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 or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period. 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 or already taking beta-blocker therapy during the measurement period. CMS145: Coronary Artery Disease (CAD): Beta-Blocker Therapy-- Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <=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 current initial population logic requires a patient have two encounters during the measurement period. The intent is for these two encounters to be two discrete, unique encounters. However, the current logic allows for two encounters with the same date/time to meet the two Qualifying Encounters requirement which would qualify a patient if the same encounter was entered/captured twice.  Goal of review Obtain technical feedback

Proposed solution ​Update logic so that second qualifying encounter must start after first qualifying encounter. Logic updates are as follows:  CMS135 and CMS144 Prior Logic:  AgeInYearsAt(date from start of "Measurement Period")>= 18   and Count("Qualifying Encounter During Measurement Period")>= 2   and exists "Heart Failure Outpatient Encounter" CMS135 and CMS144 Updated Logic: AgeInYearsAt(date from start of "Measurement Period")>= 18   and exists ( "Qualifying Encounter During Measurement Period" Encounter1       with "Qualifying Encounter During Measurement Period" Encounter2         such that Encounter2.relevantPeriod starts after          end of Encounter1.relevantPeriod)   and exists "Heart Failure Outpatient Encounter" CMS145 Prior Logic:  AgeInYearsAt(date from start of "Measurement Period")>= 18   and Count("Qualifying Encounter During Measurement Period")>= 2   and ( exists "Qualifying CAD Encounter" ) CMS145 Updated Logic:  AgeInYearsAt(date from start of "Measurement Period")>= 18   and exists ( "Qualifying Encounter During Measurement Period" Encounter1       with "Qualifying Encounter During Measurement Period" Encounter2         such that Encounter2.relevantPeriod starts after          end of Encounter1.relevantPeriod  )   and exists "Qualifying CAD Encounter" Rationale for change ​The change will ensure that in the event the same encounter is entered or captured twice, it will not qualify a patient (who may only have one true qualifying encounter) for the initial population.