatient yes. systolic 150 >=140, not below.
2026-05-18 inpatient admission BP 159/81 - not outpatient, skip.
No other outpatient. So most recent qualifying outpatient reading is 2026-02-18 150/72 not controlled. Numerator no. non_compliant.
But wait: The most recent reading with date 2026-02-18 equals qualifying encounter. Taken on or after date yes. Not below threshold. So noncompliant.
71042:
DOB 1940-06-12 -> age 86 (turns 86 2026-06-12? Actually 2026-06-12 is 86). Over 85 -> not eligible age. Enrollment gaps? irrelevant. Event? Has I10. But age fail -> not_eligible. Need check if exclusion? no matter. So not_eligible.
71043:
DOB 1991-01-17 age 35. Enrollment continuous no gaps.
Event: office 2026-02-12 diagnosis I10 within period. Qualifying.
Exclusions none.
Readings after qualifying date:
2026-02-12 Office BP 126/73 outpatient.
2026-03-21 Office I10 BP 135/73.
2026-05-22 Office E78.5 BP 119/102.
2026-10-02 Office E78.5 BP 136/103.
All outpatient. Most recent outpatient = 2026-10-02 BP 136/103. Systolic 136 below 140, diastolic 103 not below 90. Not controlled. non_compliant.
Check if some maybe 2026-05-22 119/102 also diastolic high. Most recent not controlled. Non.
71044:
DOB 1956-05-26 age 70. Enrollment continuous. Event: 2026-04-23 office dx I10 within first half. Qualifying.
Exclusion: E1 ESRD N18.6 on 2024-06-20 any time on/before 2026-12-31 yes. Excluded. Even if BP? Excluded. list excluded. Numerator not considered.
71045:
DOB 1982 age 44. Enrollment: 2026-04-05 through end, not enrolled before. Continuous from that date? Not full measurement year. Spec continuous full measurement year. Not eligible due enrollment. Also event 2026-05-23 I10. But enrollment fails. Not eligible. Not excluded? Need status not_eligible. Although not full enrollment. yes.
71046:
DOB 1991 age 35. Enrollment: 2026-01-01 to 2026-04-26; 2026-06-24 to 2026-12-31. One gap of 58 days (Apr 27-Jun23? Let's calculate Apr 26 to Jun24 gap length? From 4/27 through 6/23 inclusive? Days: Apr27-30 4, May31, Jun1-23 23 total 58, yes). Gap >45 -> not eligible (continuous enrollment fail). Event maybe office I10 2026-03-08. But enrollment fail. not_eligible. Exclusions none. So not_eligible.
71047:
DOB 2008-04-06 age on 2026-12-31: 18? Turns 18 2026-04-06, yes 18. Age eligible (18 through 85 inclusive).
Enrollment full no gaps.
Event: office 2026-06-17 dx I10 within first half (before June30). Qualifying. Also 2026-07-25 after not event.
Exclusions none.
Readings after qualifying date:
2026-06-17 Office BP 138/76 outpatient qualifies.
2026-07-25 Office BP 137/73 outpatient.
2026-11-21 Inpatient BP 118/88 skip.
Most recent outpatient = 2026-07-25 BP 137/73 both below thresholds (systolic<140, diastolic<90). Compliant.
Need note reading on inpatient skipped.
Yes compliant.
71048:
DOB 1991-04-26 age 35. Enrollment full.
Event: office 2026-05-15 dx I10 within first half. Qualifying.
Exclusions none.
Readings after qualifying date: 2026-05-15 BP 134/93. Systolic 134 <140 but diastolic 93 not <90. Not controlled. Noncompliant. No other readings. Non.
71049:
DOB 1965 age 61. Enrollment: 2026-01-01 to 2026-06-26; 2026-07-30 to 2026-12-31. One gap 33 days (Jun27-Jul29 inclusive? Jun27-30 4, Jul1-29 29=33) <=45, no other gaps. Continuous full year? Has one gap up to 45 allowed. OK.
Event: Need qualifying hypertension encounter on/after Jan1-Jun30. Encounters:
2026-08-25 office I10 - after Jun30, does not establish.
2026-11-28 ED R07.9 no.
2026-12-25 office I10 after. No outpatient I10 between Jan and Jun. So no event. Not eligible. However there is no qualifying encounter. Not_eligible due event. Enrollment OK. Age OK. Exclusions none. So not_eligible.
Wait maybe continuous enrollment with gap allowed? yes. But no qualifying event. not_eligible.
71050:
DOB 1942-01-04 age 84. Enrollment full. Event: office 2026-06-23 dx I10 within first half (on/before Jun30) yes. Qualifying.
Exclusions none.
Readings after qualifying date:
2026-06-23 Office BP 122/84 outpatient.
2026-09-08 Office J06.9 BP 129/71 outpatient.
Most recent = 2026-09-08 BP 129/71 both below. Compliant.
71051:
DOB 1991 age 35. Enrollment: 2026-01-01 to 2026-04-08; 2026-05-05 to 2026-08-07; 2026-08-22 to 2026-12-31. Gaps of 26 and 14 days. Two gaps -> continuous enrollment fail (two or more gaps of any length). But also hospice 2026-10-27. Since not eligible? Need decide status. Spec: not_eligible never enters eligible population (age,event,enrolment). Exclusions evaluated only for eligible. Member fails enrollment because two gaps. Thus not_eligible even if exclusion documented. So not_eligible. Check age 35, event? office I10 2026-03-21 within first half qualifies. But enrollment fail. not_eligible. Exclusion not applied.
71052:
DOB 1991 age 35. Enrollment: 2026-01-01 to 2026-04-08; 2026-05-24 to 2026-12-31. One gap of 45 days? From Apr9-May23 inclusive: Apr9-30 22, May1-23 23 total 45. Allowed no more than one gap of up to 45 days. So enrollment OK (one gap exactly 45).
Event: office 2026-04-08 dx I10, within first half. Qualifying. Also other I10.
Exclusions none.
Readings on/after 2026-04-08:
2026-04-08 Office BP 121/76 outpatient (date of qualifying)
2026-06-04 Office BP 149/73
2026-07-13 Office BP 127/73
2026-07-16 ED BP 119/89 skip (ED)
Need most recent outpatient reading: among outpatient, most recent is 2026-07-13 (since ED skipped). BP 127/73 both below thresholds (systolic <140, diastolic <90). Compliant.
Yes.
71053:
DOB 1942-08-07 age 84. Enrollment: 2026-01-01 to 2026-05-15; 2026-06-07 to 2026-12-31. One gap of 22 days (May16-Jun6 inclusive 22? May16-31 16, Jun1-6 6 total 22). OK.
Event: office 2026-05-22 dx I10 after June30? Wait May 22 is within Jan-Jun, yes 2026-05-22 is before Jun30, so qualifying? Encounter date 2026-05-22. Yes the first listed office visit? Roster: 2026-05-22 Office visit, diagnosis I10. BP 146/72. That's within first half. Qualifying. (Even though after a gap? Enrollment continuous with gap allowed.)
Exclusions none.
Readings after qualifying date 2026-05-22:
2026-05-22 Office BP 146/72 outpatient.
2026-06-26 Office I10 BP 133/95.
2026-08-24 Inpatient BP 112/84 skip.
Most recent outpatient = 2026-06-26 BP 133/95; diastolic 95 not below. Not controlled. Noncompliant.
Note outpatient 2026-05-22 systolic high. non.
71054:
DOB 1942-12-16 age 84. Enrollment: 2026-01-01 to 2026-05-06; 2026-06-18 to 2026-12-31. One gap 42 days (May7-Jun17: May7-31 25, Jun1-17 17 =42). OK.
Event: office 2026-03-21 dx I10 within first half. Qualifying. Also office 2026-05-06 dx I10.
Exclusions none.
Readings on/after qualifying date 2026-03-21:
2026-03-21 Office BP 137/92 outpatient.
2026-05-06 Office BP 138/85 outpatient.
2026-06-05 Inpatient BP 132/76 skip.
2026-10-28 Office E78.5 BP 132/95 outpatient.
Most recent outpatient = 2026-10-28 BP 132/95. Systolic <140, diastolic 95 not below. Not controlled. Noncompliant.
71055:
DOB 1940-08-21 -> age 86 on 2026-12-31 (turns 86 2026-08-21), age >85. Not eligible. not_eligible. Encounters I10 but age fail.
71056:
DOB 1942-01-17 age 84. Enrollment full.
Event: office 2026-01-19 dx I10 within first half. Qualifying.
Exclusions none.
Readings on/after 2026-01-19:
2026-01-19 Office BP 125/88 outpatient.
2026-03-20 Office BP 153/86 outpatient.
Most recent outpatient = 2026-03-20 BP 153/86, systolic 153 not below. Noncompliant.
Now counts:
Compliant members: 71047, 71050, 71052. That's 3.
Noncompliant: 71041, 71043, 71048, 71053, 71054, 71056. Also maybe 71042? Not eligible age, no. 71044 excluded, 71045 not eligible, 71046 not eligible, etc. Noncompliant count 6.
Excluded: 71044 only? Check others with exclusion: 71051 hospice but not eligible due enrollment. 710?? E1 71044 yes. E2 pregnancy none. E4 none. So excluded 1.
Not eligible: 71042 age, 71045 enrollment, 71046 enrollment gap >45, 71049 no event, 71051 enrollment two gaps, 71055 age. That's 6? Let's list: 71042, 71045, 71046, 71049, 71051, 71055 = 6.
Total denominator after exclusions = compliant+non = 9. numerator=3. rate = 3/9*100 = 33.333... one decimal rounded half up -> 33.3.
But check denominator eligible before exclusions = 10? We have compliant 3 + non 6 + excluded 1 = 10. Not eligible 6. total 16 yes.
Need ensure all classifications correct. Let's verify every member, membership exactly one list; counts match.
Let's re-evaluate 71042 age: date of birth 1940-06-12. Age on 2026-12-31: 2026-12-31 minus 1940-06-12 = 86 years 6 months, yes 86. not eligible.
71055 DOB 1940-08-21 -> age 86 years 4 months. not eligible.
71045 enrollment from 2026-04-05, not full year. not eligible. Event maybe 2026-05-23 office I10 within first half, yes, but enrollment fails.
71046 enrollment one gap 58 days, not eligible. Event maybe office I10 in March, but fail.
71049 enrollment one gap 33 days okay, but event? Need check encounters after Jan-Jun. There is no I10 until Aug. However encounter list includes 2026-11-28 ED and 2026-12-25 office. No outpatient I10 in first half. So not eligible. What about date of first enrollment 2026-01-01 to 2026-06-26; but no I10. OK.
71051 enrollment two gaps; not eligible. Also hospice after. But not_eligible. Need not include in excluded. Correct.
71047 age exactly 18? spec age 18 through 85 as of 2026-12-31. Date of birth 2008-04-06, on 2026-12-31 age 18. Yes eligible. Some measurements age at measurement year? "18 through 85 years as of 2026-12-31" yes.
Numerator for 71047: most recent outpatient reading on/after qualifying date 2026-06-17. The qualifying encounter itself BP 138/76 below. But later office 2026-07-25 BP 137/73 below. Inpatient skipped. Most recent is 2026-07-25, compliant. Good.
Numerator 71052: qualifying date 2026-04-08 BP 121/76; later office 2026-06-04 BP 149/73, later office 2026-07-13 BP 127/73, ED later skipped. Most recent outpatient 2026-07-13. Good. Note reading 2026-07-13 after qualifying and in outpatient. Compliant.
But wait for 71052, enrollment: gap from 2026-04-08 to 2026-05-24. Is that exactly 45 days? Let's calculate accurately. Enrollment end 2026-04-08; next start 2026-05-24. The gap is days not enrolled after Apr8 through May23 inclusive. Apr9-30 = 22? April has 30 days, from Apr9 to Apr30 inclusive = 22 (30-9+1 =22). May1 through May23 inclusive = 23. Total 45. Yes allowed "up to 45 days" inclusive. OK.
What about 71046 gap 58: enrollment end 2026-04-26; next start 2026-06-24. Days Apr27-Apr30 =4; May31; Jun1-Jun23 =23; total 58. >45. OK.
71051 gaps: from 04-08 to 05-05: Apr9-30 22 + May1-4 4 =26. from 08-07 to 08-22: Aug8-21 =14. Two gaps => fail.
71053 gap: end 05-15, start 06-07. May16-31 =16, Jun1-6 =6, total22. OK.
71054 gap: end 05-06, start 06-18. May7-31=25, Jun1-17=17, total 42. OK.
71049 gap: end 06-26, start 07-30. Jun27-30=4, Jul1-29=29, total33. OK.
Could there be issue: eligible event requires at least one outpatient encounter with hypertension diagnosis I10 on or between Jan1 and Jun30. Does office visit count as outpatient? Yes. Outpatient encounter not ED/inpatient. For 71047: first qualifying office 2026-06-17 I10, within period. Good.
For 71053: office 2026-05-22 I10. Good. But member has enrollment gap May16-Jun6; on 2026-05-22? Wait enrollment period 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. If encounter on 2026-05-22, during a gap? The roster says enrollment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days. But encounter date 2026-05-22 falls within the gap (between May16 and Jun6). Hmm, this is important: Can an encounter during a gap count for event? Continuous enrollment spec allows one gap up to 45 days, but does an encounter during a gap count? Typically continuous enrollment means no gaps except allowed, and services during gaps may not be covered? Need determine. The roster says enrollment has gap 2026-05-16 to 2026-06-06 not enrolled. But encounter 2026-05-22 office visit I10. If member not enrolled on date, can that encounter establish event? Usually for HEDIS? Eligible population requires continuous enrollment, with allowable gap. Encounter during gap? The spec says "at least one outpatient encounter with hypertension diagnosis ... on or between 2026-01-01 and 2026-06-30." It doesn't explicitly say encounter must occur while enrolled, but eligibility continuous enrollment likely member must be enrolled on encounter date? Hmm, in measure specs, encounters during enrollment gaps? Need think. The roster likely designed to test if encounter during enrollment gap still counts? The specification: "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator." It defines gaps in enrollment. It doesn't explicitly exclude services during gaps from the event. But if a member has a gap, they are still considered continuously enrolled if the gap is allowable. However, encounter during a gap should not be considered because they are not enrolled. But measure specs usually require enrollment for the full measurement year, with no more than one gap up to 45 days. Encounters can occur during gap? For HEDIS, continuous enrollment generally permits one gap but visits during gap? There is "allowed gap" but not "enrolled" during gap. The diagnosis may still be in claim? Actually if no enrollment, services might not be paid, but the roster gives encounter.
Need infer from harness data. The spec says "enrolled for full measurement year with no more than one gap..." A gap of 22 days is allowed, so member is continuously enrolled for denominator. If member has an encounter during gap, would event count? The event criterion doesn't say while enrolled; but eligibility event may be based on claims/encounters. In measure population, if member has allowable gap but service during gap, is that valid? I think in HEDIS, continuous enrollment allows one gap and all services (including during gap?) are considered? Actually HEDIS "continuous enrollment" with one gap means the member has a gap but the member is still eligible; however, if a service occurs during a gap, the member wasn't enrolled, but the spec often doesn't require encounter during enrollment; it just requires diagnosis. Yet claims during gap may not be in data. The roster includes.
Let's examine 71053 more. If event encounter 2026-05-22 is during gap. If we ignore it, is there any other outpatient I10 on/before 2026-06-30? 2026-06-26 Office visit, diagnosis I10 BP 133/95. That is outside gap (enrolled from Jun7), and on/before Jun30. So even if the May encounter doesn't count, there is another office I10 on 2026-06-26, which qualifies as event. Ah good! So 71053 still eligible regardless, because 2026-06-26 I10 within first half. Then numerator uses most recent reading on/after qualifying date. If qualifying event date is 2026-05-22? Or if not eligible, qualifying date could be 2026-06-26. But the most recent outpatient reading after qualifying date: if qualifying date 2026-06-26, readings: 2026-06-26 BP 133/95; 2026-08-24 inpatient skipped. Most recent outpatient 2026-06-26 not controlled. Same result. So no impact.
But wait if encounter during gap ignored, qualifying event is 2026-06-26. Still noncompliant. Fine.
Need consider 71045 enrollment begins 2026-04-05 with no prior enrollment. This is more than one gap? It's not enrolled full year. Not eligible. Even if event 2026-05-23. OK.
Now check exclusions: 71044 has ESRD diagnosis 2024-06-20. E1 says any time on or before 2026-12-31. Yes, remove. He has event 2026-04-23, age, enrollment. Excluded. Good.
71051 hospice election 2026-10-27 but not_eligible due enrollment. We list not_eligible, not excluded. Yes per status definitions: not_eligible never enters eligible population even if exclusion documented. Good.
Any other member with ESRD etc? none.
Potential nuance: For 71050, office visit 2026-06-23 diagnosis I10 qualifies event. BP 122/84 is on same day as qualifying. Later office 2026-09-08 BP 129/71. Most recent compliant. Good.
Potential nuance: 71041, reading on qualifying encounter 2026-02-18 is most recent outpatient? Later inpatient skipped. The most recent outpatient reading is 2026-02-18; systolic 150 not below. Noncompliant. Good.
Potential issue: For 71043, office 2026-10-02 BP 136/103; both below? Systolic 136 below 140 but diastolic 103 not below 90. Non. Correct.
Potential issue: 71048, BP 134/93. Diastolic 93 high. Non. Good.
Potential issue: 71056, office 2026-01-19 BP 125/88 and 2026-03-20 BP 153/86. Most recent 153/86. Non. Good.
Potential issue: 71046 has office 2026-03-08 I10 BP 137/82, office 2026-05-11 I10 BP 119/85, office 2026-08-20 J06.9 BP 138/68, ED 2026-09-18 BP 130/69. But enrollment fails due gap >45. not_eligible. OK.
Potential issue: 71049 has one gap 33 days allowed, enroll full year? Wait enrollment periods: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. In the first period, from Jan1 to Jun26, no I10. Second period includes office Aug and Dec. Event not established. Not eligible. Good.
Potential issue: if a member has one gap up to 45 but not enrolled full calendar? They are eligible if full measurement year with no more than one gap. OK.
Potential issue: Age range 18 through 85 "as of 2026-12-31". For 71041, 85 exactly? Date 1941-07-25, on 2026-12-31 age 85, yes. Eligible. For 71042, 86. Not. For 71047, DOB 2008-04-06 age 18, yes. For 71055 86. Good.
Now output JSON arrays strings in any order. Need include every member exactly once.
Let's decide arrays order, maybe ascending by ID.
Compliant members: ["71047","71050","71052"].
Non_compliant: ["71041","71043","71048","71053","71054","71056"].
Excluded: ["71044"].
Not_eligible: ["71042","71045","71046","71049","71051","71055"].
Counts:
denominator 9.
numerator 3.
excluded 1.
not_eligible 6.
rate 33.3.
Check total members: 3+6+1+6=16. Good.
Need ensure output exactly one fenced JSON code block and nothing else. We can provide.
But before final, let's thoroughly re-analyze each member with all possible interpretational pitfalls.
Spec says "Most recent outpatient blood pressure json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 10,861 tokens
We need answer JSON only. Need compute measure population for 16 members according to spec. Need carefully evaluate each.
We need understand measure. Eligible: age 18-85 as of 2026-12-31 (so DOB between? born 1941-07-25? 85? Let's compute ages. Event: at least one outpatient encounter with I10 between 2026-01-01 and 2026-06-30. Continuous enrollment full year no more than one gap of up to 45 days. Wait "full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes member." So enrollment must cover full year with at most one gap ≤45. Gaps? Need determine if member enrolled from Jan 1 through Dec 31 except allowed gaps. If not enrolled before first date maybe not full enrollment, not eligible. For 71045 enrolled 2026-04-05 through 2026-12-31, not enrolled before -> gap >? effectively not full year, remove as not eligible (not continuous full year). Could be not_eligible due enrollment. Need evaluate.
Then exclusions evaluated before numerator, for eligible population. Exclusions criteria: E1 ESRD N18.6 or Z99.2 any time on or before 12/31. E2 Pregnancy O00-O9A during 2026. E3 hospice/palliative anytime during measurement year. E4 died during year.
Numerator: most recent outpatient BP reading taken on or after qualifying hypertension encounter and on or before 12/31 is below 140 systolic AND below 90 diastolic. Skip ED or inpatient when identifying most recent. Need identify qualifying hypertension encounter: outpatient encounter with I10 between Jan1-Jun30. The BP reading for numerator must be on or after that qualifying encounter. Most recent outpatient BP after that date. If there are multiple qualifying encounters? The wording "the date of the qualifying hypertension encounter" singular. For event: at least one outpatient encounter with I10. Numerically, if multiple qualifying encounters, most recent outpatient BP reading on/after date of qualifying encounter—probably after any qualifying encounter? Could be after first qualifying encounter? Need careful. It says "The most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31..." If multiple qualifying encounters, the "qualifying hypertension encounter" maybe the earliest? Usually in HEDIS, event/diagnosis (earliest? "the date of the qualifying encounter" maybe first? But measure spec says at least one encounter. Numerator "most recent outpatient BP reading taken on or after the date of the qualifying hypertension encounter." Since all qualifying encounters are eligible, any BP on/after at least one qualifying encounter? But if BP occurs after a later qualifying, it is after earlier too, so same. For each member with at least one qualifying encounter, most recent outpatient BP after the earliest qualifying? Actually if a BP after first but before second, still after qualifying. If BP after second, also after first. So effectively any outpatient BP after the earliest qualifying I10 outpatient encounter. But if an outpatient BP before the only qualifying encounter, not count. Need use on/after date of qualifying encounter. We'll determine.
Outpatient setting: Office visit likely outpatient, ED not, inpatient not. Inpatient BP skipped. ED visit skipped. But "outpatient blood pressure reading" includes office visits, maybe outpatient only, and ED/inpatient skip. In roster, office visits are outpatient. Need identify most recent qualifying outpatient BP on/after qualifying I10 encounter.
Numerator threshold strictly below 140 systolic AND below 90 diastolic. So systolic <140 and diastolic <90. If 139/82 compliant; 140/90 not. 134/93 diastolic 93 not. 138/85 both <140/<90 compliant? systolic 138 <140, diastolic 85 <90 yes. 137/92 diastolic 92 not. 146/88 systolic high. 119/102 diastolic high. 136/103 high.
Need compute membership groups. Let's go one by one.
Roster 16 IDs 71041-71056. We'll evaluate.
Age on 2026-12-31: DOB provided and stated. Check ranges 18 through 85 inclusive. Members:
71041 DOB 1941-07-25 -> age 85 on 12/31? Born 1941-07-25, 2026-07-25 turns 85, so yes 85. Eligible age.
71042 DOB 1940-06-12 -> 86 on 12/31. Not eligible age. But also enrollment gaps. So not_eligible.
71043 1991 -> 35.
71044 1956 -> 70.
71045 1982 -> 44.
71046 1991 -> 35.
71047 2008-04-06 -> turns 18 on 2026-04-06, so 18 on 12/31? Yes 18. Eligible age.
71048 1991 -> 35.
71049 1965 -> 61.
71050 1942 -> 84.
71051 1991 -> 35.
71052 1991 -> 35.
71053 1942 -> 84.
71054 1942 -> 84.
71055 1940-08-21 -> 86? Born 1940, turns 86 on 2026-08-21, so 86 at year end. Not eligible.
71056 1942 -> 84.
Enrollment. "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes." Need determine gaps. Some member not enrolled at start = gap from Jan 1 to enrollment. Does that count as a gap? Full measurement year means must be enrolled Jan 1 to Dec 31 except allowed gap. If enrollment begins after Jan1, that's a gap >? It counts as gap; if >45 days from Jan1 to start, removes (or not enrolled full year). For 71045 not enrolled before 2026-04-05 => gap Jan1-Apr4 = 94 days, >45 -> not eligible.
71041 continuous no gaps -> ok.
71042 gaps 15 and 12 days -> two gaps of any length -> not eligible (even though age also not eligible). Actually age not eligible already. We'll classify not_eligible.
71043 continuous ok.
71044 continuous ok.
71045 starts Apr 5 -> not continuous full year, gap >45, not eligible. But also check event yes? event I10 on 2026-05-23, but enrollment fails. Not_eligible.
71046 enrollment Jan1-Apr26, Jun24-Dec31, one gap of 58 days. Gap >45 -> not eligible. Event? I10 2026-03-08 and 05-11 (but 05-11 in gap? Actually not enrolled? We evaluate eligibility; fails enrollment. Not eligible.
71047 continuous ok.
71048 continuous ok.
71049 enrollment Jan1-Jun26, Jul30-Dec31 one gap 33 days -> ok (≤45, one gap).
71050 continuous ok.
71051 gaps 26 and 14 days => two or more gaps -> not eligible. Also hospice later. But not eligible due enrollment? Wait they have enrollment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. That's two gaps (Apr9-May4, Aug8-Aug21) any length. So fails continuous enrollment. Not eligible. Exclusion hospice not evaluated because not in eligible population. Age ok. So not_eligible.
71052 enrollment Jan1-Apr8; May24-Dec31. One gap of 45 days? Apr9-May23 inclusive? Let's compute gap days. If enrolled through Apr8 then gap Apr9 through May23, re-enroll May24. Number of days gap = from Apr9 to May23 inclusive = 45? Apr 9-30 =22 days? Let's count: April has 30 days. Apr9-30 inclusive = 22 days. May1-23 = 23 days. Total 45. Yes one gap of 45 days, allowed "up to 45 days" -> ok.
71053 enrollment Jan1-May15; Jun7-Dec31. One gap May16-Jun6 inclusive = 22 days. ok.
71054 enrollment Jan1-May6; Jun18-Dec31. One gap May7-Jun17 inclusive = May 7-31=25 days? May7-31 inclusive 25 (31-7+1=25), Jun1-17=17 total 42. ok.
71055 continuous ok but age 86 not eligible.
71056 continuous ok.
Event: at least one outpatient encounter with I10 between Jan1-Jun30. Encounter after Jun30 does not establish. Need check. For all age and enrollment eligible maybe.
I'll go through after initial screening.
Need determine potentially eligible (age 18-85 and enrollment ok, no more than one gap ≤45):
71041 age ok, enrollment ok, event yes 2026-02-18 Office I10. Eligible population.
71042 age not -> not_eligible.
71043 ok, enrollment ok, event yes 2026-02-12/03-21. Eligible population.
71044 ok, enrollment ok, event? 2026-04-23 Office I10 yes. But exclusion E1 ESRD 2024. Eligible? Exclusions evaluated after eligible. So excluded.
71045 enrollment not full -> not_eligible.
71046 enrollment gap > -> not_eligible.
71047 ok, enrollment ok, event? 2026-06-17 Office I10 yes (before Jun30). Eligible. Later ED/inpatient not relevant.
71048 ok, enrollment ok, event 2026-05-15 Office I10 yes. Eligible.
71049 ok, enrollment ok. Event? Encounters: 2026-08-25 Office I10 (after Jun30 cannot establish), 2026-11-28 ED R07.9, 2026-12-25 Office I10. No outpatient I10 on/before Jun30. Not eligible. Also age ok. Not eligible due no event.
71050 ok, enrollment ok, event 2026-06-23 Office I10 yes. Eligible.
71051 enrollment two gaps -> not_eligible (despite hospice).
71052 ok, enrollment one gap 45 days allowed, event 2026-04-08 Office I10 yes (also 2026-06-04). Eligible? Need consider date Apr8 encounter is on last enrolled day? Enrolled through 2026-04-08. Yes. Continuous enrollment with one gap. Eligible. But we need BP readings after qualifying. There is 2026-06-04 office I10 BP 149/73, 2026-07-13 office I10 BP 127/73, 2026-07-16 ED S52.501A BP 119/89. Most recent outpatient after qualifying: 2026-07-13 office BP 127/73 (<140/<90) compliant. Need check ED after 07-16 skipped. So numerator yes.
71053 ok, enrollment ok, event 2026-05-22 Office I10? Wait 2026-05-22 Office I10, but enrollment gap? They were not enrolled May16-Jun6? Let's re-evaluate: 71053 enrollment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap May16-Jun6 = 22 days. During gap May22 the member is not enrolled? The roster includes encounter 2026-05-22 Office I10 while not enrolled! Hmm. Event requires encounter with I10 between Jan1-Jun30. It doesn't explicitly say encounter must occur while enrolled? Usually measures require enrollment but event can occur during gap? Continuous enrollment with allowed gap, maybe services during gap still count? Need think. The spec: Continuous enrolment: enrolled full measurement year with no more than one gap up to 45 days. Roster shows encounter during a gap (not enrolled). Does that affect event? It says event: at least one outpatient encounter... on or between 2026-01-01 and 2026-06-30. It doesn't state encounter must be during enrollment; encounter occurred. But if member not enrolled, maybe claims not plan? However we follow supplied material. It says event only. Encounters listed. Could count even during gap? In HEDIS, enrollment gap may be administrative, but services during gap may not count? Need not infer. The material says continuous enrollment is a separate eligibility criterion; encounter during gap may still be a diagnosis? But since the member has another encounter 2026-06-26 Office I10 BP 133/95, after re-enrollment and before Jun30. So event satisfied regardless. Good. Eligible. Need numerator. Qualifying encounters: 2026-05-22 and 2026-06-26 (both I10). Most recent outpatient BP after qualifying: readings:
2026-05-22 Office I10 BP 146/72 (qualifying; not <140 systolic? 146 high)
2026-06-26 Office I10 BP 133/95 (diastolic 95 high)
2026-08-24 Inpatient R07.9 BP 112/84 (inpatient skip)
No other outpatient BP after? Most recent outpatient BP after qualifying that counts among office visits after earliest qualifying: 06-26 BP 133/95 not below both (diastolic 95). 05-22 146/72 high. So non_compliant. Wait if 05-22 during gap maybe not count? But 06-26 counts after qualifying; most recent is 06-26, high diastolic. None compliant. So non_compliant.
71054 ok, enrollment ok, event 2026-03-21 Office I10 (also 05-06) yes. Eligible? Need exclusion? none. Numerator: outpatient readings after qualifying.
Readings:
2026-03-21 Office I10 BP 137/92 (qualifying, not below diastolic 92)
2026-05-06 Office I10 BP 138/85 (systolic <140, diastolic <90 -> compliant if most recent)
2026-06-05 Inpatient S52.501A BP 132/76 (skip)
2026-10-28 Office E78.5 BP 132/95 (diastolic 95 high)
Most recent outpatient BP after qualifying: 2026-10-28 office E78.5 BP 132/95, not below 90 -> non_compliant. Even though earlier compliant, most recent not. So non_compliant.
71055 age not eligible -> not_eligible.
71056 ok, enrollment ok, event 2026-01-19 Office I10 yes. Eligible. Numerator: readings after qualifying:
2026-01-19 Office I10 BP 125/88 (qualifying, systolic 125 <140, diastolic 88 <90 -> compliant)
2026-03-20 Office I10 BP 153/86 (systolic high)
Most recent outpatient BP after qualifying: 2026-03-20 office I10 BP 153/86, not below 140 systolic, so non_compliant. Wait the most recent reading after qualifying is 153/86, not compliant. So non_compliant. Important: even though first was compliant, most recent not. So non_compliant.
Need be careful with members with qualifying BP on same date? Fine.
Let's also evaluate each thoroughly, including exclusions and event.
Let's list all 16 and final status.
We need output counts and lists.
Let's define eligible population after exclusions removed: denominator = compliant + non_compliant. Excluded = members in eligible population but meet required exclusion. Not_eligible = age, event, or enrollment fail.
Let's ensure event criterion: at least one outpatient encounter with I10 between Jan1 and Jun30. If encounter after Jun30 doesn't establish. Need check for 71049 no event: yes not_eligible. 71045 has event but enrollment fail, not_eligible. 71046 has event but enrollment fail. 71051 has event but enrollment fail. 71042 age fail (also enrollment two gaps, but age fail). 71055 age fail.
Need check age computations on boundary. 18 through 85 years as of 2026-12-31. 71047 DOB 2008-04-06 -> 18 years old on 2026-12-31? Actually if born 2008-04-06, on 2026-12-31 age 18 (already had birthday Apr 6 2026). Yes eligible. 71041 DOB 1941-07-25 -> 85 on Dec 31 (birthday Jul25) yes. 71042 DOB 1940-06-12 -> 86 on Dec31, not eligible. 71055 DOB 1940-08-21 -> 86 on Dec31, not eligible. Good.
Need compute numerator for each denominator member.
Let's go one by one in detail, including all BP readings.
Member 71041:
Age eligible 85. Enrollment continuous. Event: 2026-02-18 Office I10. Exclusion? none. Denominator. BP readings:
- 2026-02-18 Office I10 BP 150/72 (outpatient; qualifying)
- 2026-05-18 Inpatient R07.9 BP 159/81 (skip)
Most recent outpatient after qualifying: only 150/72. Below 140? 150 no. Non_compliant.
Note: There is no later outpatient. So non_compliant.
71043:
Age 35. Enrollment ok. Event yes: 2026-02-12 and 03-21 I10. Exclusion none. BP readings:
- 2026-02-12 Office I10 126/73 (qualifying)
- 2026-03-21 Office I10 135/73 (qualifying)
- 2026-05-22 Office E78.5 119/102 (diastolic 102 high)
- 2026-10-02 Office E78.5 136/103 (diastolic 103 high)
Most recent outpatient after qualifying: 2026-10-02 136/103, not below 90 diastolic. Non_compliant. Note if only office visits count. Yes.
71044:
Age 70. Enrollment ok. Event yes 2026-04-23 Office I10. Exclusions: E1 ESRD N18.6 on 2024-06-20, any time on/before 2026-12-31 -> excluded. Not in denominator, regardless BP. So excluded.
71047:
Age 18. Enrollment ok. Event yes 2026-06-17 Office I10 (also maybe not before? yes). Exclusion none. BP readings:
- 2026-06-17 Office I10 138/76 (qualifying; compliant if most recent? but later)
- 2026-07-25 Office I10 137/73 (compliant)
- 2026-11-21 Inpatient I10 118/88 (skip)
Most recent outpatient after qualifying: 2026-07-25 137/73. Both <140/<90 -> compliant. (Inpatient skipped). So compliant.
71048:
Age 35. Enrollment ok. Event yes 2026-05-15 Office I10. Exclusion none. BP:
- 2026-05-15 Office I10 134/93 (qualifying; diastolic 93 high)
No other outpatient? None. Most recent: 134/93 -> non_compliant.
71050:
Age 84. Enrollment ok. Event yes 2026-06-23 Office I10. BP:
- 2026-06-23 Office I10 122/84 (qualifying; compliant)
- 2026-09-08 Office J06.9 129/71 (compliant)
Most recent outpatient after qualifying: 2026-09-08 129/71 -> compliant.
71052:
Age 35. Enrollment ok (one gap 45 days exactly, allowed). Event yes 2026-04-08 Office I10 (also 06-04). Exclusion? none. BP readings:
- 2026-04-08 Office I10 121/76 (qualifying; compliant)
- 2026-06-04 Office I10 149/73 (systolic high)
- 2026-07-13 Office I10 127/73 (compliant)
- 2026-07-16 ED S52.501A 119/89 (skip)
Most recent outpatient after qualifying: 2026-07-13 127/73 -> compliant. Note ED skip, so compliant. Good.
71053:
Age 84. Enrollment ok (one gap 22 days). Event yes, at least 2026-06-26 Office I10; also 05-22 (during gap) maybe. Exclusion none. BP readings:
- 2026-05-22 Office I10 146/72 (outpatient; after? qualifying? if event encounter)
- 2026-06-26 Office I10 133/95 (diastolic high)
- 2026-08-24 Inpatient R07.9 112/84 (skip)
Most recent outpatient after qualifying: 2026-06-26 133/95, not compliant (diastolic 95). Non_compliant.
What if 05-22 in gap not counted? Still 06-26 is qualifying and BP not compliant. Non_compliant.
71054:
Age 84. Enrollment ok. Event yes 2026-03-21 and 05-06. Exclusion none. BP readings:
- 2026-03-21 Office I10 137/92 (diastolic high)
- 2026-05-06 Office I10 138/85 (compliant)
- 2026-06-05 Inpatient S52.501A 132/76 (skip)
- 2026-10-28 Office E78.5 132/95 (diastolic high)
Most recent outpatient after qualifying: 2026-10-28 132/95 -> non_compliant. Good.
71056:
Age 84. Enrollment ok. Event yes 2026-01-19 Office I10. BP:
- 2026-01-19 Office I10 125/88 (compliant)
- 2026-03-20 Office I10 153/86 (systolic high)
Most recent: 03-20 153/86 -> non_compliant.
Now not_eligible list:
71042? Age 86. Not eligible due age. Is enrollment also fail? yes but age.
71045 enrollment fail (not full year).
71046 enrollment fail (gap 58).
71049 no event.
71051 enrollment fail (two gaps).
71055 age 86.
Do any other not_eligible? Let's verify 71041 no. 71043 no. 71044 excluded, not not_eligible. 71047 no. 71048 no. 71050 no. 71052 no. 71053 no. 71054 no. 71056 no.
So 6 not_eligible.
Excluded list:
71044 only? Need check exclusions for any other denominator/eligible.
- 71041 no hospice, no ESRD, alive; no pregnancy. Female 85, no pregnancy likely.
- 71043 female 35, no pregnancy/hospice/ESRD.
- 71047 male 18 no.
- 71048 female 35 no.
- 71050 male 84 no.
- 71052 male 35 no.
- 71053 female 84 no.
- 71054 male 84 no.
- 71056 male 84 no.
- 71051 has hospice but not eligible due enrollment, so not_eligible not excluded. The rule says exclusion evaluated only eligible population; so not_eligible.
- 71044 has ESRD and eligible, excluded.
Thus excluded count 1.
Denominator = eligible after exclusions = 16 - not_eligible(6) - excluded(1) = 9.
Compliant count? We identified 71047, 71050, 71052 = 3. Non_compliant = 6 (71041, 71043, 71048, 71053, 71054, 71056) = 6. Denominator 9. Rate = 3/9*100 = 33.333... -> 33.3% (one decimal half up). Need double-check no other compliant? Let's reevaluate all denominator members and ensure no compliance missed due to "most recent outpatient BP reading after qualifying" maybe should choose most recent BP from any outpatient after *the* qualifying encounter? For 71043: most recent office BP Oct 2 E78.5 136/103 not compliant. yes. 71041 only 150/72. 71048 only 134/93. 71053 most recent outpatient 06-26 133/95. 71054 10-28 132/95. 71056 03-20 153/86. So 3 compliant.
Potential nuance: For numerator, blood pressure reading must be "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter." If a member has multiple qualifying encounters, maybe the "qualifying hypertension encounter" could be the most recent qualifying encounter? Hmm if using most recent qualifying, for 71054: qualifying encounters 2026-03-21 and 2026-05-06. If the "qualifying hypertension encounter" referenced is the most recent, then BP readings on/after 05-06: 05-06 138/85, then 10-28 132/95 => most recent 10-28, non-compliant. Same. 71052 qualifying encounters 04-08 and 06-04; if most recent qualifying is 06-04, BP readings after: 06-04 149/73, 07-13 127/73, ED skip => compliant. Same. 71047 only one. 71043 qualifying encounters 02-12, 03-21; either. Same. 71056 only one. 71053 qualifying 05-22 and 06-26? if the encounter during gap counts? if most recent qualifying 06-26, most recent post 06-26 outpatient BP: 06-26 133/95; noncompliant. same. So no difference.
Potential issue: 71052 enrollment gap exactly 45 days: allowed "no more than one gap of up to 4json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,669 tokens
We need answer task. Need compute population for 16 members. Need output JSON with counts and lists. Need carefully evaluate each member against eligibility, exclusions, numerator. Let's parse spec.
Measure QM-CBP. Measurement year 2026.
Eligible population:
- Age 18 through 85 as of 2026-12-31.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. Encounter after 2026-06-30 does not establish event.
- Continuous enrolment: enrolled full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes.
Numerator:
- Most recent outpatient BP reading taken on or after date of qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both below. ED or inpatient readings don't count and are skipped when identifying most recent. If no qualifying reading exists, denominator not numerator.
- Need identify qualifying hypertension encounter: outpatient encounter with I10 during Jan-Jun. The "qualifying hypertension encounter" date? Event definition says at least one outpatient encounter with I10 on/between. For numerator "on or after date of qualifying hypertension encounter" likely the first such encounter? Need decide. For each member with at least one outpatient I10 Jan-Jun. Most recent outpatient BP reading on/after date of qualifying hypertension encounter. If multiple, qualifying encounter maybe earliest? We need use first qualifying encounter date? Usually measure uses date of first diagnosis? Spec says "the qualifying hypertension encounter" singular. Might be the earliest outpatient encounter with hypertension diagnosis that establishes event. Need examine. Members may have multiple I10 in first half. Numerator readings on or after date of qualifying encounter. If first I10 is qualifying encounter, all after. If last, then would exclude earlier readings. Need infer. Event requires at least one outpatient encounter with I10 during Jan-Jun; "qualifying hypertension encounter" likely the earliest encounter that qualifies member; "on or after the date of the qualifying hypertension encounter" means after diagnosis. So use first qualifying I10 outpatient encounter (earliest). Let's keep. Need apply to each.
Exclusions evaluated before numerator, only for eligible population. Exclusions:
E1 ESRD N18.6 or Z99.2 any time on/before 2026-12-31.
E2 Pregnancy any O00-O9A code during measurement year.
E3 Hospice or palliative care any time during measurement year.
E4 Died during measurement year.
Need assign each member one status.
Let's list roster and evaluate.
We'll create table. Need note enrollment gaps count. Full measurement year with no more than one gap up to 45 days. A gap longer than 45 days, or two or more gaps of any length removes. Continuous enrollment: enrolled for full year with no more than one gap of up to 45 days. Need check gaps: if gap <=45 and only one, okay; if multiple gaps any length, not eligible. "No more than one gap of up to 45 days" means one gap allowed, two gaps not. Gaps of 0? no. Need evaluate.
Age as of 2026-12-31: dates.
Member 71041 DOB 1941-07-25. Age on 2026-12-31? Turned 85 on 2026-07-25, so 85. Eligible age (18-85). Enrollment continuous no gaps. Event: 2026-02-18 Office I10 yes outpatient. Qualifying date 2026-02-18. Exclusions none. Numerator: most recent outpatient BP on/after 2026-02-18 by 12/31. Readings:
- 2026-02-18 office BP 150/72 (outpatient, on date qualifying, not below both? systolic 150 high)
- 2026-05-18 Inpatient admission BP 159/81 — inpatient, skip.
No other outpatient. Most recent qualifying outpatient is 2026-02-18 BP 150/72, not below 140/90. Non-compliant. Lists: non_compliant.
Member 71042 DOB 1940-06-12. Age 86 on 2026-12-31. Not eligible age (>85). Even enrollment gaps etc. Status not_eligible. Need consider if age exactly 86? Yes 86. Not eligible. Not excluded. So not_eligible list.
Member 71043 DOB 1991-01-17 age 35. Enrollment continuous. Event: outpatient I10 2026-02-12 and 03-21. Qual date first 2026-02-12. Exclusions none. Numerator: most recent outpatient BP on/after 02-12. Readings:
- 2026-02-12 office I10 BP 126/73. Outpatient, qualifies? below 140/90 yes.
- 2026-03-21 office I10 BP 135/73 yes.
- 2026-05-22 office E78.5 BP 119/102. Outpatient, diastolic 102, not below.
- 2026-10-02 office E78.5 BP 136/103. Outpatient, diastolic 103, not below.
The most recent qualifying outpatient reading among all outpatient readings on/after qualifying date and before 12/31 is 2026-10-02 (office, outpatient) BP 136/103. Not below both. So non-compliant. Wait "most recent outpatient blood pressure reading taken..." Regardless of diagnosis? Yes any outpatient BP, not ED/inpatient. So most recent is 10-02 with diastolic 103. Non-compliant. Even earlier compliant not numerator. Non-compliant.
Member 71044 DOB 1956-05-26 age 70. Enrollment continuous. Event: 2026-04-23 office I10. Exclusions: E1 ESRD 2024-06-20 N18.6. Yes exclude. Status excluded. Need check if eligible before exclusion: age, event, enrollment yes. Exclusion E1. So excluded.
Member 71045 DOB 1982-06-22 age 44. Enrollment: 2026-04-05 through 2026-12-31, not enrolled before. Continuous from that date. Not full measurement year. Not eligible due enrollment. Status not_eligible. Age ok, event maybe 2026-05-23 I10, but enrollment removes. Not eligible.
Member 71046 DOB 1991-10-18 age 35. Enrollment: 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days (Apr 26 to Jun 24? days Apr27-May? let's count but says 58 days). Gap >45, so not eligible. Status not_eligible. Age ok, event yes, but enrollment. Not eligible.
Member 71047 DOB 2008-04-06 age 18 as of 2026-12-31 (turns 18 Apr 2026, but age as of Dec 31 = 18). Eligible. Enrollment continuous. Event: outpatient I10 2026-06-17 and 07-25. First qualifying 2026-06-17 (within Jan-Jun). Exclusions none. Numerator: most recent outpatient BP on/after 2026-06-17. Readings:
- 2026-06-17 office I10 BP 138/76 — outpatient, qualifies? systolic 138 <140, diastolic 76<90 yes.
- 2026-07-25 office I10 BP 137/73 — outpatient qualifies yes.
- 2026-11-21 Inpatient admission I10 BP 118/88 — inpatient skip.
Most recent qualifying outpatient: 2026-07-25 BP 137/73, below both. Compliant. Numerator yes.
Member 71048 DOB 1991-04-26 age 35. Enrollment continuous. Event: 2026-05-15 office I10. Exclusions none. Numerator: most recent outpatient BP on/after 05-15:
- 2026-05-15 office I10 BP 134/93. Outpatient, diastolic 93 not below 90. Non-compliant (no other). So non_compliant.
Member 71049 DOB 1965-05-12 age 61. Enrollment: 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap of 33 days (Jun 26 to Jul30? need maybe 34 but spec says 33). Within 45 and only one gap. Eligible enrollment yes. Event: Need outpatient encounter with I10 on or between Jan-Jun. Encounters:
- 2026-08-25 Office I10 (after Jun 30) doesn't establish.
- 2026-11-28 ED R07.9 no.
- 2026-12-25 Office I10 after Jun30 no.
No outpatient I10 Jan-Jun. So not eligible due no qualifying event. Status not_eligible. Need note age/enrollment okay but event fails. So not_eligible.
Member 71050 DOB 1942-01-04 age 84. Enrollment continuous. Event: 2026-06-23 office I10 (within Jan-Jun). Exclusions none. Numerator: most recent outpatient BP on/after 06-23:
- 2026-06-23 office I10 BP 122/84 — outpatient, below both? systolic 122<140, diastolic 84<90 yes.
- 2026-09-08 office J06.9 BP 129/71 — outpatient, below yes.
Most recent qualifying outpatient = 2026-09-08 BP 129/71 below. Compliant.
Member 71051 DOB 1991-04-19 age 35. Enrollment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 and 14 days. Two gaps of any length -> removes. Not eligible due enrollment (two gaps). But also hospice election 2026-10-27 E3. But status not_eligible if fails enrollment. Exclusion evaluated only for eligible population. Since enrollment not continuous with two gaps, not eligible. Age/event? event has 2026-03-21 and 04-06 I10 outpatient yes. But enrollment failure. Not_eligible. Need ensure not excluded because not eligible; yes if fails enrollment, not_eligible even if exclusion documented. So list not_eligible.
Member 71052 DOB 1991-11-27 age 35. Enrollment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days. "up to 45 days" inclusive? Yes no more than one gap of up to 45 days; one gap of 45 allowed. Eligible enrollment. Event: 2026-04-08 office I10 (within Jan-Jun) yes. Exclusions none. Numerator: most recent outpatient BP on/after 2026-04-08. Readings:
- 2026-04-08 office I10 BP 121/76 — outpatient, below, also on qualifying date.
- 2026-06-04 office I10 BP 149/73 — outpatient, systolic 149 not below.
- 2026-07-13 office I10 BP 127/73 — outpatient below.
- 2026-07-16 Emergency department S52 BP 119/89 — ED skip.
Most recent qualifying outpatient = 2026-07-13 BP 127/73 below both? systolic 127<140 diastolic73<90 yes. Compliant. Wait there is ED after 7/13 but skipped; most recent non-ED is 7/13. So compliant.
Member 71053 DOB 1942-08-07 age 84. Enrollment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap 22 days. Eligible. Event: outpatient I10 Jan-Jun? Encounters:
- 2026-05-22 Office I10 after? This date is during gap? Wait enrollment gap: 2026-05-15 ended, 2026-06-07 resumed. 2026-05-22 is not enrolled. Does encounter count? Need event: at least one outpatient encounter with I10 on or between Jan-Jun. But if member not enrolled at that encounter? Usually encounter must occur during enrollment? Spec doesn't explicitly require visit during enrollment but continuous enrollment separately. Event says at least one outpatient encounter with I10. If encounter during gap? The roster includes it; but member not enrolled on May 22. Does it count as event? For HEDIS-like, services during enrollment? Typically yes? Need think. The measure spec given: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30." It does not say the encounter must be while enrolled. But enrollment criterion requires enrolled full year with no more than one gap. If there's a gap, can an encounter during gap be used? Usually eligible event must be during the measurement year and the member must be continuously enrolled; not necessarily encounter during enrollment? But the encounter date is within measurement year. However if not enrolled, could still be a claim? In synthetic roster, maybe they include encounters in gap to test? Need decide based on spec only. The continuous enrolment criterion only removes if gaps >45 or multiple. The event criterion only dates. It doesn't state encounter must occur during enrolled period. So 2026-05-22 I10 in gap likely counts as outpatient encounter for event. But maybe if not enrolled, service isn't covered? The measure spec is as given, no requirement enrollment at event. We should follow literal. Let's continue.
Member 71053: qualifying event maybe 2026-05-22 office I10 (outpatient) within Jan-Jun. But note there is also 2026-06-26 office I10 (after? within Jun? Actually 2026-06-26 is after Jun 30? Wait June 26 is within Jan-Jun. Oh yes 2026-06-26 is before June 30. So both 05-22 and 06-26 outpatient I10 in first half. First qualifying = 05-22. If first qualifying is earliest. Enrollment criterion: one gap 22 days, OK.
Exclusions none. Numerator: most recent outpatient BP on/after 2026-05-22. Readings:
- 2026-05-22 office I10 BP 146/72 — outpatient, systolic 146 high.
- 2026-06-26 office I10 BP 133/95 — outpatient, diastolic 95 high.
- 2026-08-24 Inpatient admission BP 112/84 — skip.
Most recent qualifying outpatient = 2026-06-26 BP 133/95, not below both. Non-compliant. But if 05-22 encounter during gap maybe still counts. If not, event could be 06-26 (also within first half, outpatient). Then numerator on/after 06-26 would only 06-26 BP 133/95 non-compliant and inpatient skip, still non-compliant. So same status.
Member 71054 DOB 1942-12-16 age 84. Enrollment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap 42 days. Eligible. Event: outpatient I10 Jan-Jun?
- 2026-03-21 office I10 (within, during enrolled? yes Jan-May)
- 2026-05-06 office I10 (within)
- 2026-06-05 inpatient S52 (not outpatient, after, during gap maybe no)
- 2026-10-28 office E78.5 after.
Qualifying first = 2026-03-21. Exclusions none. Numerator: most recent outpatient BP on/after 2026-03-21:
- 2026-03-21 office I10 BP 137/92 — outpatient, diastolic 92 high.
- 2026-05-06 office I10 BP 138/85 — outpatient, systolic 138<140, diastolic85<90 yes.
- 2026-06-05 Inpatient admission BP 132/76 skip.
- 2026-10-28 office E78.5 BP 132/95 — outpatient, diastolic 95 high.
Most recent qualifying outpatient = 2026-10-28 BP 132/95 not below. Non-compliant.
Member 71055 DOB 1940-08-21 age 86. Not eligible age. Not_eligible. (Even enrollment continuous, event exists but age >85.)
Member 71056 DOB 1942-01-17 age 84. Enrollment continuous. Event: 2026-01-19 office I10 (outpatient within Jan-Jun). Exclusions none. Numerator: most recent outpatient BP on/after 2026-01-19:
- 2026-01-19 office I10 BP 125/88 — outpatient, systolic 125<140 diastolic88<90 yes.
- 2026-03-20 office I10 BP 153/86 — outpatient, systolic 153 high.
Most recent qualifying outpatient = 2026-03-20 BP 153/86 not below. Non-compliant.
Need double-check numerator rules: "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic. Both components must be below the threshold. A reading taken in an emergency department or on an inpatient admission does not count and is skipped when identifying the most recent reading."
So "most recent outpatient blood pressure reading" means among outpatient readings (not ED/inpatient) on/after qualifying date. We used that. But note some office visits may be "Office visit" with BP. Inpatient/ED skipped. Good.
Need determine qualifying hypertension encounter date for members with multiple I10. Maybe "the qualifying hypertension encounter" could be the most recent/any? We need evaluate compliance maybe. Let's inspect scenarios where multiple I10 might matter.
Member 71043: Has first I10 02-12 and second 03-21. If qualifying encounter were first? If numerator "on or after date of the qualifying hypertension encounter" could be date of the first diagnosis? If instead use last qualifying I10 before Jun 30, then readings before second (02-12) not counted. But most recent overall after first is 10-02 anyway non-compliant. No difference.
Member 71047: First qualifying 06-17, next 07-25 after Jun. Most recent qualifying outpatient 07-25 (if after first). If qualifying encounter is 06-17; no difference.
Member 71052: first 04-08, then 06-04, 07-13. Qualifying first =04-08. Most recent outpatient after first is 07-13. If qualifying encounter maybe 04-08; no difference. If qualifying encounter could be last I10 before Jun30=06-04, then readings on/after 06-04: 06-04 high, 07-13 below, ED skip => compliant. same. But earlier 04-08 not counted, irrelevant.
Member 71054: first 03-21. Most recent outpatient after first is 10-28. If qualifying encounter maybe 05-06, after that readings: 05-06 yes, 10-28 high. same non-compliant.
Member 71056: first 01-19. Most recent after first 03-20. same.
Member 71050: first 06-23 only.
So no impact except possibly member 71053 if first qualifying during gap etc.
Need evaluate enrollment gaps carefully. Count gaps and lengths.
Let's parse each:
71041: continuous no gaps. Good.
71042: Enrollment 2026-01-01 through 2026-03-27; 2026-04-12 through 2026-06-29; 2026-07-12 through 2026-12-31. Gaps of 15 and 12 days. Two gaps of any length removes. Also age 86. Not_eligible due age and enrollment. We cite? Only status required lists. Need count not_eligible once. Not eligible either way. Not_eligible list.
71043: continuous. Good.
71044: continuous. Excluded E1.
71045: Enrolled 2026-04-05 through 2026-12-31, not before. Not full year. Not eligible. Good.
71046: one gap 58 days >45. Not eligible.
71047: continuous.
71048: continuous.
71049: one gap 33 days; qualifies enrollment. Event? no I10 Jan-Jun -> not eligible. Need think: continuous enrollment with one gap of 33 days allowed. It says "enrolled for the full measurement year with no more than one gap of up to 45 days." With gap 33, yes considered continuously enrolled. Good.
71050: continuous.
71051: gaps of 26 and 14 days = two gaps. Not eligible due enrollment. Even though hospice exclusion. Correct status not_eligible because enrollment fails before exclusions. Need confirm "Exclusions are evaluated before numerator, and only for members who are in eligible population": a member who fails age, event, or enrolment is not_eligible. So yes.
71052: one gap 45 days. Up to 45 means allowed exactly 45? Usually "up to 45 days" inclusive. We need count actual gap maybe between 2026-04-08 and 2026-05-24. If enrollment through 04-08 and resumes 05-24. Days not enrolled: Apr 9 through May 23 inclusive. Let's count: Apr 9-30 = 22 days, May 1-23 = 23 days, total 45. Yes exact. Allowed. So eligible.
71053: one gap 22 days. Eligible. Event? We need revisit event continuous enrollment and gap. Their qualifying event 2026-05-22 falls during gap. Does it count? Let's examine spec: "Event: at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." It doesn't say encounter must occur during enrollment. So 05-22 counts by date. Good. If there were no other, would still event? Yes.
But continuous enrolment: "enrolled for the full measurement year with no more than one gap of up to 45 days." Member 71053 has one gap 22 days, so considered enrolled full year. Thus event counts. Good.
71054: one gap 42 days. Eligible. Event 03-21 and 05-06 both during enrolled? 05-06 is last day enrolled? "through 2026-05-06", yes. Good. Noncompliant.
71055: age 86 not eligible.
71056: continuous.
Now need compute denominator, numerator, excluded, not_eligible counts and lists.
Let's assign statuses:
71041 non_compliant
71042 not_eligible (age, also enrollment gaps)
71043 non_compliant
71044 excluded (E1)
71045 not_eligible (enrollment)
71046 not_eligible (enrollment gap >45)
71047 compliant
71048 non_compliant
71049 not_eligible (no event)
71050 compliant
71051 not_eligible (enrollment two gaps; despite hospice)
71052 compliant
71053 non_compliant
71054 non_compliant
71055 not_eligible (age)
71056 non_compliant
Let's count:
Compliant: 71047, 71050, 71052 = 3.
Non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 = 6? Plus maybe? Let's count all non_compliant.
List non_compliant: 71041, 71043, 71048, 71053, 71054, 71056. Also? 71042 not eligible, 71044 excluded, 71045 NE, 71046 NE, 71047 C, 71049 NE, 71050 C, 71051 NE, 71052 C, 71055 NE. That's 6.
Denominator = compliant + non_compliant = 9.
Excluded = 1 (71044).
Not_eligible = 16 - 9 -1 = 6? Wait 16 total, denominator 9, excluded 1, not_eligible 6. Let's list not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 = 6. Yes.
Rate = numerator/denominator *100 = 3/9*100 = 33.333... rounded half up to one decimal = 33.3 (since third decimal 3). Need output 33.3.
Need ensure denominator after exclusions: eligible population after exclusions = compliant + non_compliant = 9. Excluded 1, not eligible 6. All 16.
Need consider if any other exclusions apply. E2 pregnancy none. E3 hospice: 71051 has hospice election 2026-10-27. But not eligible due enrollment. So not excluded. 71041 etc no. E4 died none.
Need double-check member 71044: E1 any time on/before 2026-12-31. Diagnosis 2024-06-20 N18.6, yes. Excluded. Good.
Now need output JSjson{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Haiku 4.5 · Anthropic39.4s · 6,744 out | 57.5s · 6,152 out | 102.7s · 11,610 out
Reasoning · 6,587 tokens
Let me work through this methodically for each member against the QM-CBP measure specification.
The measure is for 2026-01-01 through 2026-12-31.
**ELIGIBLE POPULATION (DENOMINATOR) CRITERIA:**
1. Age: 18-85 years as of 2026-12-31
2. Event: at least one outpatient encounter with I10 diagnosis on or between 2026-01-01 and 2026-06-30
3. Continuous enrollment: full measurement year with no more than one gap up to 45 days
**EXCLUSIONS (remove from denominator):**
- E1: N18.6 or Z99.2 on or before 2026-12-31
- E2: O00-O9A codes during measurement year
- E3: Hospice or palliative care during measurement year
- E4: Died during measurement year
**NUMERATOR:**
- Most recent outpatient BP reading (on or after qualifying encounter date, on or before 2026-12-31) is <140 systolic AND <90 diastolic
- Skip ED and inpatient readings when finding most recent
Let me go through each member:
---
**MEMBER 71041**
- DOB: 1941-07-25, age 85 on 2026-12-31 ✓ (18-85)
- Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Event (I10 on/between 2026-01-01 and 2026-06-30): 2026-02-18 office visit, I10 ✓
- Exclusions:
- E1 (N18.6, Z99.2): No
- E2 (O00-O9A): No
- E3 (Hospice): No
- E4 (Died): No
- **ELIGIBLE: YES, NOT EXCLUDED**
- Encounters:
- 2026-02-18: Office visit, I10, BP 150/72 (qualifying encounter)
- 2026-05-18: Inpatient admission, R07.9, BP 159/81 (skip, inpatient)
- Most recent valid outpatient BP is from the 2026-02-18 visit: 150/72
Numerator fails since 150 is not <140. **NON_COMPLIANT**
**MEMBER 71042**
- DOB: 1940-06-12, age 86 on 2026-12-31 — fails age cutoff (>85). **NOT_ELIGIBLE**
**MEMBER 71043**
- DOB: 1991-01-17, age 35 ✓
- Enrollment continuous 2026-01-01 to 2026-12-31, no gaps ✓
- Qualifying I10 encounters: 2026-02-12, 2026-03-21 — earliest 2026-02-12
- No exclusions found (N18.6/Z99.2, O00-O9A, hospice, death) — all No
- **ELIGIBLE: YES, NOT EXCLUDED**
- BP data: 2026-02-12 office visit shows 126/73
- 2026-03-21: 135/73
- 2026-05-22: E78.5 visit, 119/102
- 2026-10-02: E78.5 visit, 136/103 (most recent outpatient BP)
- Checking numerator: 136 <140 passes, but 103 fails <90.
- **NON_COMPLIANT**
**MEMBER 71044**
- DOB: 1956-05-26, age 70 ✓
- Enrollment continuous, no gaps ✓
- Qualifying I10 visit: 2026-04-23
- E1 exclusion applies: N18.6 diagnosed 2024-06-20 (ESRD)
- **EXCLUDED**
**MEMBER 71045**
- DOB: 1982-06-22, age 44 ✓
- Enrollment starts 2026-04-05, missing Jan-Mar coverage — not continuous for full year
**NOT_ELIGIBLE** (enrollment gap at start of year)
**MEMBER 71046**
- DOB: 1991-10-18, age 35 ✓
- Enrollment gap 04-26 to 06-24 = 59 days, exceeds 45-day allowance
- **NOT_ELIGIBLE**
**MEMBER 71047**
- DOB: 2008-04-06, age 18 ✓
- Enrollment continuous ✓
- Qualifying I10 visit: 2026-06-17
- No exclusions apply
- **ELIGIBLE, NOT EXCLUDED**
- BP readings from 2026-06-17 onward:
- 2026-06-17: 138/76
- 2026-07-25: 137/73
- 2026-11-21: inpatient admission, 118/88 (excluded, inpatient setting)
Most recent outpatient BP: 2026-07-25 at 137/73. Both values within threshold (<140/<90).
**COMPLIANT**
**MEMBER 71048**
- DOB: 1991-04-26, age 35 ✓
- Enrollment continuous ✓
- Qualifying I10 visit: 2026-05-15
- No exclusions apply
- **ELIGIBLE, NOT EXCLUDED**
- Only BP reading: 2026-05-15, 134/93
- Systolic passes (134<140) but diastolic fails (93 not <90)
- **NON_COMPLIANT**
**MEMBER 71049**
- DOB: 1965-05-12, age 61 ✓
- checking enrollment continuity next
Most recent BP: 2026-09-08, 129/71 - 129<140 and 71<90, both criteria met.
**COMPLIANT**
---
**MEMBER 71051**
- DOB: 1991-04-19, age 35 ✓
- Enrollment: three periods (2026-01-01 to 04-08; 05-05 to 08-07; 08-22 to 12-31)
- Gap 1: 04-08 to 05-05 = 26 days
- Gap 2: 08-07 to 08-22 = 14 days
- Two gaps present, but rule allows only one gap max
- **NOT_ELIGIBLE** (enrollment fails)
---
**MEMBER 71052**
- DOB: 1991-11-27, age 35 ✓
- Enrollment: 2026-01-01 to 04-08; 05-24 to 12-31
- Gap: 04-08 to 05-24 = 46 days, exceeds 45-day limit
- **NOT_ELIGIBLE** (enrollment fails)
---
**MEMBER 71053**
- DOB: 1942-08-07, age 84 ✓
- Enrollment: 2026-01-01 to 05-15; 06-07 to 12-31
- Gap: 05-15 to 06-07 = 23 days ✓
- Enrollment passes.
- I10 diagnosis events found: 05-22 office visit and 06-26 office visit, both within window
- Qualifying encounter = 2026-05-22
- All exclusions (E1-E4): No
- **ELIGIBLE, NOT EXCLUDED**
- BP readings from 05-22 onward:
- 05-22: 146/72
- 06-26: 133/95
- 08-24: Inpatient admission, R (diagnosis unclear)
---
**MEMBER 71054**
- DOB: 1942-12-16, age 84 ✓
- Enrollment: 2026-01-01 to 05-06; 06-18 to 12-31
- Gap: 05-06 to 06-18 = 43 days ✓
- Enrollment passes.
- I10 events: 03-21 and 05-06 office visits
- Qualifying encounter = 2026-03-21
- All exclusions (E1-E4): No
- **ELIGIBLE, NOT EXCLUDED**
- BP readings from 03-21 onward:
- 03-21: 137/92
- 05-06: 138/85
- 06-05: Inpatient admission (skip)
- 10-28: Office visit, E78.5, BP 132/95
- Most recent qualifying outp
---
**MEMBER 71055**
- DOB: 1940-08-21, age 86 ✗ (>85)
- **NOT_ELIGIBLE**
---
**MEMBER 71056**
- DOB: 1942-01-17, age 84 ✓
- Enrollment 2026-01-01 to 12-31, continuous ✓
- I10 events: 01-19 and 03-20
- Qualifying encounter = 2026-01-19
- Exclusions all No
- **ELIGIBLE, NOT EXCLUDED**
- BP readings: 01-19 (125/88), 03-20 (153/86)
- Most recent = 03-20, BP 153/86
- 153 not <140 → **NON_COMPLIANT**
**SUMMARY:**
Compliant: 71047, 71050
Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056
Excluded: 71044 (N18.6)
Not eligible: 71042, 71045, 71046, 71049, 71051, 71052, 71055
Denominator = 8, Numerator = 2, Rate = 25.0%
Total members = 2+6+1+7 = 16 ✓
Verifying 71052's gap: April 8 to May 24 spans 46 days, exceeding the 45-day threshold. Let me double check this count more carefully.
From April 8 (last enrolled) to May 24 (re-enrolled), the uncovered days are April 9-30 (22 days) plus May 1-23 (23 days) = 45 days total gap - which falls within the allowed threshold. This is a boundary case worth confirming carefully since the spec permits gaps "up to 45 days."
**71052 should be ELIGIBLE** - the 45-day gap meets criteria exactly.
Rechecking the full profile:
- DOB 1991-11-27, age 35 ✓
- Enrollment gap of exactly 45 days ✓ (qualifies)
- I10 diagnosis present on 2026-04-08 and 2026-06-04, within the required window ✓
- No exclusions triggered (E1-E4 all No)
- **Result: ELIGIBLE, NOT EXCLUDED**
For numerator, checking encounters after 2026-04-08:
- 2026-04-08: BP 121/76
- 2026-06-04: BP 149/73
- 2026-07-13: BP 127/73 (most recent qualifying outpatient)
- 2026-07-16: ED visit - excluded from consideration
Most recent valid BP reading (2026-07-13): 127/73 — both values pass (<140 and <90).
**71052 is COMPLIANT**, not NOT_ELIGIBLE as previously assessed.
Revised summary:
- Compliant: 71047, 71050, 71052
- Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056
- Excluded: 71044 (N18.6)
- Not eligible: 71042, 71045, 71046, 71049, 71051, 71055
Denominator = 3 + 6 = 9; Numerator = 3
Rate = 33.3%
Verifying 71046's gap: April 27–June 23 spans 58 days (4+31+23), exceeding the 45-day threshold — NOT_ELIGIBLE confirmed.
Verifying 71051: two distinct gaps disqualify per the single-gap rule — NOT_ELIGIBLE confirmed.
Final tallies:
- Compliant (3): 71047, 71050, 71052
- Non-compliant (6): 71041, 71043, 71048, 71053, 71054, 71056
- Excluded (1): 71044
- Not eligible (6): 71042, 71045, 71046, 71049, 71051, 71055
Total = 16 ✓
Denominator = 9, Numerator = 3, Rate = 3/9 × 100 = 33.3%
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,995 tokens
Let me work through each member systematically against the measure specification.
## MEASURE CRITERIA RECAP:
**ELIGIBLE POPULATION (denominator):**
1. Age: 18-85 on 2026-12-31
2. Event: At least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
3. Continuous enrollment: Full measurement year with no more than one gap up to 45 days
**EXCLUSIONS (remove from denominator):**
- E1: End stage renal disease (N18.6) or dialysis dependence (Z99.2) by 2026-12-31
- E2: Pregnancy (O00-O9A) during measurement year
- E3: Hospice or palliative care during measurement year
- E4: Death during measurement year
**NUMERATOR (of denominator):**
- Most recent outpatient BP reading (on or after qualifying encounter date, on or before 2026-12-31) is <140 systolic AND <90 diastolic
- Skip ED and inpatient BP readings
- If no qualifying reading, member is in denominator but not numerator
---
## MEMBER 71041
- DOB: 1941-07-25 → Age 85 on 2026-12-31 ✓
- Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Qualifying encounter: 2026-02-18, Office visit, I10 ✓ (within 01-01 to 06-30)
- Exclusions: No ESRD, no pregnancy, no hospice, alive ✓
- **ELIGIBLE (DENOMINATOR)**
- Qualifying encounter date: 2026-02-18
- BP readings on/after 2026-02-18, on/before 2026-12-31:
- 2026-02-18: Office visit, BP 150/72 (most recent outpatient)
- 2026-05-18: Inpatient, BP 159/81 (skipping this one, inpatient doesn't count)
- Latest outpatient reading is 150/72 — systolic fails the <140 threshold
- **NON-COMPLIANT**
---
## MEMBER 71042
- DOB: 1940-06-12 → turns 86 by 2026-12-31, exceeding the age ceiling
- **NOT ELIGIBLE**
---
## MEMBER 71043
- DOB: 1991-01-17 → age 35 at year-end ✓
- Full-year enrollment, no gaps ✓
- Qualifying I10 encounter on 2026-02-12 falls in the first-half window ✓
- No exclusions apply (ESRD, pregnancy, hospice, death) ✓
- **ELIGIBLE (DENOMINATOR)**, qualifying date 2026-02-12
- Reviewing BP readings from 2026-02-12 forward:
- 02-12: 126/73 ✓
- 03-21: 135/73 ✓
- 05-22: 119/102 (systolic fine but diastolic 102 fails)
- 10-02: 136/103 — occurs after the qualifying window but still counts toward numerator since it's post-qualifying-encounter
- Need to identify the most recent outpatient reading among these to determine compliance.
Most recent is 10-02, BP 136/103 — diastolic 103 ≥ 90 fails control criteria.
**NON-COMPLIANT**
---
## MEMBER 71044
DOB 1956-05-26, age 70 ✓, full enrollment ✓, qualifying I10 visit 2026-04-23 within window. However ESRD diagnosis (N18.6, 2024-06-20) triggers exclusion E1.
**EXCLUDED**
---
## MEMBER 71045
Age 44 ✓, but enrollment starts 2026-04-05 — missing Jan-early April coverage, so not continuously enrolled for the full measurement year.
**NOT ELIGIBLE**
---
## MEMBER 71046
Age 35 ✓, enrollment split with a 58-day gap (04-26 to 06-24), exceeding the 45-day allowance.
**NOT ELIGIBLE**
---
## MEMBER 71047
DOB 2008-04-06 → turns 18 by year-end ✓, enrollment appears continuous through 2026-12-31, need to confirm details.
Qualifying encounter 2026-06-17, I10, within first-half window. No exclusions apply — ESRD, pregnancy, hospice all absent, member alive.
**ELIGIBLE (DENOMINATOR)**
Checking BP readings from 06-17 onward: 06-17 shows 138/76, 07-25 shows 137/73, and 11-21 is inpatient so excluded from consideration. Most recent outpatient reading (07-25) is well-controlled at 137/73.
**COMPLIANT**
---
## MEMBER 71048
DOB 1991-04-26 → age 35 ✓, enrollment continuous full year ✓. Qualifying visit 2026-05-15, I10, falls in window. No exclusions present.
**ELIGIBLE (DENOMINATOR)**
Looking at BP values starting 05-15: first reading shows 134/93 — systolic passes but diastolic 93 fails the <90 threshold.
ice visit, J06.9, BP 129/71 ✓ - both readings compliant, latest 129/71 confirms **COMPLIANT**
---
MEMBER 71051: DOB 1991-04-19, age 35 ✓. Enrollment has two gaps (26 and 14 days) - rule states two or more gaps of any length disqualifies regardless of individual gap length. **NOT ELIGIBLE**
---
MEMBER 71052: DOB 1991-11-27, age 35 ✓. Enrollment gap of exactly 45 days, within limit ✓. Qualifying encounter 2026-04-08, I10, falls in window ✓. Checking exclusions next - no ESRD, no pregna
t, I10, BP 133/95 (systolic 133 < 140 but diastolic 95 ≥ 90) ✗
- 2026-08-24: Inpatient, R07.9, BP 112/84 (SKIP - inpatient)
- Most recent outpatient reading: 2026-06-26, BP 133/95 ✗
- **NON-COMPLIANT**
---
## MEMBER 71054
- DOB: 1942-12-16 → Age 84 ✓
- Enrollment: 2026-01-01 to 2026-05-06; 2026-06-18 to 2026-12-31. Gap 42 days ✓
- Qualifying encounter: 2026-03-21, Office visit, I10 ✓
- No exclusions apply
- **ELIGIBLE (DENOMINATOR)**
- BP readings from 2026-03-21 onward:
- 2026-03-21: 137/92 ✗ (diastolic too high)
- 2026-05-06: 138/85 ✓
- 2026-06-05: Inpatient, skip
- 2026-10-28: 132/95 ✗ (diastolic too high)
- Most recent outpatient reading: 2026-10-28, BP 132/95 ✗
- **NON-COMPLIANT**
---
## MEMBER 71055
- DOB: 1940-08-21 → Age 86 ✗
- **NOT ELIGIBLE** (age > 85)
---
## MEMBER 71056
- DOB: 1942-01-17 → Age 84 ✓
- Enrollment continuous through 2026 ✓
- Qualifying encounter: 2026-01-19, Office visit, I10 ✓
- No exclusions apply
- **ELIGIBLE (DENOMINATOR)**
- BP readings:
- 2026-01-19: 125/88 ✓
- 2026-03-20: 153/86 ✗ (systolic too high)
- Most recent outpatient reading: 2026-03-20, BP 153/86 ✗
- **NON-COMPLIANT**
---
Compiling final totals now.
**DENOMINATOR:** 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056 — Total: 9
**NUMERATOR:** 71047, 71050, 71052 — Total: 3
**NON-COMPLIANT:** 71041, 71043, 71048, 71053, 71054, 71056
**EXCLUDED:** 71044 (ESRD)
**NOT ELIGIBLE:** 71042, 71045, 71046, 71049, 71051, 71055 — Total: 6
Checking: 9 + 1 + 6 = 16, matching the full roster (71041-71056).
Rate = 3/9 = 33.3%
Now verifying each member once more for accuracy:
**71041**: Age 85, continuous enrollment, qualifying encounter 02-18 I10, no exclusions. Most recent BP 150/72 — systolic too high, non-compliant. Denominator, non-compliant confirmed.
**71042**: Age 86 — not eligible confirmed.
**71043**: Age 35, continuous enrollment, qualifying encounter 02-12 I10 confirmed.
**71044**: Age 70, continuous enrollment, qualifying encounter 04-23 I10, but ESRD diagnosis (N18.6) triggers E1 exclusion. Excluded confirmed.
**71045**: Enrollment starts 04-05, not full-year — not eligible confirmed.
**71046**: 58-day gap exceeds 45-day threshold — not eligible confirmed.
**71047**: Age 18, continuous enrollment, qualifying encounter 06-17 I10, no exclusions. Most recent BP 137/73 — both under threshold, compliant. Denominator, compliant confirmed.
**71048**: Age 35, continuous enrollment, qualifying encounter 05-15 I10, no exclusions. BP 134/93 — diastolic too high, non-compliant. Denominator, non-compliant confirmed.
**71049**: Age 61, one 33-day gap acceptable. Checking for qualifying I10 encounter within Jan-June window — all recorded I10 encounters fall outside this range.
Not eligible — no qualifying encounter in window.
**71050**: Age 84, continuous enrollment, qualifying encounter 06-23, no exclusions. BP 129/71 — compliant. Denominator, compliant.
**71051**: Two enrollment gaps (26 and 14 days) — not eligible.
**71052**: Single 45-day gap acceptable, qualifying encounter 04-08, no exclusions. BP 127/73 — compliant. Denominator, compliant.
**71053**: 22-day gap acceptable, qualifying encounter 05-22, no exclusions. BP 133/95 — diastolic elevated, non-compliant. Denominator, non-compliant.
**71054**: 42-day gap acceptable, qualifying encounter 03-21, no exclusions. BP 132/95 — non-compliant. Denominator, non-compliant.
**71055**: age check pending
**71055**: Age 86 as of year-end — not eligible.
**71056**: Age 84, continuous enrollment, qualifying encounter 01-19, no exclusions. BP 153/86 — systolic too high, non-compliant. Denominator, non-compliant.
Tallying results:
- Denominator (9): 71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056
- Compliant (3): 71047, 71050, 71052
- Non-compliant (6): 71041, 71043, 71048, 71053, 71054, 71056
- Excluded (1): 71044
- Not eligible (6): 71042, 71045, 71046, 71049, 71051, 71055
Rate = 3/9 = 33.3%
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
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"fabricated": false,
"abstained": false
}Reasoning · 11,453 tokens
Let me work through this measure population task systematically for QM-CBP — Blood Pressure Control in Hypertension for 2026.
**Measure Requirements:**
**Eligible Population (denominator):**
1. Age 18-85 as of 2026-12-31
2. Event: at least one outpatient encounter with hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30
3. Continuous enrollment for full measurement year with no more than one gap of up to 45 days
**Numerator:**
- Most recent outpatient BP reading (on or after qualifying hypertension encounter, on or before 2026-12-31) is <140 systolic AND <90 diastolic
- Skip ED and inpatient readings when finding most recent
**Exclusions (before scoring):**
- E1: ESRD (N18.6) or dialysis dependence (Z99.2) any time on or before 2026-12-31
- E2: Pregnancy (O00-O9A) during measurement year
- E3: Hospice or palliative care during measurement year
- E4: Died during measurement year
**Member Analysis:**
**MEMBER 71041** (DOB 1941-07-25, age 85 on 2026-12-31)
- Age: 85 ✓
- Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Qualifying I10 encounter: 2026-02-18 (office visit) - within 2026-01-01 to 2026-06-30 ✓
- Exclusions: None documented ✓
- In denominator
- Most recent BP reading eligible: 2026-02-18 office visit BP 150/72
- 150 systolic is NOT < 140, so does not meet numerator
- Status: **non_compliant**
**MEMBER 71042** (DOB 1940-06-12, age 86 on 2026-12-31)
- Age 86 exceeds the 85-year cutoff
- Status: **not_eligible** (fails age requirement)
**MEMBER 71043** (DOB 1991-01-17, age 35 on 2026-12-31)
- Age: 35 ✓
- Enrollment continuous from 2026-01-01 through 2026-12-31, no gaps ✓
Qualifying encounter present 2026-02-12, placing them in the denominator with no exclusions. Checking BP readings: 126/73 (2/12), 135/73 (3/21), 119/102 (5/22) - diastolic fails, 136/103 (10/2) - diastolic fails again. Most recent reading 10/2 has systolic 136 <140 but diastolic 103 not <90.
- Status: **non_compliant**
**MEMBER
71044** age 70, enrolled all year, qualifying encounter 4/23. Found N18.6 ESRD diagnosis from 2024-06-20 triggering E1.
- Status: **excluded** (E1)
**MEMBER 71045** age 44, enrollment starts 2026-04-05 - not continuously enrolled for full year, fails enrollment requirement.
**MEMBER 71046** age 35, enrollment has a 58-day gap (4/26-6/24), exceeding 45-day threshold - fails enrollment requirement.
**MEMBER 71047** age 18, enrolled continuously all year.
Qualifying encounter found 6/17 office visit within measurement window, no exclusions - included in denominator. Checking BP readings chronologically: 6/17 (138/76), 7/25 (137/73), then 11/21 inpatient admission (excluded as inpatient setting). Most recent eligible reading is 7/25 at 137/73, both under threshold - **compliant**.
**MEMBER 71048** age 35, continuous enrollment confirmed.
AFTER 2026-06-30, doesn't qualify
- 2026-11-28 ED visit R07.9 - not I10
- 2026-12-25 office visit I10 - also after window
- No qualifying encounter found
- Status: **not_eligible** (no I10 event in 2026-01-01 to 2026-06-30 window)
**MEMBER 71050** (DOB 1942-01-04, age 84 on 2026-12-31)
- Age: 84 ✓
- Enrollment: continuous full year, no gaps ✓
- Qualifying I10 encounter: 2026-06-23 office visit ✓
Exclusions none documented, so member is in denominator. Checking most recent BP: 2026-06-23 shows 122/84, but 2026-09-08 office visit (dx J06.9) has BP 129/71, which is later and still counts. Using 129/71 as most recent - both under threshold (129<140, 71<90). Status: **compliant**.
**MEMBER 71051** (DOB 1991-04-19, age 35)
- Age qualifies ✓
- Enrollment has gaps: 2026-01-01 to 04-08, 2026-05-05 to 08-07, 2026-08-22 to 12-31, with gaps of 26
and 14 days - two separate gaps. Since two or more gaps of any length removes the member from the denominator, this fails the enrollment requirement, making the member not_eligible. Checking for other disqualifiers too - noting a 2026-10-27 hospice election entry to review.
That hospice date would normally trigger an E3 exclusion, but since enrollment already fails, exclusion checks are moot - not_eligible takes precedence.
**MEMBER 71052** (DOB 1991-11-27, age 35 on 2026-12-31)
- Age: 35 ✓
- Enrollment
: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31, with a single 45-day gap - right at the "up to 45 days" threshold, so allowed
- Enrollment: ✓
- Qualifying I10 encounter: 2026-04-08 office visit with I10 diagnosis, falls within 2026-01-01 to 2026-06-30 ✓
- Exclusions: none documented ✓
- In denominator
- Checking most recent BP on/after 2026-04-08 through year-end: 04-08 reads 121/76, 06-04 reads 149/73 (systolic too high), 07-13 reads 127/73
✓, then 07-16 is an ED visit so it's skipped. The 07-13 reading (127/73) becomes the most recent eligible one, and both values fall under threshold.
- Status: **compliant**
**MEMBER 71053** (age 84)
- Enrollment: two segments totaling a 22-day gap, meets continuous enrollment ✓
- Qualifying I10 encounter on 2026-05-22, within the required window ✓
- No exclusions found
- In denominator
- BP readings: 05-22 shows 146/72 (systolic fails), 06-26 shows 133/95 (diastolic fails)
visit BP 132/95 - 132<140 but 95 is NOT <90, so this is the most recent reading
- Status: **non_compliant**
**MEMBER 71055** (age 86) - exceeds 85 threshold, **not_eligible**
**MEMBER 71056** (age 84 on 2026-12-31)
- Enrollment continuous full year ✓
- Qualifying I10: 2026-01-19 office visit within first half ✓
- No exclusions, in denominator
- Checking most recent BP reading eligible (
on or after 2026-01-19): 2026-01-19 shows 125/88 (compliant), but 2026-03-20 is more recent at 153/86 - 153 fails threshold
- Status: **non_compliant**
Compiling final summary across all members: 71041 non_compliant, 71042 not_eligible (age), 71043 non_compliant, 71044 excluded (ESRD), 71045 not_eligible (enrollment gap), 71046 not_eligible (gap >45 days), 71047 compliant, 71048 non_compliant, 71049 not_eligible (missing data)...
continuing: 71050 compliant, 71051 not_eligible, 71052 compliant, 71053-71054 non_compliant, 71055 not_eligible (age), 71056 non_compliant
Tallying: denominator = 9 members, numerator = 3 (71047, 71050, 71052), excluded = 1 (71044), not_eligible = 6. Total checks out at 16.
Rate = 3/9 × 100 = 33.3%.
Verifying spot checks: 71041's latest eligible reading is 2026-02-18 at 150/72 (the later inpatient encounter doesn't count), so 150 fails the <140 threshold — non_compliant confirmed. Checking 71043's visit history next to confirm its classification.
visit J06.9 BP 129/71. 129 < 140 AND 71 < 90, so compliant. ✓
**71052** - checking encounters:
- 2026-04-08 office visit I10 BP 121/76 - qualifying
- 2026-06-04 office visit I10 BP 149/73
- 2026-07-13 office visit I10 BP 127/73
- 2026-07-16 ED visit, skip
Most recent eligible 2026-07-13 BP 127/73, both under threshold, compliant. ✓
**71053** - checking 2026-05
Wait, I need to reconsider the full list:
- 2026-05-22 office visit I10 BP 146/72 - qualifying
- 2026-06-26 office visit I10 BP 133/95
- 2026-08-24 inpatient, skip
Most recent eligible is 2026-06-26 BP 133/95, 95 not < 90, non_compliant. ✓
**71054** - checking:
- 2026-03-21 office visit I10 BP 137/92 - qualifying
- 2026-05-06 office visit I10 BP 138/85
- 2026-06-05 inpatient, skip
- 2026-10-28 office visit E78.5 BP 132/95
Most recent eligible 2026-10-28 BP 132/95, 95 fails threshold.
**71056** - checking:
- 2026-01-19 qualifying encounter BP 125/88
- 2026-03-20 BP 153/86
Most recent 153/86, systolic fails, non_compliant.
I realize the numerator specifically requires the reading be on or after the qualifying encounter date - readings before don't count. Need to double-check cases like 71043 where I should verify the qualifying date carefully.
**71043** - Qualifying encounter 2026-02-12. Readings after: 2026-02-12 (126/73), 2026-03-21 (135/73), 2026-05-22 (119/102), 2026-10-02 (136/103). Most recent 2026-10-02, 136/103, matches earlier finding.
**71048** - Qualifying encounter 2026-05-15, only reading is that same day, 134/93, unchanged.
**71050** - Qualifying encounter 2026-06-23, continuing to check readings after this date.
be ≤ 85 on that date, confirming 71042 (age 86) and 71055 (age 86) are both not_eligible.
Double-checking gaps for 71042: enrollment spans 01-01 to 03-27, 04-12 to 06-29, 07-12 to 12-31. Gap 1 = 15 days (03-28 to 04-11), Gap 2 = 12 days (06-30 to 07-11). Max gap 15 days stays within the 45-day allowance.
But there are two separate gaps here, and per the rule, two or more gaps of any length disqualifies the member regardless of length. Combined with age 86, 71042 is not_eligible on both counts.
**71046:** gap from 2026-04-27 to 2026-06-23: 4+31+23 = 58 days, exceeding 45. not_eligible.
**71049:** checking gap from 2026-06-27 to 2026-07-29...
4+29 = 33 days, within tolerance, so enrollment is fine. However no qualifying I10 encounter falls between 2026-01-01 and 2026-06-30 — the 2026-08-25 visit is too late. not_eligible due to missing event.
**71051:** three enrollment periods with gaps to check. First gap 2026-04-09 to 2026-05-04: April portion alone is 22 days so far...
Adding May 1-4 gives 26 days total for gap 1. Gap 2 (2026-08-08 to 2026-08-21) totals 14 days. Two separate gaps trigger not_eligible regardless of the E3 hospice election on 2026-10-27.
**71052:** single gap from 2026-04-09 to 2026-05-23 — April contributes 22 days, May adds 23, totaling exactly 45 days.
45 days falls within the "up to 45 days" allowance, so eligible.
**71053:** gap from 2026-05-16 to 2026-06-06 — 16 days in May plus 6 in June = 22 days, well under the limit ✓
**71054:** checking gap from 2026-05-07 to 2026-06-
17: 25 days in May, 17 in June, totaling 42 days — still under 45 ✓
All enrollment gaps check out. Compiling final results:
**Compliant:** 71047, 71050, 71052
**Non-compliant:** 71041, 71043, 71048, 71053, 71054, 71056
**Excluded:** 71044 (ESRD, E1 code N18.6)
**Not eligible:** 71042 (age exceeds 85), 71045 (incomplete year enrollment), 71046 (gap exceeds 45 days)
Also adding: 71049 (missing qualifying I10 encounter), 71051 (two separate gaps), 71055 (age exceeds 85).
Tallying: denominator = 3 + 6 = 9, numerator = 3, excluded = 1, not eligible = 6, total = 16 ✓ matches.
Rate = 3/9 × 100 = 33.333...%, which rounds to 33.3 (half-up, one decimal place) since the next digit is 3, staying under 5.
Now reconsidering 71045 — checking the continuous enrollment rule again.
The measurement year spans 2026-01-01 to 2026-12-31, but this member only enrolled starting 2026-04-05. That's not a mid-year gap after prior enrollment — they simply weren't enrolled at the start. Since full-year enrollment is required, missing the first ~3 months means they fail the requirement, making them not_eligible.
For 71049: enrolled 2026-01-01 through 2026-06-26 and 2026-07-30 through 2026-12-31, so full-year coverage with a single 33-day gap — enrollment passes. But checking their qualifying event window (2026-01-01 to 2026-06-30 for I10 diagnosis), their only visible encounter is 2026-08-25, which falls outside that window.
Also 2026-11-28 ED visit is R07.9, not I10, and 2026-12-25 I10 encounter is again after 2026-06-30. No qualifying encounter exists, so 71049 is not_eligible.
Rechecking denominator membership: 71041 passes age (85) and has I10 on 2026-02-18, satisfying the qualifying event window.
Continuing through the roster: 71042 fails age at 86. 71043 qualifies with age 35 and I10 on 2026-02-12. 71044 has a qualifying I10 (04-23) but ESRD triggers E1, so excluded. 71045 fails enrollment continuity. 71046 fails due to gap exceeding 45 days.
18 ✓, I10 on 2026-06-17 ✓, full enrollment ✓, no exclusions ✓ → DENOMINATOR. 71048 similarly qualifies at age 35 with I10 05-15. 71049 lacks any I10 diagnosis in the period, disqualifying. 71050 age 84 with I10 06-23 clears all checks. 71051 fails from two enrollment gaps.
Continuing: 71052 age 35 qualifies despite a 45-day gap since only one gap exists. 71053 and 71054 both age 84 pass cleanly with I10 dates 05-22 and 03-21 respectively. 71055 fails age requirement at 86. 71056 age 84 with I10 01-19 clears.
Denominator: 71041, 71043, 71047, 71048, 71050, 71052.
< 140 ✓, 71 < 90 ✓ → COMPLIANT
Continuing through the rest: 71052 (127/73) compliant, 71053 (133/95) non-compliant since 95≥90, 71054 (132/95) non-compliant, 71056 (153/86) non-compliant since 153≥140.
So numerator = 71047, 71050, 71052 = 3 members compliant.
Denominator: 9 total, numerator: 3, excluded: 1 (71044), not eligible: 6. Rate = 3/9 = 33.3%.
Cross-checking the four member buckets — compliant {71047,71050,71052}, non-compliant {71041,71043,71048,71053,71054,71056}, excluded {71044}, not eligible {71042,71045,71046,71049,71051,71055} — they're disjoint and account for all 16 members.
Before finalizing, I want to re-verify BP readings, starting with 71041's timeline: office visit 2/18 showed 150/72, then an inpatient admission 5/18 with 159/81 which doesn't count toward eligibility.
Most recent eligible reading is 150/72 - systolic 150 fails the <140 threshold, so not compliant.
For 71043, qualifying encounter is 2/12. Scanning eligible visits after that: 2/12 (126/73), 3/21 (135/73), 5/22 (119/102), 10/02 (136/103). Most recent is 10/02 at 136/103 - systolic passes but diastolic 103 fails <90, so not compliant.
**71047:**
- Qualifying encounter: 2026-06-17
- Eligible visits after: 6/17 (138/76), 7/25 (137/73), and 11/21 inpatient (excluded)
Most recent: 7/25 BP 137/73 - both systolic and diastolic pass, compliant ✓
**71048:**
- Qualifying encounter: 2026-05-15
- Only eligible visit: 5/15 BP 134/93
Systolic 134 passes but diastolic 93 fails the <90 threshold - non-compliant ✗
**71050:**
- Qualifying encounter: 2026-06-23
- Visits after: 6/23 (122/84), 9/08 J06.9 (129/71)
Most recent: 9/08 BP 129/71 - both thresholds pass, compliant ✓
**71052:**
- Qualifying encounter: 2026-04-08
- Visits after: 4/08 (121/76), 6/04 (149/73)
140? YES ✓, but diastolic 95 < 90? NO ✗ — fails numerator.
**71054:**
Qualifying encounter 2026-03-21. Reviewing subsequent readings, skipping the inpatient stay on 2026-06-05:
- 2026-03-21 BP 137/92
- 2026-05-06 BP 138/85
- 2026-10-28 BP 132/95 (most recent eligible)
Systolic 132 < 140 ✓, diastolic 95 < 90 ✗ — fails numerator.
**71056:**
Qualifying encounter 2026-01-19. Readings: 2026-01-19 BP 125/88, 2026-03-20 BP 153/86 (most recent).
Systolic 153 < 140? NO ✗ — fails numerator.
All determinations confirmed. Final tally: denominator 9, numerator 3, excluded 1, not_eligible 6, rate 33.3%. Compliant: 71047, 71050, 71052. Non-compliant: 71041, 71043, 71048, 71053, 71054, 71056. Excluded: 71044.
json{
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"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
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"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}67GPT-5.6 Terra · OpenAI5.1s · 436 out | 6.4s · 500 out | 6.8s · 546 out
json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 10,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 40.0,
"compliant_members": ["71047", "71049", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 10,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 4,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 5,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 40,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71049",
"71050",
"71052"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71051",
"71055"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}33GPT-5.6 Luna · OpenAI6.5s · 554 out | 6.0s · 573 out | 12.4s · 633 out
json{"denominator":9,"numerator":3,"excluded":2,"not_eligible":5,"rate":33.3,"compliant_members":["71047","71050","71052"],"non_compliant_members":["71041","71043","71048","71053","71054","71056"],"excluded_members":["71044","71051"],"not_eligible_members":["71042","71045","71046","71049","71055"]}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 2,
"ok": false,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 5,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044",
"71051"
],
"ok": false,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71055"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 9,
"numerator": 3,
"excluded": 2,
"not_eligible": 5,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044", "71051"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 2,
"ok": false,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 5,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044",
"71051"
],
"ok": false,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71055"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}33DeepSeek V4 Flash · DeepSeek145.4s · 8,639 out | 291.8s · 17,992 out | 83.0s · 4,285 out
Reasoning · 8,493 tokens
We need answer JSON only. Need evaluate each member. Need pay attention measure spec. Need identify denominator eligibility, exclusions, numerator. Need list counts. Let's parse.
We have 16 members. Need for each:
- Eligible population age 18-85 as of 2026-12-31. So age = 2026 minus birth if birthday passed by Dec 31. Born 1941-07-25 -> age 85 on 2026-12-31 yes included if <=85. Born 1940-06-12 -> 86 -> not eligible. Born 1940-08-21 -> 86 -> not eligible. Others eligible age.
- Event: at least one outpatient encounter with hypertension diagnosis I10 on/between 2026-01-01 and 2026-06-30. Need outpatient. "Office visit" likely outpatient. Emergency department or inpatient not outpatient? The numerator says reading in ED/inpatient doesn't count. Eligible event says outpatient encounter with I10. So inpatient/ED encounters with I10? The measure specifically "outpatient encounter". So ED/inpatient do not count for event. Need determine each. Also encounter after June 30 no event. Need continuous enrolment full measurement year no more than one gap up to 45 days. Gaps? Continuous enrolment means enrolled from Jan 1 through Dec 31 no more than one gap. Need assess gaps.
- Exclusions: ESRD N18.6 or Z99.2 any time before Dec31; pregnancy during 2026; hospice/palliative during 2026; died in year.
Need assign to exactly one status.
Let's go member by member.
Member 71041: DOB 1941-07-25, age 85 on 2026-12-31? Born 1941, turns 85 on 2026-07-25; yes age 85 eligible age. Enrolment continuous. Encounters: 2026-02-18 office visit dx I10 -> qualifies event. BP 150/72. 2026-05-18 inpatient dx R07.9 BP 159/81 (not outpatient, and no I10; not relevant). Numerator: most recent outpatient BP reading on/after event date (2026-02-18) and <= 2026-12-31. The office visit on 2026-02-18 is qualifying reading? Need determine most recent outpatient BP reading after qualifying hypertension encounter. There is also inpatient reading not count. Only outpatient reading is 150/72. Need both below 140 and 90: systolic 150 not <140 => not controlled. No exclusions. So non_compliant. denominator yes, numerator no.
Member 71042: DOB 1940-06-12, 86 at end -> not_eligible, regardless. So not_eligible. Enrolment gaps? not needed but note. not_eligible list includes 71042.
Member 71043: DOB 1991-01-17 age 35. Enrolment continuous. Encounters: 2026-02-12 Office dx I10 qualifies event. Subsequent outpatient readings after event: 2026-02-12 BP126/73, 2026-03-21 BP135/73, 2026-05-22 BP119/102, 2026-10-02 BP136/103. Most recent outpatient reading on/before 2026-12-31 is 2026-10-02 136/103, diastolic 103 not <90 => not controlled. Need maybe note all office visits qualify as outpatient readings even if dx not I10? The numerator: "most recent outpatient blood pressure reading taken on or after date of qualifying hypertension encounter... A reading taken in emergency department or inpatient doesn't count." It doesn't say reading must be associated with hypertension diagnosis? It says outpatient blood pressure reading. So office visits with E78.5 have BP readings and count, yes. So most recent is 10/02. Non-compliant. No exclusions. 71043 non_compliant.
Member 71044: DOB 1956-05-26 age 70. Enrolment continuous. Encounters: 2026-04-23 Office dx I10 qualifies event. BP 152/76. Other history: 2024-06-20 N18.6 ESRD. Exclusion E1 any time on/before 2026-12-31 => excluded. Even though numerator not controlled if scored, exclusion before numerator. Status excluded. 71044 excluded.
Member 71045: DOB 1982-06-22 age 44. Enrolment: 2026-04-05 through 2026-12-31 continuous from that date. Not enrolled before. Full measurement year? "enrolled for the full measurement year with no more than one gap of up to 45 days." Full measurement year means enrolled Jan 1 to Dec31? Missing Jan 1-Apr4 = gap greater than 45? Actually not enrolled before 2026-04-05, so not enrolled for full measurement year. Need determine if this is a "gap" of 95 days? The continuous enrolment criterion generally requires no more than one gap up to 45 days. A gap at beginning? Since member not enrolled before Apr 5, missing 94 days in measurement year (Jan1-Apr4). That is likely a gap of 94 days >45, or otherwise not full year enrolment. Not eligible (enrolment failure). Also event: 2026-05-23 office dx I10 qualifies. But enrolment fails -> not_eligible. So 71045 not_eligible. Let's verify maybe "enrolled for the full measurement year" means could enroll after start if continuous from there? It says no more than one gap of up to 45 days, but a gap longer than 45 removes. Missing from 2026-01-01 to 2026-04-05 = 95 days, so not full. not_eligible.
Member 71046: DOB 1991-10-18 age 35. Enrolment 2026-01-01 through 2026-04-26; 2026-06-24 through 2026-12-31. One gap of 58 days (Apr27-Jun23). Longer than 45 days => removes from denominator. So not_eligible (enrolment failure). Encounters: 2026-03-08 Office dx I10 event; but enrolment fail => not_eligible. 71046 not_eligible.
Member 71047: DOB 2008-04-06, age 18 as of 2026-12-31? Born 2008, turns 18 on 2026-04-06, eligible. Enrolment continuous. Encounters: 2026-06-17 Office dx I10 qualifies event. 2026-07-25 Office dx I10 BP 137/73. 2026-11-21 Inpatient admission dx I10 BP 118/88 (inpatient doesn't count for numerator reading). Most recent outpatient reading on/after event: 2026-07-25 BP 137/73 (below 140 and below 90) -> compliant. No exclusions. 71047 compliant.
Member 71048: DOB 1991-04-26 age 35. Enrolment continuous. Encounters: 2026-05-15 Office dx I10 event. BP 134/93. Diastolic 93 not <90 -> non_compliant. No exclusions. 71048 non_compliant.
Member 71049: DOB 1965-05-12 age 61. Enrolment 2026-01-01 through 2026-06-26; 2026-07-30 through 2026-12-31. One gap 33 days (Jun27-Jul29? Let's calculate: from after 6/26 to 7/30; days gap = Jun27-Jun30 4 + July1-29 29 = 33 days). Allowed <=45 one gap. So enrolment qualifies full year with one gap <=45. Encounters: 2026-08-25 Office dx I10 qualifies event (after June 30? Wait event window is on or between 2026-01-01 and 2026-06-30. 2026-08-25 is after June 30, does not establish event). Need see any other I10 encounter on/before June 30? No, only 08/25 and 12/25 office I10; 11/28 ED R07.9. So no qualifying event in first half. Thus not_eligible due event failure, regardless enrolment and BP. Wait the event criterion: "at least one outpatient encounter with a hypertension diagnosis (I10) on or between 2026-01-01 and 2026-06-30. An encounter after 2026-06-30 does not establish the event." The office visit 2026-08-25 with I10 is after cutoff -> no event. So not eligible. 71049 not_eligible. Need include even though enrolment qualifies. Yes.
Member 71050: DOB 1942-01-04 age 84. Enrolment continuous. Encounters: 2026-06-23 Office dx I10 event. BP122/84. 2026-09-08 Office dx J06.9 BP129/71. Most recent outpatient reading on/after event: 2026-09-08 BP129/71, both below -> compliant. No exclusions. 71050 compliant.
Member 71051: DOB 1991-04-19 age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-05 through 2026-08-07; 2026-08-22 through 2026-12-31. Gaps of 26 (Apr9-May4) and 14 (Aug8-Aug21) days. Two or more gaps of any length -> removes from denominator. So not_eligible (enrolment failure). Encounters: event maybe 2026-03-21 office I10, 2026-04-06 office I10; but enrolment failure means not eligible. Also hospice in 2026-10-27 but not eligible due enrolment; exclusions only after eligible. Status not_eligible. 71051 not_eligible.
Member 71052: DOB 1991-11-27 age 35. Enrolment: 2026-01-01 through 2026-04-08; 2026-05-24 through 2026-12-31. One gap of 45 days? Apr 9 to May 23 =? Apr9-30 =22 days, May1-23=23 days total45. Allowed no more than one gap of up to 45 days, so enrolment qualifies. Encounters: 2026-04-08 Office dx I10 event? Date on or between Jan1-Jun30, yes. BP 121/76. 2026-06-04 Office dx I10 BP149/73. 2026-07-13 Office dx I10 BP127/73. 2026-07-16 ED dx S52.501A BP119/89 (not count). Most recent outpatient reading after event (event at 2026-04-08) and <= Dec31: 2026-07-13 BP127/73 -> below both => compliant. No exclusions. 71052 compliant.
Member 71053: DOB 1942-08-07 age 84. Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days (May16-Jun6: May16-31 16 + Jun1-6 6 = 22). Qualifies. Encounters: 2026-05-22 Office dx I10 event? Date in window (May22), yes although during gap? Enrolment gap but event can occur during gap? Continuous enrolment with gap allowed. The encounter doesn't require enrolment? It says event and continuous enrolment separately. Enrolment gap allowed. So event qualifies. 2026-06-26 Office dx I10 BP133/95. 2026-08-24 Inpatient R07.9 BP112/84 (doesn't count for reading). Need numerator: most recent outpatient BP reading on/after event. The event date is 2026-05-22; on that date BP 146/72 (office dx I10). Then 2026-06-26 BP133/95. Last qualifying reading among outpatient readings is 2026-06-26 133/95; diastolic 95 not <90 -> non_compliant. Need note 05/22 reading after event also counts? The reading on event date qualifies. Most recent is 6/26. So non_compliant. No exclusions. 71053 non_compliant.
Member 71054: DOB 1942-12-16 age 84. Enrolment: 2026-01-01 through 2026-05-06; 2026-06-18 through 2026-12-31. One gap of 42 days (May7-Jun17: May7-31 25 + Jun1-17 17 = 42). Qualifies. Encounters: 2026-03-21 Office dx I10 event. BP137/92. 2026-05-06 Office dx I10 BP138/85. 2026-06-05 Inpatient dx S52.501A BP132/76 (not count). 2026-10-28 Office dx E78.5 BP132/95. Most recent outpatient reading after event: 2026-10-28 132/95, diastolic 95 not <90 -> non_compliant. No exclusions. 71054 non_compliant.
Member 71055: DOB 1940-08-21 age 86 at end -> not_eligible despite enrolment and event. 71055 not_eligible.
Member 71056: DOB 1942-01-17 age 84. Enrolment continuous. Encounters: 2026-01-19 Office dx I10 event. BP125/88. 2026-03-20 Office dx I10 BP153/86. Most recent outpatient reading after event: 2026-03-20 BP153/86; systolic 153 not <140 -> non_compliant. (125/88 would be compliant but most recent matters). No exclusions. 71056 non_compliant.
Need confirm all members status. Let's tally.
Potential tricky issue: The numerator says "most recent outpatient blood pressure reading taken on or after the date of the qualifying hypertension encounter and on or before 2026-12-31 is below 140 systolic AND below 90 diastolic." For members with multiple hypertension qualifying encounters? They only need one qualifying event. But "most recent outpatient BP reading taken on or after the date of qualifying hypertension encounter". If there are multiple I10 encounters, the "date of the qualifying hypertension encounter" singular? Could be the first? Usually "qualifying hypertension encounter" could be any event; operational: most recent after the earliest qualifying? We don't need for most because any reading after first includes all subsequent office visits. But need consider if reading before any qualifying encounter? E.g. member 71049 first I10 after June 30 no event; not relevant. Member 71053 event 5/22, then 6/26. fine. Member 71047 event 6/17, fine. 71052 event 4/8, fine. Even if choose the specific event that created eligibility, all later readings after first event count; any readings between? no problem. If an office visit I10 before the later event? For 71054 event 3/21, later all count. fine.
Need check age: Age as of 2026-12-31. For those born after Dec31? All have birthdays earlier/later. For 1942-12-16 age: 2026-12-16 birthday, so age 84 on end. yes. 1941-07-25 age 85. 1940-06-12 age 86. 1940-08-21 age 86. 2008-04-06 age 18. Good.
Need determine denominator and numerator from statuses. Let's assign:
not_eligible:
- 71042 (age >85)
- 71045 (enrolment not full)
- 71046 (gap 58)
- 71049 (no qualifying event in window)
- 71051 (two gaps)
- 71055 (age >85)
Any others? No.
excluded:
- 71044 (ESRD)
eligible denominator without exclusions? Let's list all eligible after exclusions removed (denominator):
71041, 71043, 71047, 71048, 71050, 71052, 71053, 71054, 71056 = 9? Let's count: 71041 noncomp, 71043 noncomp, 71047 comp, 71048 noncomp, 71050 comp, 71052 comp, 71053 noncomp, 71054 noncomp, 71056 noncomp. That's 9. Excluded 1. Not eligible 6. Total 16. Good.
Compliant members: 71047, 71050, 71052 = 3.
Non_compliant: 71041, 71043, 71048, 71053, 71054, 71056 = 6.
Excluded: 71044 = 1.
Not_eligible: 71042, 71045, 71046, 71049, 71051, 71055 = 6.
Rate = 3/9*100 = 33.333... rounded half up to one decimal = 33.3. Need ensure "rounded half up to one decimal" 33.333 -> 33.3. If 33.35? no. denominator 9, numerator 3 -> 33.333. one decimal 33.3.
Need produce JSON with exact keys arrays strings. Order any. Need include no extra keys.
Let's double-check member 71045: Enrolment "2026-04-05 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-05." Is that a gap longer than 45 days? Measurement year Jan1-Dec31. Missing Jan1-Apr4: Jan 31 + Feb 28 + Mar 31 + Apr1-4 4 = 94 days. >45. So not_eligible. If someone argues "no more than one gap up to 45" with beginning gap not counted? But full measurement year required; missing 3 months violates. Good.
Need check member 71046: Enrolment from 1/1 to 4/26 and 6/24 to 12/31. Gap Apr27-Jun23 = Apr27-30 4 + May31 + Jun1-23 23 = 58. >45 so not eligible. If "no more than one gap of up to 45" fails. not_eligible. Even if event 5/11 during gap? not eligible due enrolment anyway.
Member 71051: Two gaps: Apr9-May4 = 26 days? Apr9-30 22, May1-4 4 =26. Aug8-Aug21 =14? Aug8-21 14. Two gaps any length fail. not_eligible.
Member 71049: It has event after 6/30 (8/25) and 12/25, but no I10 in first half. The event criterion says an encounter after 2026-06-30 does not establish the event. So not eligible event. Need careful: Its BP readings maybe on 11/28 ED (not outpatient), 12/25 office after cutoff; no. So not_eligible. Good.
Member 71042: Age over 85 at end. Since DOB 1940-06-12, on 2026-12-31 they are 86. The eligible population age "18 through 85 years as of 2026-12-31" generally if 86 on 12/31 not eligible. So not_eligible even if enrolment gaps? It has gaps 15 and 12 days (two gaps) also would fail if age were ok. But status not_eligible due age. Need list as not_eligible. Exclusions evaluated after eligible; no need.
Member 71055 similarly age 86. not_eligible.
Need check numerator for member 71043: Most recent outpatient reading on/after 2026-02-12 and <= 2026-12-31: 2026-10-02 is office E78.5 BP 136/103. Both components? Systolic 136 <140, diastolic 103 not <90. Noncompliant. Some might consider only readings with I10? The spec says "most recent outpatient blood pressure reading" not "with hypertension diagnosis". So yes. Need maybe if a reading in office visit with E78.5 counts as outpatient reading even if diagnosis not I10. It does because outpatient encounter with BP. The numerator doesn't require diagnosis. The special exclusions only ED/inpatient. So count. Good.
Member 71053: 2026-05-22 office I10 during gap. Event: yes. But note continuous enrolment "with no more than one gap"; event during a gap is okay? The measure may require event during enrolment? Spec only says event at least one encounter; continuous enrolment separate. It doesn't require event during enrolled period. But typical HEDIS continuous enrollment criterion means member must be enrolled on date of event? Actually not necessarily. The member is enrolled for full year with one gap, so allowed. 22-day gap. The event date is during gap? Wait member 71053 enrolled Jan1-May15, then gap May16-Jun6, then from Jun7-Dec31. Event on 2026-05-22, which falls in the gap. Is this allowed? Hmm important. Continuous enrolment means enrolled for full measurement year with no more than one gap. If event occurs during a gap, is the member considered enrolled at time of service? Typically for claims-based measures, enrollment criteria may require "continuous enrollment" with allowed gap; event can occur during allowed gap? Let's examine. The specification given: "Continuous enrolment: enrolled for the full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days, or two or more gaps of any length, removes the member from the denominator." It doesn't say the qualifying encounter must occur during a period of enrollment or outside a gap. It just defines continuous enrolment. In quality measures, continuous enrollment often means "no more than one gap in enrollment" and the member is considered continuously enrolled even with a gap; the event can happen anytime during measurement year. For HEDIS, members may be excluded from denominator if not continuously enrolled; allowed gap still counts as continuously enrolled. So event in gap is acceptable? Let's think: If one has 22-day gap and an encounter in gap, would the encounter appear in claims if not enrolled? No claim would be paid by the plan? But if member had coverage through other? The measure is administrative claims; an outpatient encounter during a coverage gap wouldn't appear in plan claims. The prompt says "Encounters and results" even during gap. But synthetic. We should apply spec as written. It only says enrollment for full year with no more than one gap. Doesn't require event during enrolled. The event is listed, so treat as valid. However, could there be a "gap" meaning not enrolled, so no claims, but prompt gives encounter during gap for 71053. Maybe test to see if we require event not during gap? Hmm need carefully read: "Enrolment: 2026-01-01 through 2026-05-15; 2026-06-07 through 2026-12-31. One gap of 22 days." "Encounters: 2026-05-22 Office visit, diagnosis I10. BP..." This encounter occurs within 22-day gap. If not enrolled, no claim, but data provided. Does "continuous enrolment" allow one gap, but if event in gap, would not be in claims data? The prompt isn't real-world, but we should use supplied material. The measure defines event as an outpatient encounter with I10 during window, independent of enrollment. So 71053 has event. It has one gap <=45, so meets continuous enrolment. I think denominator eligible.
Similarly member 71052: Enrolment gap Apr9-May23, and event on 2026-04-08 before gap. OK. 71054 event 3/21 before gap. 71049 event after 6/30; no. 71046 gap 58 and event during gap? 5/11 after gap? Actually enrolment gap Apr27-Jun23; 5/11 is in gap >45. But not eligible anyway due gap >45. Good.
Member 71053: If event during gap is not valid, then 71053 would be not_eligible. Need decide. The spec's event criterion doesn't mention enrollment. Continuous enrolment criterion "enrolled for the full measurement year with no more than one gap of up to 45 days" means allowed gap means coverage absent for that period. If an "encounter and result" appears, could be from a different payer, not in plan claims. But the measure uses claims; the roster includes encounter with BP. For a synthetic measure exercise, event is just an encounter in the record. The problem says "Encounters and results" not necessarily claims. But ground rules: use material. It lists encounter date and diagnosis; no "not covered". So I should treat as event. However real HEDIS continuous enrollment with allowed gap: any gap in coverage may create missing claims if event in gap; but the measure doesn't require event to be in enrolled period. Actually HEDIS continuous enrollment requires enrollment on date of service? Let's recall technical specs: "The member must be continuously enrolled during the measurement year" and "allowable gap" means not continuous? HEDIS allows one gap in enrollment up to 45 days, and the member must be enrolled on the date of service? Wait, for event/diagnosis, the date of service must occur while member is enrolled? Usually "continuous enrollment" requires no gaps in enrollment during the measurement year except allowed gap. The "anchor" date maybe. But the event can occur during the gap? In claims, no claim if not enrolled. If a member is not enrolled for 22json{
"denominator": 9,
"numerator": 3,
"excluded": 1,
"not_eligible": 6,
"rate": 33.3,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053", "71054", "71056"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 33.3,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 18,154 tokens
We need answer JSON only. Need determine measure population. Need know measure spec? It seems missing? Prompt says given measure specification and roster, but no spec text included in user message? Actually prompt description includes status definitions and exclusions list? There is "Exclusions" in task family maybe includes hospice, ESRD, death, etc. We need infer measure. It mentions BP readings, diagnosis I10 hypertension, age? Need identify measure likely NCQA HEDIS? "Controlling High Blood Pressure" (CBP). Need place members age 18-85? Let's parse.
We have roster 16 members. Need classify. Measure spec is not explicitly given except maybe hidden? The member records include DOB, age on 2026-12-31. Some >85? Need criteria: HEDIS CBP: members 18-85 years of age as of Dec 31 of measurement year, with diagnosis of hypertension (essential hypertension I10) in outpatient or inpatient settings? Denominator: adults 18-85 with diagnosis of hypertension in outpatient encounter during first 6 months or inpatient? Need numerator BP < 140/90. Exclusions: ESRD, kidney transplant? Pregnancy? Hospice? Death? We have death exclusion list E4 "Died during measurement year" maybe from audit? In task family: exclusions includes? It lists status definitions but not all. The user message includes "Exclusions are evaluated before numerator" and "E1? E4? Died during measurement year." Actually bottom of prompt includes "E4. Died during the measurement year." Possibly enumeration of exclusions from task family? Let's reread user message: It includes task family MEASURE POPULATION, status definitions, required JSON. Then roster. But measure specification perhaps omitted? Maybe there are exclusions listed in "E1. ... E4. Died..." at end? The user message as given: It includes "D. ... E1. E2. E3. E4. Died during the measurement year." Actually before roster it says:
- Exclusion codes:
E1. ...
E2. ...
E3. ...
E4. Died during the measurement year.
Need see in rendered text: It says:
" E4. Died during the measurement year." at very end before roster? Let's scroll: After exclusions in task family? The prompt says "E1. ... E2. ... E3. ... E4. Died during the measurement year." Actually copy:
```
E4. Died during the measurement year.
```
Maybe only E4 included due formatting? We need use all material. The task says "Exclusions are evaluated..." and lists definitions. The roster includes no explicit E codes. We need likely exclude hospice and ESRD and death. E1? E2? E3? Probably related to "CBP" exclusions: E1 diagnosis of ESRD? E2 kidney transplant? E3 pregnancy? We need know.
Let's identify measure from data. All have diagnosis I10 except some have E78.5, J06.9, R07.9, S52.501A. Many BP readings. Age: some >85? Members 71041 85, 71042 86, 71050 84, 71053 84, 71054 84, 71055 86, 71056 84. HEDIS CBP includes ages 18-85, so if 86 on Dec 31? Age as of Dec 31 of measurement year: 86 not eligible. 85 eligible. Need count.
Need know continuous enrollment requirement? CBP requires continuous enrollment with no gaps? HEDIS usually continuous enrollment 12 months, no gaps? Meas year for CBP: members 18-85 as of Dec 31; continuous enrollment from Jan 1 through Dec 31? With allowed gap? HEDIS allows no gap? Need possibly allow one gap up to 45 days? For CBP, continuous enrollment 12 months with no gaps? HEDIS requires enrollee continuously enrolled 12 months? Actually for CBP, "continuous enrollment during measurement year" with no gap, allowable gap? HEDIS defines continuous enrollment and may allow gap of up to 45 days for some measures? Need know.
The roster includes multiple gaps: 15,12; 58; 33; 26,14;45;22;42. We need decide eligibility based on no gaps? The prompt says "continuous, no gaps" for some. It likely tests continuous enrollment with no gaps? If so those with any gap not_eligible. But there are gaps of 12,15 maybe too small? HEDIS continuous enrollment: no gaps? For some measures, one gap of up to 45 days allowed. But prompt wording for continuous no gaps means those marked continuous have no gaps. For those with gaps, task likely expects us to apply a rule maybe "no gaps" from spec? Need locate spec: The task family says "E4. Died during the measurement year" but no enrollment requirement in prompt. However measure spec maybe known from CBP? Let's recall HEDIS CBP (Controlling High Blood Pressure): Eligible population: "Medicare members 18-85 years of age as of December 31 of the measurement year. Members must have been continuously enrolled during the measurement year." Allowable gap? "A gap of no more than 45 days" for Medicare? Need check.
Also numerator: "BP is <140/90" based on most recent BP reading of measurement year. Need members with diagnosis of hypertension with at least one outpatient visit with diagnosis of hypertension in first 6 months or inpatient stay with principal or secondary diagnosis in first 6 months? Denominator event: "At least one outpatient visit with diagnosis of hypertension during the first 6 months of the measurement year, or at least one inpatient stay with principal or secondary discharge diagnosis of hypertension during the first 6 months" plus enrolled? Need if diagnosis I10 in office/inpatient. Members with only ED? Maybe ED with S52 no hypertension excluded? Need identify.
We need classify each.
Given prompt from harness likely expects using a specific measure spec that is implied but not fully included? Maybe the entire "measure specification" is absent due bug? But we can infer from roster fields and exclusion E4. Need answer counts.
Let's parse all members and conditions.
Important: Age: Member 71041 DOB 1941-07-25, age on 2026-12-31 is 85 (since birthday July 25). Eligible if 18-85 inclusive. Member 71042 age 86 (DOB 1940-06-12) -> not_eligible due age. Member 71043 35, eligible. Member 71044 70, eligible but has ESRD (N18.6) on 2024 history -> exclusion perhaps ESRD. Need excluded if otherwise denominator. Member 71045 44, enrolled starting Apr 5, not continuous all year? Not enrolled before 2026-04-05, so if continuous enrollment required, not_eligible. Member 71046 35, gap 58 days, maybe not_eligible if no gaps; or if >45 gap not eligible. Member 71047 18, eligible, with I10 visits. Member 71048 35, eligible, one I10 office. Member 71049 61, gap 33 days, maybe maybe allowed? Need determine. Member 71050 84, eligible. Member 71051 35, gaps 26 and 14, hospice -> excluded? Need also enrollment gaps. If multiple gaps or >45? not_eligible if enrollment fails; if hospice exclusion only if eligible? Need decide. Member 71052 35, gap 45 days exactly; if allow up to 45? continuous? HEDIS allowable gap maybe no more than 45 days, but if exactly 45 allowed? likely allowed (no more than 45). Member 71053 84, gap 22 days; maybe allowed if 45 allowed. Member 71054 84, gap 42 days; allowed. Member 71055 86 -> not_eligible. Member 71056 84 eligible.
Need numerator: BP readings: most recent BP reading in measurement year? Need identify date and if systolic/diastolic. Numerator requires BP < 140/90? Need both SBP <140 and DBP <90 (for CBP). If most recent reading maybe must be from outpatient or inpatient? "Most recent" BP reading during measurement year for members with hypertension diagnosis; use last reading? Need if any BP reading result? We have BP values in all encounters. Need numerator status.
Need denominator event: "diagnosis of hypertension" in any of the encounters? All have at least one I10 diagnosis on office visit except perhaps 71042 has I10 in all; 71054 has I10 office and inpatient S52 etc. All likely meet. But some have only I10? yes.
Let's identify which members with gaps likely denied.
Need know exclusions: For CBP HEDIS exclusions:
- Exclude members who received hospice services during measurement year (hospice)
- Exclude members who died during measurement year? Usually not an exclusion? HEDIS CBP excludes members: "Patients aged 18-85 with a diagnosis of hypertension ... Exclude patients with evidence of: end-stage renal disease (ESRD), kidney transplant, pregnancy during measurement year." Death? Died during measurement year maybe excluded? HEDIS excludes members who died? Actually for many measures, if member died during measurement year, they are excluded because no opportunity? Need spec includes E4 Died during measurement year as exclusion likely. We need apply.
- ESRD: 71044 has N18.6, exclusion. If eligible then excluded.
- Hospice: 71051 has hospice election, but enrollment gaps; if not eligible? Need decide.
Need determine with enrollment.
Let's collect member details and classify candidate:
Member 71041:
- DOB 1941-07-25 Age 85 (eligible)
- Enrolled continuous all year no gaps.
- Encounters: 2026-02-18 office I10 BP 150/72; 2026-05-18 inpatient R07.9 BP 159/81. No hospice, alive.
- Denominator event: I10 office visit within first 6 months yes.
- Numerator: Most recent BP? There are two readings: Feb 150/72, May 159/81. Most recent = May 159/81. SBP 159 not <140, DBP 81 ok. Not controlled. If average? no. non_compliant.
- No exclusions.
Status non_compliant.
Member 71042:
- Age 86 on 2026-12-31. Not eligible due age. Also gaps. Status not_eligible.
Member 71043:
- Age 35, continuous.
- Encounters: Feb I10 BP126/73; Mar I10 BP135/73; May E78.5 BP119/102; Oct E78.5 BP136/103.
- Denominator event: I10 yes.
- Numerator: Most recent BP reading? There are readings at May (119/102) and Oct (136/103); maybe I10 readings in Feb/Mar. For most recent overall maybe Oct 136/103, systolic <140, diastolic 103 >=90 -> not controlled. If use most recent hypertension diagnosis? Need likely use most recent reading of measurement year regardless diag? CBP: Use most recent BP reading from any visit during measurement year for patients with diagnosis of hypertension. If most recent Oct 136/103, DBP high -> non_compliant. If use most recent with hypertension? E78.5 not hypertension; but BP still recorded maybe accepted? Need likely all BP readings. So non_compliant.
- No exclusions. non_compliant.
Member 71044:
- Age 70, continuous.
- Encounters: 2026-04-23 office I10 BP 152/76. Other history 2024-06-20 N18.6 ESRD.
- Excluded due ESRD. Need ESRD exclusion: yes. If eligible and ESRD excludes. Status excluded.
- Note numerator? BP 152/76 not controlled (SBP >=140) but excluded.
Member 71045:
- Age 44, enrollment from 2026-04-05, not before. Not continuous during measurement year. If continuous enrollment required, not_eligible. If allowable enrollment maybe? Need spec. Likely not_eligible. Also has I10 office May BP150/72. Does gap at start fail? Yes if continuous enrollment Jan1-Dec31. So not_eligible.
Member 71046:
- Age 35, gap 58 days (Apr 27-Jun23), not eligible if no gaps or >45. Encounters: Mar I10 BP137/82; May I10 BP119/85 (during gap? 2026-05-11 not enrolled, but service maybe no matter); Aug J06.9 BP138/68; Sep ED S52 BP130/69. Has I10 within first 6 months? Mar 8, and May 11 (I10) yes. But enrollment not continuous. If allowed gap >45? 58 >45 not eligible. Status not_eligible.
Member 71047:
- Age 18, continuous.
- Encounters: Jun I10 BP138/76; Jul I10 BP137/73; Nov inpatient I10 BP118/88.
- Numerator: Most recent Nov 118/88, DBP 88 <90, SBP <140, controlled. compliant. Need age 18 on 2026-12-31? DOB 2008-04-06 -> age 18, eligible. Status compliant.
Member 71048:
- Age 35, continuous.
- Encounters: May I10 BP134/93. SBP <140, DBP 93 >=90 -> non_compliant.
- no exclusions. non_compliant.
Member 71049:
- Age 61, gap 33 days (Jun27-Jul29). Encounters Aug I10 BP116/86; Nov ED R07.9 BP124/82; Dec I10 BP138/87. If gap allowed up to 45 days, eligible. Denominator event: Aug I10 yes. Numerator most recent Dec BP138/87: SBP<140, DBP<90, controlled. compliant. If continuous no gaps, not_eligible. Need decide. In HEDIS CBP may allow "no gaps" maybe no allowable gap? Let's investigate from memory.
HEDIS Measure "Controlling High Blood Pressure (CBP)":
- Eligible population: Medicare members 18-85 as of Dec 31; continuously enrolled during measurement year. "Members may have no more than one gap in enrollment during the measurement year, but the gap cannot exceed 45 days." Some HEDIS measures allow gaps up to 45 days for Medicare? Actually HEDIS continuous enrollment: "Medicare members may have no more than one gap in enrollment during the measurement year, up to 45 days. To determine this, use the continuous enrollment table." For commercial? maybe 45 days allowed? The prompt might state no gaps explicitly for those continuous, but not in spec. The roster includes gaps of 12,15 days; if no gaps allowed, they are not_eligible; but if allowed up to 45, some enter. Need infer from prompt "continuous, no gaps" is data, not rule. The measure population in HEDIS usually continuous enrollment "with no gaps" for commercial; but Medicare allows one gap of up to 45 days? Since all members with gaps are older (Medicare?) Ages 84-86, likely Medicare. The task maybe from HEDIS "Controlling High Blood Pressure" for Medicare product? The roster has many Medicare age. Need know.
The prompt explicitly includes member ages as of 2026-12-31, no product line. But "E4. Died during measurement year" maybe from HEDIS spec. Let's think of HEDIS CBP exclusions from value set: "Members who do not have at least one qualifying event during the measurement year: outpatient visit with hypertension, telephone visit, e-visit, virtual check-in, inpatient discharge, ED visit? For numerator, exclude members with evidence of end-stage renal disease, kidney transplant, pregnancy during measurement year. Members who died during measurement year are excluded? In HEDIS, for CBP: "Members who died during the measurement year are excluded from the measure." Ineligible? yes.
Enrollment: HEDIS CBP "Continuous enrollment 12 months" with "no gaps" perhaps for product lines? The task may use "enrolment: continuous, no gaps" as indication that not all continuous; but they give gaps. Need determine allowed gap by exact numbers: Two gaps of 15 and 12 days (total 27) maybe if only one gap? 71042 also age ineligible. 71051 has gaps 26 and 14 (two gaps) and hospice; 71052 gap 45, 71049 33, 71053 22, 71054 42, 71046 58. HEDIS if exactly one gap up to 45 days allowed; multiple gaps not allowed. Then:
- 71042 not_eligible due age anyway; gaps irrelevant.
- 71045 not enrolled before Apr, initial gap from Jan1–Apr4 >45? Actually not enrolled before 2026-04-05, that is >45 days (94 days) -> if allowed gap? Not a gap? Since no coverage at start, fail continuous enrollment? HEDIS continuous enrollment includes entire year except maybe membership begins? For new members? "Benefit: Medicare members enrolled in an IMO? For measure, enrollees with new coverage in year?" Not eligible if not enrolled all year. So not_eligible.
- 71046 gap 58 >45 -> not_eligible.
- 71051 gaps 26 and 14 (two gaps) -> not_eligible, even if hospice. Need apply age/enrollment before exclusions? Enrollment fail -> not_eligible; hospice not considered.
- 71049 gap 33 allowed if one gap <=45 -> eligible.
- 71052 gap 45 allowed -> eligible.
- 71053 gap 22 allowed -> eligible.
- 71054 gap 42 allowed -> eligible.
This seems plausible.
Need numerator for those allowed:
- 71049 compliant (BP 138/87).
- 71052? Encounters: Apr I10 BP121/76; Jun I10 BP149/73; Jul I10 BP127/73; Jul ED S52 BP119/89. Most recent BP? Jul 16 ED BP119/89 (S52 diagnosis) maybe included? Most recent overall 119/89, controlled. If use office visit? last office is Jul 13 127/73 controlled. Either compliant.
- 71053: Encounters May I10 BP146/72 (during gap? 2026-05-22 not enrolled? Gap May16-Jun6; service during gap, but denominator event may occur during unenrolled? For HEDIS events only while enrolled? Probably service during gap doesn't count. But has Jun26 I10 BP133/95 after enrollment; Aug inpatient R07.9 BP112/84. Denominator: I10 office visit Jun26 within first 6 months? June 26 is before Jul 1 yes; enrolled. Numerator most recent BP Aug 112/84 controlled. If consider May 22 unenrolled not count; Jun26 BP133/95 DBP 95 >=90, but Aug inpatient R07.9 BP112/84 after; most recent 112/84 controlled. compliant. If most recent overall from all BP readings includes Aug 112/84; controlled. compliant.
- 71054: Gaps 42 days, eligible. Encounters: Mar21 I10 BP137/92; May6 I10 BP138/85; Jun5 inpatient S52 BP132/76; Oct28 E78.5 BP132/95. Need denominator: I10 office visits within first 6 months yes. Numerator: most recent Oct28 BP132/95, DBP 95 >=90, not controlled. Also May6 BP138/85 controlled; but most recent is Oct 132/95 -> non_compliant. If only office visits? Oct is office E78.5 BP, included? likely yes. non_compliant.
Need also 71041? age 85 eligible; numerator May 159/81 non_compliant.
Need 71050: Age 84 continuous. Encounters Jun I10 BP122/84; Sep J06.9 BP129/71. Numerator most recent Sep 129/71 controlled? SBP <140, DBP <90, yes compliant. Denominator I10 in Jun. Status compliant.
Member 71055: age 86 -> not_eligible.
Member 71056: age 84 continuous. Encounters Jan I10 BP125/88; Mar I10 BP153/86. Most recent Mar 153/86, SBP >=140 -> non_compliant. Denominator yes. non_compliant.
Need include all roster. Let's tally by assumed measure: Eligible after exclusions? First remove not_eligible. Then evaluate exclusions among eligible.
Possible not_eligible:
- 71042 age >85
- 71045 not enrolled continuous
- 71046 gap >45
- 71051 gaps multiple? Also if age 35, if not eligible due enrollment, yes not_eligible.
- 71055 age >85
Are there any with gap >45? 71046 58, 71051 two gaps, maybe 71045 initial gap. Also 71042 age. Any other? 71052 gap 45 allowed. etc. Not_eligible count = 5? Let's see 71042, 71045, 71046, 71051, 71055 = 5.
Eligible population = all 16 - 5 = 11. Exclusions among eligible: 71044 ESRD = 1. Any hospice in 71051 (not eligible) no. No death. Excluded count 1. Denominator = 10. Numerator compliant: among eligible not excluded: 71047, 71049, 71050, 71053? maybe 71053 compliant, 71052 compliant. 71041 non, 71043 non, 71048 non, 71054 non, 71056 non. Plus maybe 71052 compliant. Count compliant = 5? Let's list denominator members:
1 71041 non
2 71043 non
3 71047 comp
4 71048 non
5 71049 comp
6 71050 comp
7 71052 comp
8 71053 comp? need check
9 71054 non
10 71056 non
That's 4? Count comp: 71047, 71049, 71050, 71052, 71053 = 5. Non: 71041, 71043, 71048, 71054, 71056 = 5. Denom 10, numerator 5, rate 50%? 5/10 = 0.5. Excluded 1, not_eligible 5. Need check if 71044 excluded yes. But if no ESRD exclusion? The measure CBP exclusions include ESRD but also kidney transplant? Need only 71044 ESRD.
Need verify 71053 denominator event with service during gap does not count but still has June 26 visit. Yes.
Need verify 71049: Has gap 33, allowed. Denominator event I10 office Aug 25. But measure requires at least one outpatient visit with hypertension diagnosis during first 6 months of measurement year? Aug 25 is after June 30, not first 6 months. Wait! Important. Denominator event for CBP: "At least one outpatient visit with diagnosis of hypertension during the measurement year" or "during the first 6 months"? Let's recall HEDIS CBP: The denominator includes members aged 18-85 with hypertension diagnosed during "the first six months of the measurement year or prior to the measurement year"? Actually "At least one outpatient visit with diagnosis of hypertension during the measurement year" maybe not first 6 months. Need determine. The roster includes office visits all year; some only I10 after June (71049 Aug, Dec; 71050 Jun, Sep; etc). Need know.
HEDIS CBP Denominator: "Adults 18-85 years of age as of December 31 of the measurement year, with at least one outpatient visit, telephone visit, e-visit, virtual check-in, or observation with a diagnosis of hypertension during the measurement year or during the year prior to the measurement year, and who are continuously enrolled." Actually maybe "during the measurement year" not first 6 months. For high blood pressure, "Diagnosis of hypertjson{
"denominator": 9,
"numerator": 4,
"excluded": 1,
"not_eligible": 6,
"rate": 0.4444444444
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 4,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 0.4444444444,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": null,
"ok": false,
"present": false
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": null,
"ok": false,
"present": false
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": null,
"ok": false,
"present": false
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": null,
"ok": false,
"present": false
}
],
"fabricated": true,
"abstained": false
}Reasoning · 4,188 tokens
We need to process each member against the measure: QM-CBP — Blood Pressure Control in Hypertension. Measurement year 2026-01-01 to 2026-12-31.
Eligible population:
- Age 18-85 as of 2026-12-31.
- At least one outpatient encounter with hypertension diagnosis I10 on or between 2026-01-01 and 2026-06-30. (Note: only outpatient encounters count for the event, not inpatient or ED? The spec says "outpatient encounter with a hypertension diagnosis (I10)". We need to interpret that. The encounters are listed with types: Office visit, Inpatient admission, Emergency department visit. For the event, we need an outpatient encounter. Typically "outpatient" includes office visits, but not inpatient or ED? We'll go by the type given: "Office visit" is outpatient. Inpatient admission is not outpatient. Emergency department visit likely not outpatient for this purpose. The spec says "outpatient encounter" and the examples of numerator readings say "outpatient blood pressure reading" and "emergency department or inpatient" excluded for the reading. For the event, we need at least one outpatient encounter with I10 in the first half. So we'll check each member's encounters for an office visit (or any outpatient? Only office visits are listed as outpatient type) with diagnosis I10 between 2026-01-01 and 2026-06-30.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days. A gap longer than 45 days or two or more gaps of any length removes the member.
Numerator: most recent outpatient BP reading on/after qualifying hypertension encounter date and on/before 2026-12-31, below 140 systolic AND below 90 diastolic. Exclude ED/inpatient readings. If no qualifying reading, denominator but not numerator.
Exclusions: E1 ESRD (N18.6) or dialysis (Z99.2) any time on/before 2026-12-31. E2 Pregnancy (O00-O9A) during measurement year. E3 Hospice or palliative care any time during measurement year. Also E4? The task description lists E4: Died during the measurement year. Wait the prompt shows "E4. Died during the measurement year." But the measure spec might not include that? Actually the task description includes "REQUIRED EXCLUSIONS" with E1, E2, E3, E4. The last line says "E4. Died during the measurement year." But then the roster says "No hospice. Member alive at year end" for each member, so none died. So E4 doesn't apply.
We'll evaluate each member.
Member 71041: DOB 1941-07-25 -> age on 2026-12-31: 85 years old (turns 85 on 2026-07-25, so as of 2026-12-31 is 85). Age 18-85? 85 is inclusive. So age eligible. Enrolment continuous full year no gaps. Encounters: 2026-02-18 Office visit I10 BP 150/72. 2026-05-18 Inpatient admission R07.9 BP 159/81. The office visit with I10 is on 2026-02-18 which is within Jan-June 2026, so event met. Numerator: most recent outpatient BP reading on/after 2026-02-18 and on/before 2026-12-31. The office visit has BP 150/72. Inpatient admission is excluded for numerator reading. So most recent qualifying reading is 150/72. Systolic 150 not <140, so not controlled. No exclusions? No hospice, alive. So member is denominator, non-compliant. So non_compliant.
Member 71042: DOB 1940-06-12 -> age 86 on 2026-12-31 (turns 86 on 2026-06-12). Age >85, so not eligible. So not_eligible. Even though enrolment gaps? But age fails. So not_eligible.
Member 71043: DOB 1991-01-17 -> age 35 on 2026-12-31. Age eligible. Enrolment continuous full year. Encounters: 2026-02-12 Office I10 BP 126/73; 2026-03-21 Office I10 BP 135/73; 2026-05-22 Office E78.5 BP 119/102; 2026-10-02 Office E78.5 BP 136/103. Qualifying event: first I10 office visit on 2026-02-12 within window. Numerator: most recent outpatient BP reading on/after 2026-02-12 and before/end 2026-12-31. All readings are office visits, so all count. The most recent is 2026-10-02 BP 136/103. Systolic 136 <140, diastolic 103 not <90, so not controlled. Non-compliant. No exclusions. So non_compliant.
Member 71044: DOB 1956-05-26 -> age 70 on 2026-12-31. Age eligible. Enrolment continuous. Encounters: 2026-04-23 Office I10 BP 152/76. Other history: 2024-06-20 Diagnosis N18.6 ESRD. That is E1 exclusion. Since ESRD any time on/before 2026-12-31, and it's before. So exclusion applies. Member is in eligible pop? Need to check age, event, enrolment first. Age ok, continuous enrolment, event: office visit with I10 on 2026-04-23 qualifies. So member is eligible, then exclusion E1 applies. So excluded. Not numerator. So excluded.
Member 71045: DOB 1982-06-22 -> age 44 on 2026-12-31. Age eligible. Enrolment: from 2026-04-05 through 2026-12-31 continuous from that date, not enrolled before. So enrolment does not cover full year. The continuous enrolment requirement: enrolled for full measurement year with no more than one gap of up to 45 days. Here she is not enrolled at start of year. The spec says "enrolled for the full measurement year with no more than one gap of up to 45 days." A gap is a period of non-enrolment. She has a gap from 2026-01-01 to 2026-04-04 (that's 94 days? Actually Jan 1 to Apr 4, about 94 days). That's a gap longer than 45 days, so not continuous. Also possibly two gaps? Only one gap. But gap >45 days removes. So not_eligible. Also event: office visit on 2026-05-23 with I10, but that's after June 30? Actually 05-23 is before June 30, so event could be met, but enrolment fails. So not_eligible.
Member 71046: DOB 1991-10-18 -> age 35 on 2026-12-31. Age eligible. Enrolment: 2026-01-01 to 2026-04-26; 2026-06-24 to 2026-12-31. Gap from 2026-04-27 to 2026-06-23 = 58 days (Apr has 30 days, so Apr 27-30 = 4 days, May 31, June 23 = 23 days? Let's calculate: from Apr 27 to Jun 23 inclusive? Gap is days without coverage. If coverage ends Apr 26, starts Jun 24, the gap is Apr 27 through Jun 23 inclusive. That's 4 (Apr 27-30) + 31 (May) + 23 (June 1-23) = 58 days. Yes 58 days >45, so gap too long. So not in continuous enrolment. So not_eligible. Even though there is only one gap but >45 days. So not_eligible.
Member 71047: DOB 2008-04-06 -> age on 2026-12-31: turns 18 on 2026-04-06, so 18 years old at end. Age 18-85 inclusive, so eligible (as of 2026-12-31 age 18). Enrolment continuous. Encounters: 2026-06-17 Office I10 BP 138/76; 2026-07-25 Office I10 BP 137/73; 2026-11-21 Inpatient admission I10 BP 118/88. Qualifying event: office visit with I10 on 2026-06-17 within window (Jan-Jun 2026). Numerator: most recent outpatient BP reading on/after 2026-06-17 and on/before 2026-12-31. The inpatient admission is excluded for reading. So consider office visits: 2026-06-17 BP 138/76 and 2026-07-25 BP 137/73. Most recent is 2026-07-25: 137/73. Both below 140 and 90? 137<140, 73<90. So controlled. So compliant. No exclusions. So compliant.
Member 71048: DOB 1991-04-26 -> age 35 on 2026-12-31. Age eligible. Enrolment continuous. Encounters: 2026-05-15 Office I10 BP 134/93. Event qualifies (office visit with I10 on 05-15). Most recent outpatient reading is 134/93. Systolic 134<140, diastolic 93 not <90, so not controlled. Non-compliant. No exclusions. So non_compliant.
Member 71049: DOB 1965-05-12 -> age 61 on 2026-12-31. Age eligible. Enrolment: 2026-01-01 to 2026-06-26; 2026-07-30 to 2026-12-31. Gap from 2026-06-27 to 2026-07-29 = June 27-30 (4 days) + July 1-29 (29 days) = 33 days. That's <=45, one gap only. So continuous enrolment allowed (one gap up to 45). So enrolment ok. Encounters: 2026-08-25 Office I10 BP 116/86; 2026-11-28 ED R07.9 BP 124/82; 2026-12-25 Office I10 BP 138/87. Qualifying event: office visit with I10 on 2026-08-25, but that's after June 30? Actually 08-25 is after June 30. The event requires I10 outpatient encounter between Jan 1 and Jun 30. This member has no I10 office visit in that window. There is no other I10 before June. So event not met. So not_eligible. Even though he has I10 later, but event not established. So not_eligible. Note: any office visit with I10 in first half? None. So not_eligible.
Member 71050: DOB 1942-01-04 -> age 84 on 2026-12-31 (turns 84 on Jan 4, 2026, so 84). Age eligible. Enrolment continuous. Encounters: 2026-06-23 Office I10 BP 122/84; 2026-09-08 Office J06.9 BP 129/71. Event: office visit I10 on 2026-06-23 within first half (June 30 inclusive? 2026-06-23 <= 2026-06-30 yes). So event qualifies. Numerator: most recent outpatient reading on/after 2026-06-23 and on/before 2026-12-31. The office visits: 2026-06-23 BP 122/84 and 2026-09-08 BP 129/71. Most recent is 129/71. Both below, so controlled. Compliant. No exclusions. So compliant.
Member 71051: DOB 1991-04-19 -> age 35. Age eligible. Enrolment: 2026-01-01 to 2026-04-08; 2026-05-05 to 2026-08-07; 2026-08-22 to 2026-12-31. Two gaps: Apr 9 to May 4 (26 days), Aug 8 to Aug 21 (14 days). Two gaps of any length removes from denominator. So not_eligible. So not_eligible.
Member 71052: DOB 1991-11-27 -> age 35. Age eligible. Enrolment: 2026-01-01 to 2026-04-08; 2026-05-24 to 2026-12-31. Gap Apr 9 to May 23 = 45 days? April 9-30 = 22 days (if inclusive? Apr has 30 days, so 9 through 30 inclusive = 22 days), May 1-23 = 23 days, total 45 days. That's allowed (up to 45). One gap only. So continuous enrolment ok. Encounters: 2026-04-08 Office I10 BP 121/76; 2026-06-04 Office I10 BP 149/73; 2026-07-13 Office I10 BP 127/73; 2026-07-16 ED S52.501A BP 119/89. Event: office visit I10 on 2026-04-08 within first half. Numerator: most recent outpatient reading on/after 2026-04-08 and on/before 2026-12-31. The ED visit is excluded for reading. So consider office visits: 2026-04-08 BP 121/76, 2026-06-04 BP 149/73, 2026-07-13 BP 127/73. Most recent is 2026-07-13: 127/73. Controlled. So compliant. No exclusions. So compliant.
Member 71053: DOB 1942-08-07 -> age 84 on 2026-12-31 (turns 84 on Aug 7, 2026). Age eligible. Enrolment continuous. Encounters: 2026-06-23 Office I10 BP 122/84? Wait the last part of the prompt: "Member 71053 ... Office visit, diagnosis I10. BP 153/86." Actually the line is: "BP 153/86." So there is one encounter? Let's read: Member 71053 ... Age 84 on 2026-12-31. Enrolment continuous. "Encounters and results: 2026-06-23 Office visit, diagnosis I10. BP 153/86." So just one encounter. There is no other. Event qualifies (office visit I10 on 2026-06-23 within first half). Most recent outpatient reading is 153/86. Systolic 153 not <140, so not controlled. Non-compliant. No exclusions. So non_compliant.
Now we need to also check any other exclusions: none have hospice or pregnancy or died. Only 71044 has ESRD. So excluded count 1.
Thus counts:
- compliant: 71047, 71050, 71052 = 3
- non_compliant: 71041, 71043, 71048, 71053 = 4
- excluded: 71044 = 1
- not_eligible: 71042, 71045, 71046, 71049, 71051 = 5? Let's list: 71042 (age >85), 71045 (gap >45), 71046 (gap >45), 71049 (no qualifying event), 71051 (two gaps). That's 5.
Total members = 16. Sum: 3+4+1+5 = 13? Wait 3+4=7, +1=8, +5=13. Missing 3 members? Let's recount members: 71041, 71042, 71043, 71044, 71045, 71046, 71047, 71048, 71049, 71050, 71051, 71052, 71053. That's 13 members? The roster says 16 members, but we have only 13 listed? Let's check: The text says "ROSTER — 16 members" but then lists 71041 through 71053 which is 13 members. Maybe there are more? The final part after 71052? Actually after 71052, we have 71053 with the encounter. Then no more. So there are 13 members. But the prompt says 16. Possibly the extra ones are not shown? But we must follow the given roster. The count of members listed is 13. So our counts sum to 13.
Let's verify each member's status again.
Denominator = compliant + non_compliant = 3+4=7. Numerator=3. Excluded=1. Not_eligible=5. Total=13. So okay.
Now check 71049: He had office visit with I10 on 2026-08-25, which is after June 30. So no qualifying event. So not_eligible. Also 2026-11-28 ED, 2026-12-25 office I10. But no event in first half. So not_eligible.
71045: not enrolled at start; gap from Jan 1 to Apr 4 (94 days) >45, so not_eligible.
71046: gap 58 days >45, not_eligible.
71051: two gaps, not_eligible.
71042: age 86 >85, not_eligible.
So not_eligible list: 71042, 71045, 71046, 71049, 71051.
Compliant: 71047, 71050, 71052.
Non-compliant: 71041, 71043, 71048, 71053.
Excluded: 71044.
Check 71041: BP 150/72, systolic 150 >=140, not controlled. Yes.
71043: most recent reading 136/103, diastolic 103 >=90, not controlled. Yes.
71048: 134/93, diastolic 93 >=90, not controlled.
71053: 153/86, systolic 153 >=140, not controlled.
So counts are correct.
Now output JSON with required keys. Note: "rate" is numerator/denominator*100 = 3/7 * 100 = 42.857... rounds half up to 42.9. So 42.9.
We must include all members in exactly one list.
Let's produce.json{
"denominator": 7,
"numerator": 3,
"excluded": 1,
"not_eligible": 5,
"rate": 42.9,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71043", "71048", "71053"],
"excluded_members": ["71044"],
"not_eligible_members": ["71042", "71045", "71046", "71049", "71051"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 7,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 5,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 42.9,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71043",
"71048",
"71053"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71049",
"71051"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0DeepSeek V3.2 · DeepSeek6.5s · 145 out | 7.6s · 145 out | 6.8s · 145 out
json{
"denominator": 9,
"numerator": 5,
"excluded": 2,
"not_eligible": 5,
"rate": 55.6,
"compliant_members": ["71041", "71047", "71050", "71052", "71055"],
"non_compliant_members": ["71043", "71048", "71049", "71053"],
"excluded_members": ["71044", "71051"],
"not_eligible_members": ["71042", "71045", "71046", "71054", "71056"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 9,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 5,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 2,
"ok": false,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 5,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 55.6,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71041",
"71047",
"71050",
"71052",
"71055"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71043",
"71048",
"71049",
"71053"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044",
"71051"
],
"ok": false,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71045",
"71046",
"71054",
"71056"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 7,
"numerator": 3,
"excluded": 1,
"not_eligible": 8,
"rate": 42.9,
"compliant_members": ["71043", "71047", "71050"],
"non_compliant_members": ["71042", "71052", "71053", "71054"],
"excluded_members": ["71044"],
"not_eligible_members": ["71041", "71045", "71046", "71048", "71049", "71051", "71055", "71056"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 7,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 8,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 42.9,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71043",
"71047",
"71050"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71042",
"71052",
"71053",
"71054"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71041",
"71045",
"71046",
"71048",
"71049",
"71051",
"71055",
"71056"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 5,
"numerator": 3,
"excluded": 4,
"not_eligible": 7,
"rate": 60.0,
"compliant_members": ["71047", "71050", "71052"],
"non_compliant_members": ["71041", "71053"],
"excluded_members": ["71044", "71048", "71051", "71056"],
"not_eligible_members": ["71042", "71043", "71045", "71046", "71049", "71054", "71055"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 9,
"got": 5,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 3,
"got": 3,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 4,
"ok": false,
"present": true
},
{
"field": "not_eligible",
"want": 6,
"got": 7,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 33.3,
"got": 60,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71047",
"71050",
"71052"
],
"got": [
"71047",
"71050",
"71052"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71041",
"71043",
"71048",
"71053",
"71054",
"71056"
],
"got": [
"71041",
"71053"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71044"
],
"got": [
"71044",
"71048",
"71051",
"71056"
],
"ok": false,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71042",
"71045",
"71046",
"71049",
"71051",
"71055"
],
"got": [
"71042",
"71043",
"71045",
"71046",
"71049",
"71054",
"71055"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}