Thank you for your question on CMS347v7: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. In your initial inquiry, you asked: “The ASCVD risk score can vary throughout the measurement period as there are many components to the calculation. For inclusion in population 4, should we use the first, the most recent, or any risk score >=20 in the measure year?” The response provided at the time was inaccurate and we apologize for any confusion as a result. For any patient assessed for ASCVD risk multiple times during the measurement period, if at least one score of 20% or greater is found in the patient record they would be included in Population 4 of the measure (assuming said patient did not meet criteria for Populations 1-3). We will review and revise language as needed in the measure guidance section to make this clearer in the next annual update. Please let us know if you have any additional questions or concerns.

Previous Inquiry submitted on 4/9/24 ( CQM-6888 ): The ASCVD risk score can vary throughout the measurement period as there are many components to the calculation. For inclusion in population 4, should we use the first, the most recent, or any risk score >=20 in the measure year? Previous Response for Inquiry Submitted on 4/9/24 ( CQM-6888 ): Thank you for your question regarding 347v7, Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. For patients not included in Populations 1 through 3, in instances where there are multiple ASCVD risk estimates, reporting entities should use the most recent ASCVD risk estimate relative to the encounter qualifying the patient for Population 4. Follow-Up Inquiry submitted 10/2/24: Hello, we are following-up on the response to the previous inquiry: Can you please clarify what is meant by "most recent ASCVD risk estimate relative to the encounter qualifying the patient?" We are running into an issue where we are "treating patients out of the denominator". For example, a patient has an ASCVD risk score of 22 in January of the measurement period and included in population 4. Then patient is started on a Statin, and LDL and blood pressure (components of the risk score) drops throughout the year and by July this patient's risk score is 18. Since we are using the most recent risk score in the measurement year, this risk score of 18 removed the patient from the denominator. Is this the intent of using the most recent score?