Brief Description of Issue:

CMS347: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease - percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Description of Measure:

The current initial population for Population 1 includes all patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure. The current logic captures both patients with an active or inactive ASCVD diagnosis.  If a patient has inactive diagnosis of ASCVD, the patient most likely will not meet the numerator.  In addition, this patient would presumably fall out of the numerator year after year. One of the reasons for an inactive diagnosis is due to billing. Our proposed change is to capture only patients who have an active diagnosis of clinical ASCVD.  There will be no changes to the ASCVD procedure.   

Proposed Solution:

DESCRIPTION:
Current:
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
*All patients who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR...

Proposed:
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:
*All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; …

RATE AGGREGATION:
Current:
…
Population 1: All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure, before the end of the measurement period…

Proposed:
…
Population 1: All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure…

GUIDANCE:
Current:
Initial Population 1:
All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure, before the end of the measurement period

Proposed:
Initial Population 1:
All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

INITIAL POPULATION:
Current:
Population 1:
All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure.

Proposed:
Population 1:
All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

CQL LOGIC:
Current: Population 1
Initial Population
exists "ASCVD Diagnosis or Procedure before End of Measurement Period"
and exists "Qualifying Encounter during Measurement Period"

ASCVD Diagnosis or Procedure before End of Measurement Period
( ( ["Diagnosis": "Myocardial Infarction"]
union ["Diagnosis": "Cerebrovascular Disease, Stroke, TIA"]
union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]
union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]
union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis
where ASCVDDiagnosis.prevalencePeriod starts before
end of "Measurement Period"
)
union ( ( ["Procedure, Performed": "PCI"]
union ["Procedure, Performed": "CABG Surgeries"]
union ["Procedure, Performed": "Carotid Intervention"]
union ["Procedure, Performed": "CABG, PCI Procedure"] ) ASCVDProcedure
where Global."NormalizeInterval" ( ASCVDProcedure.relevantDatetime, ASCVDProcedure.relevantPeriod ) starts before
end of "Measurement Period"

Proposed: Population 1

Initial Population
exists "ASCVD Diagnosis Overlaps the Measurement Period or ASCVD Procedure Starts before the end of the Measurement Period"
and exists "Qualifying Encounter during Measurement Period"

ASCVD Diagnosis Overlaps the Measurement Period or ASCVD Procedure Starts before the end of the Measurement Period
( ( ["Diagnosis": "Myocardial Infarction"]
union ["Diagnosis": "Cerebrovascular Disease, Stroke, TIA"]
union ["Diagnosis": "Atherosclerosis and Peripheral Arterial Disease"]
union ["Diagnosis": "Ischemic Heart Disease or Other Related Diagnoses"]
union ["Diagnosis": "Stable and Unstable Angina"] ) ASCVDDiagnosis
where ASCVDDiagnosis.prevalencePeriod overlaps "Measurement Period" )
union ( ( ["Procedure, Performed": "PCI"]
union ["Procedure, Performed": "CABG Surgeries"]
union ["Procedure, Performed": "Carotid Intervention"]
union ["Procedure, Performed": "CABG, PCI Procedure"] ) ASCVDProcedure
where Global."NormalizeInterval" ( ASCVDProcedure.relevantDatetime, ASCVDProcedure.relevantPeriod ) starts before
end of "Measurement Period" )

Rationale for Change:

A patient with an inactive diagnosis of ASCVD does not align with the intent of the measure because the patient is no longer at high risk of cardiovascular events .