Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Marta Livingstone
    • 408-871-3226
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      Thank you for inquiring about the Statin Therapy for the Prevention and Treatment of Cardiovascular Disease eCQM.
      1. Denominator exception #5 is for medical reasons, which are outlined in the “Medical Reason” value set (2.16.840.1.113883.3.526.3.1007), which can be found in the Value Set Authority Center here. Please review the viable codes that meet the medical reasons criterion, which includes concepts such as drug interaction and contraindication.
       
      2. The measure was developed to assess only those “patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period” (Numerator). The measure specification was created with the understanding that not all patients are candidates for statin therapy. One of the allowable 15 medical reasons in the value set (e.g., contraindication to statin medications) should be captured in these instances, thereby removing the patient from the denominator. Broadening the allowable medication therapy for numerator compliance would represent a substantive change impacting the measure’s intent, which we can consider for future refinements.
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      Thank you for inquiring about the Statin Therapy for the Prevention and Treatment of Cardiovascular Disease eCQM. 1. Denominator exception #5 is for medical reasons, which are outlined in the “Medical Reason” value set (2.16.840.1.113883.3.526.3.1007), which can be found in the Value Set Authority Center here. Please review the viable codes that meet the medical reasons criterion, which includes concepts such as drug interaction and contraindication.   2. The measure was developed to assess only those “patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period” (Numerator). The measure specification was created with the understanding that not all patients are candidates for statin therapy. One of the allowable 15 medical reasons in the value set (e.g., contraindication to statin medications) should be captured in these instances, thereby removing the patient from the denominator. Broadening the allowable medication therapy for numerator compliance would represent a substantive change impacting the measure’s intent, which we can consider for future refinements.
    • CMS0347v8

      Regarding CMS347v8, can you please clarify what all the possible medical reasons are that a provider can document for not prescribing statin therapy that would count towards being a denominator exception for this measure? I understand the following below are the denominator exceptions but would like more clarity on number 5.

      1. Patients with statin-associated muscle symptoms or an allergy to statin medication.

      2. Patients who are receiving palliative or hospice care.

      3. Patients with active liver disease or hepatic disease or insufficiency.

      4. Patients with end-stage renal disease (ESRD).

      5. Patients with documentation of a medical reason for not being prescribed statin therapy.

      In addition, our providers are inquiring why Repatha, or similar medications are not considered as meeting this measure given that statins are not appropriate for all their patients. Is there consideration to include these medications in future revisions of the specifications for this measure? 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Marta Livingstone
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