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  2. CQM-5929

CMS-347 Familial Hypercholesterolemia looking for previous diagnosis causing issues

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      ​Thank you for your inquiry about CMS347v6 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. We discussed this issue with the measure’s Expert Work Group, and while they note the potential for past diagnoses which may have resolved, or false or temporary diagnoses due to coding nuances, the Expert Work Group agreed we should revert to tracking previous diagnoses or ASCVD procedures. The rationale is that the measure intent is to identify as many patients as possible who would benefit from statin therapy.
      For patients with a past diagnosis who qualify for a denominator population and for whom statin therapy would be clinically inappropriate, the denominator exception “patients with a documentation of a medical reason for not being prescribed statin therapy” would be appropriate. Use of a denominator exception would in this case remove the patient from the denominator of the measure performance rate if the numerator criteria are not met. We hope this helps.
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      ​Thank you for your inquiry about CMS347v6 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. We discussed this issue with the measure’s Expert Work Group, and while they note the potential for past diagnoses which may have resolved, or false or temporary diagnoses due to coding nuances, the Expert Work Group agreed we should revert to tracking previous diagnoses or ASCVD procedures. The rationale is that the measure intent is to identify as many patients as possible who would benefit from statin therapy. For patients with a past diagnosis who qualify for a denominator population and for whom statin therapy would be clinically inappropriate, the denominator exception “patients with a documentation of a medical reason for not being prescribed statin therapy” would be appropriate. Use of a denominator exception would in this case remove the patient from the denominator of the measure performance rate if the numerator criteria are not met. We hope this helps.
    • CMS0347v6

      I previously opened CQM-5694 with feedback from our providers that the Familial Hypercholesterolemia valueset is still too broad.  Our providers are also struggling with the fact that patients are included in the denominator based on a previous diagnosis but a statin is not clinically indicated.  

      I see that for 2023, the previous diagnosis for ASCVD has been removed and only active diagnoses are considered.

      1) Can you please consider making this same change for Familial Hypercholesterolemia?

      2) What should providers do for patients who have a familial hypercholesterolemia diagnosis in the past but do not meet best practice criteria to be on a statin?  Example - patient with elevated LDL, but below the 190 threshold, that was given a dx of hypercholesterolemia instead of hyperlipidemia at some point in the past.  Or a patient with a working diagnosis contained in that value set that was later ruled out.  Without having any of the defined exclusions, are they stuck in the denominator?

            edave Mathematica EC eCQM Team
            Kenadi Moore Kenadi Moore (Inactive)
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