Brief Description of Measure:

​CMS135: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD):
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 (LVSD):
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
CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy- Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%):
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy

Description of Issue:

​The measure headers contain examples for medical reason exceptions (e.g., allergy, intolerance, other medical reasons). However, the measure logic contains expressions for specific medical reasons beyond what is indicated in the current language (e.g., asthma, bradycardia, hypotension, etc.).  The measure developer plans to update the examples indicated in the denominator exception language related to medical reasons to include all the specific conditions or situations included in the logic so the header is aligned with the logic.

Proposed Solution:

Update medical reason exception language to ensure it is aligned with specific medical exclusions specified in logic.

CMS135:
Current:
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons).
Proposed:
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, renal failure due to ACEI, allergy, intolerance, other medical reasons).
 
CMS144:
Current:
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons).
Proposed:
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, arrhythmia, bradycardia, patients with atrioventricular block without cardiac pacer, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons).
 
CMS145:
Current:
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons).
Proposed:
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, allergy, intolerance, other medical reasons).

Rationale for Change:

​Update medical reason exception language to ensure it is aligned with specific medical conditions or situations, as currently specified in logic.