Brief Description of Measure:

CMS135: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocked (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LSVD):
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge

CMS144: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LSVD):
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge

Description of Issue:

​CMS135 and CMS144 are specified with both outpatient (Population 1) and inpatient (Population 2) populations, intended to assess whether heart failure medications are prescribed in the outpatient setting during the measurement period OR whether medications are prescribed at each inpatient hospital discharge during the measurement period. Including both the outpatient and inpatient populations in these measures essentially attempts to combine both patient-based and encounter-based measure logic into the same measure, as noted by the variation in frequency (outpatient = once per measurement period; inpatient = at every discharge) and the rate aggregation field of the header.
During testing phases of the 2022 eCQM Annual Update period, it was discovered only the first inpatient heart failure discharge is being assessed for each patient in Population 2. This seems to be a result of combining the two population types (patient-based and encounter-based) into a single measure while the current eCQM tooling is unable to support this combination of different frequencies of reporting.

Proposed Solution:

​The AHA is proposing to remove Population 2 - including revising header language, and removing relevant definitions and value sets used only in this population - from CMS135 and CMS144 as this will solve the issue of combining the measure types without operationalizing logic with substantive changes. These changes will better align the measures with outpatient care and the goals of the MIPS program.
The class of guideline recommendation and level of evidence supporting the measures will not be affected by this modification. The AHA does not anticipate that the removal of the inpatient population (Population 2) will have a significant impact on the denominator size or performance rate for either CMS135 or CMS144, since the measures are currently specified to report the inpatient or outpatient population (only one population).

Rationale for Change:

​The removal of Population 2 from CMS135 and CMS144 will resolve logic issues and better align with the goals of the Quality Payment Program by only including the outpatient population.