CMS996v5 Exclusion Criteria

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    • Type: Other
    • Resolution: Answered
    • Priority: Moderate
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    • 7576127263
    • Riverside Health
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. Therefore, if a provider does not want to conduct fibrinolytic therapy among patients in which a STEMI presents late, they can still meet the measure numerator by conducting PCI within 90 minutes of ED arrival or discharging to acute care within 45 minutes of ED arrival. Thank you for bringing these clinical guidelines to our attention, CMS and the measure developer will continue to assess potential measure refinements for future annual updates.
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. Therefore, if a provider does not want to conduct fibrinolytic therapy among patients in which a STEMI presents late, they can still meet the measure numerator by conducting PCI within 90 minutes of ED arrival or discharging to acute care within 45 minutes of ED arrival. Thank you for bringing these clinical guidelines to our attention, CMS and the measure developer will continue to assess potential measure refinements for future annual updates.
    • CMS0996v5
    • Patients with late presentations > 12 hours of symptoms are counted in the measure.

      After reviewing the 2025 ACS guidelines, as well as supporting studies and trials, we noted that there is no established benefit—nor high-level recommendation—that supports fibrinolytic therapy for patients presenting after 12 hours from symptom onset.

      In multiple studies and clinical discussions, late presentation is cited as the most common reason clinicians defer fibrinolytic therapy. Our cardiologists are concerned that this scenario is not currently included in the exclusion criteria for the measure.

      Could you please clarify whether late presentation will be considered for inclusion in the exclusion criteria, or if this is under review for future updates?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Jatifha C. Harris (Inactive)
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