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  2. CQM-6616

Please change the entire chart lookback for atrial fibrillation

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    • Rebecca Panruk
    • 907-729-4548
    • Alaska Native Medical Center
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      Thank you for your question for CMS71/eSTK-3: Anticoagulation Therapy for Atrial Fibrillation/Flutter. The value set for atrial fibrillation/Flutter does not include a code to rule out for a condition. The value sets only include diagnosis of afib/ flutter.

      The measure uses a lookback period and once patients have Afib/flutter(AF) they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return.

      Some of ways that patients may be excluded from eSTK-3 are listed below:
      - Inpatient hospitalizations for patients admitted for elective carotid intervention are not included in this measure. This exclusion is implicitly modeled by only including non-elective hospitalizations.
      - Patients with a documented reason for not prescribing anticoagulation therapy at discharge including “Medical Reason” or “Patient Refusal”.
      Show
      Thank you for your question for CMS71/eSTK-3: Anticoagulation Therapy for Atrial Fibrillation/Flutter. The value set for atrial fibrillation/Flutter does not include a code to rule out for a condition. The value sets only include diagnosis of afib/ flutter. The measure uses a lookback period and once patients have Afib/flutter(AF) they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return. Some of ways that patients may be excluded from eSTK-3 are listed below: - Inpatient hospitalizations for patients admitted for elective carotid intervention are not included in this measure. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Patients with a documented reason for not prescribing anticoagulation therapy at discharge including “Medical Reason” or “Patient Refusal”.
    • CMS0071v13
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      Causing unnecessary failures with the eSTK-3 measure. We would like to be able to submit this measure, but it seems the lookback feature for a-fib is causing issues related to current encounters vs previous encounters that a-fib really was more of a r/o issue.
      Show
      Causing unnecessary failures with the eSTK-3 measure. We would like to be able to submit this measure, but it seems the lookback feature for a-fib is causing issues related to current encounters vs previous encounters that a-fib really was more of a r/o issue.

      It does not seem that an entire chart lookback for atrial fibrillation/flutter (a-fib/flutter) is a good idea when it comes to the eSTK-3 (discharge on anticoagulant for a-fib/flutter) measure. We are finding that a lot of times a-fib is coded (many years prior) as a dx on a coding summary, but really it is being r/o. After this happens, it might be in one location in the patient's chart, for example several years before, yet we will fail this measure because the provider does not order an anticoagulant at discharge or address the a-fib the patient never really had, so it does not follow the patient as a dx, and the provider cannot possibly know what was written or coded years before, therefore, the provider cannot address a-fib when the patient comes in with a stroke because really the patient never had it but it is still hanging out on the patients record from a coding summary many years prior. It seems like the a-fib/flutter should be an encounter specific item, not the life of the patient's entire medical record.

      Again, I encourage a change around this item so that the eSTK-3 measure is more easily attainable.

      Thanks!

            JLeflore Mathematica EH eCQM Team
            rajohn Rebecca A John
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