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EH/CAH eCQMs
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Resolution: Answered
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Moderate
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None
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We plan to move forward with the proposed change during this annual update.
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 Infraction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%):
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, CMS144, and CMS 145 are currently specified with a LVEF of <40% in the denominator. The AHA/ACC Joint Task Force has updated this value to <=40% to better align with existing guidelines for the management of heart failure.
2013 ACC/AHA Guidelines: Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American College of Chest Physicians, Heart Rhythm Society and International Society for Heart and Lung Transplantation. Circulation. 2013;128:e240–327.
Proposed Solution:
CURRENT HEADER FOR CMS 135
Definition:
LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement.
Denominator:
Equals Initial Population with a current or prior LVEF < 40%
PROPOSED HEADER FOR CMS 135
Definition:
LVEF <= 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to [inclusive of] 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
Denominator:
Equals Initial Population with a current or prior LVEF <= 40%
CURRENT HEADER FOR CMS 144
Definition:
LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:
1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement.
Beta-blocker therapy:
-For patients with prior LVEF < 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.
Denominator:
Equals Initial Population with a current or prior LVEF < 40%
PROPOSED HEADER FOR CMS 144
Definition:
LVEF <= 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to [inclusive of] 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
Beta-blocker therapy:
-For patients with prior LVEF <= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.
Denominator:
Equals Initial Population with a current or prior LVEF <= 40%
CURRENT HEADER FOR CMS 145
Definition:
LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:
1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
... - For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate
...
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement.
If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF < 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.
Denominator:
Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%
PROPOSED HEADER FOR CMS 145
Definition:
LVEF <= 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:
1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
Guidance:
... - For patients with prior LVEF <=40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate
...
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to [inclusive of] 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <= 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.
Denominator:
Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%
CURRENT LOGIC FOR CMS 135, 144, 145:
Moderate or Severe LVSD Findings
( ["Diagnostic Study, Performed": "Ejection Fraction"] EjectionFraction
where EjectionFraction.result < 40 '%')
union ["Diagnosis": "Moderate or Severe LVSD"]
union ( ["Diagnosis": "Left ventricular systolic dysfunction (disorder)"] LVSD
where LVSD.severity in "Moderate or Severe")
PROPOSED LOGIC FOR CMS 135, 144, 145:
Moderate or Severe LVSD Findings
( ["Diagnostic Study, Performed": "Ejection Fraction"] EjectionFraction
where EjectionFraction.result <= 40 '%')
union ["Diagnosis": "Moderate or Severe LVSD"]
union ( ["Diagnosis": "Left ventricular systolic dysfunction (disorder)"] LVSD
where LVSD.severity in "Moderate or Severe")
Rationale for Change:
Updating LVEF threshold will better align with guidelines.