CMS996v5

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Vanessa Rojas
    • 7186928792
    • Maimonides Midwood Community Hospital
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      Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding is that the intent of your inquiry is to clarify how the measure accounts for treatment of STEMI patients who present to the emergency department with ischemic symptoms greater than 12 hours after onset for calendar year (CY) 2025 reporting period. We would like to first clarify that CMS996v6 is applicable only for the CY 2026 reporting period, while CMS996v5 applies for the CY 2025 reporting period.

      With that said, neither the CMS996v5 nor the CMS996v6 measure specifications have denominator exclusions for ED encounters where the patient presents with STEMI symptoms greater than 12 hours after onset. Therefore, this population is included in the measure denominator. Please note that the measure captures three potential numerators for ED encounters with a STEMI diagnosis: (i) PCI procedure within 90 minutes of ED arrival, (ii) fibrinolytic therapy within 30 minutes of ED arrival, or (iii) discharge to acute care within 45 minutes of ED arrival.

      The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes (https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309#sec-10) describes various scenarios as evidence is continuing to evolve in this population of late presentation STEMI. The guidelines note that coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia. In stable, asymptomatic patients with an occluded artery greater than 48 hours from symptom onset, those patients would likely benefit from expedited evaluation. If a primary PCI may not be clinically indicated based on guideline-directed therapy, ED encounters can still meet the measure numerator criteria by conducting fibrinolytic therapy within 30 minutes of ED arrival or discharging to acute care within 45 minutes of ED arrival.

      However, version CMS996v6 includes denominator exceptions for ED encounters with a documented reason (such as treatment or procedure not indicated) for (i) not administering fibrinolytic therapy within 30 minutes of ED arrival or (ii) not performing a PCI within 90 minutes of ED arrival. ED encounters with a documented reason for not administering fibrinolytic therapy or not performing a PCI within the abovementioned timeframes may still be reported; however, providers are not penalized for not meeting the numerator requirements. For more information about the denominator exceptions for CMS996v6, please refer to the updated measure specifications available in the eCQI Resource Center: https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information.
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      Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding is that the intent of your inquiry is to clarify how the measure accounts for treatment of STEMI patients who present to the emergency department with ischemic symptoms greater than 12 hours after onset for calendar year (CY) 2025 reporting period. We would like to first clarify that CMS996v6 is applicable only for the CY 2026 reporting period, while CMS996v5 applies for the CY 2025 reporting period. With that said, neither the CMS996v5 nor the CMS996v6 measure specifications have denominator exclusions for ED encounters where the patient presents with STEMI symptoms greater than 12 hours after onset. Therefore, this population is included in the measure denominator. Please note that the measure captures three potential numerators for ED encounters with a STEMI diagnosis: (i) PCI procedure within 90 minutes of ED arrival, (ii) fibrinolytic therapy within 30 minutes of ED arrival, or (iii) discharge to acute care within 45 minutes of ED arrival. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes ( https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309#sec-10 ) describes various scenarios as evidence is continuing to evolve in this population of late presentation STEMI. The guidelines note that coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia. In stable, asymptomatic patients with an occluded artery greater than 48 hours from symptom onset, those patients would likely benefit from expedited evaluation. If a primary PCI may not be clinically indicated based on guideline-directed therapy, ED encounters can still meet the measure numerator criteria by conducting fibrinolytic therapy within 30 minutes of ED arrival or discharging to acute care within 45 minutes of ED arrival. However, version CMS996v6 includes denominator exceptions for ED encounters with a documented reason (such as treatment or procedure not indicated) for (i) not administering fibrinolytic therapy within 30 minutes of ED arrival or (ii) not performing a PCI within 90 minutes of ED arrival. ED encounters with a documented reason for not administering fibrinolytic therapy or not performing a PCI within the abovementioned timeframes may still be reported; however, providers are not penalized for not meeting the numerator requirements. For more information about the denominator exceptions for CMS996v6, please refer to the updated measure specifications available in the eCQI Resource Center: https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information .
    • CMS0996v5
    • Clear guidance is requested to support accurate abstraction and denominator determination for late-presenting STEMI patients within the CMS996v6 measure

      I am writing to request clarification regarding the CMS996v6 measure and the appropriate handling of STEMI patients who present to the emergency department with ischemic symptoms greater than 12 hours after onset for calendar year 2025.

      Current clinical guidelines state that primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration, and also recommend primary PCI for patients with contraindications to fibrinolytic therapy regardless of time delay from first medical contact. However, CMS996v6 does not appear to include an explicit denominator exclusion for late presentation based on symptom duration.

      Could you please clarify the following:

      • Whether patients presenting with STEMI symptoms greater than 12 hours after onset may be excluded from the CMS996v6 denominator, and if so, under what criteria; or
      • If these patients are expected to remain in the denominator, how CMS recommends they be handled for measure compliance when primary PCI may not be clinically indicated based on guideline-directed therapy.

      This clarification would be very helpful to ensure accurate abstraction and alignment between clinical practice guidelines and measure reporting.

      Thank you for your time and assistance.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Vanessa Rojas
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