Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%)

Measure Information	2022 Performance Period
CMS eCQM ID	CMS145v10
NQF Number	0070e
MIPS Quality ID	007
Description	Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF < 40% who were prescribed beta-blocker therapy
Initial Population	All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period
Numerator	Patients who were prescribed beta-blocker therapy
Numerator Exclusions	Not Applicable
Denominator	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%
Denominator Exclusions	None
Denominator Exceptions	Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
Steward	American Heart Association-American Stroke Association
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Higher score indicates better quality
Guidance	Beta-blocker therapy: - For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents - For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement. If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF < 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.
Telehealth Eligible	Yes
Next Version	CMS145v11
Previous Version	CMS145v9

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period	2024 Performance Period
Title	Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%)	Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%)	Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)	Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF)
CMS eCQM ID	CMS145v9	CMS145v10	CMS145v11	CMS145v12
NQF Number	0070e	0070e	0070e	0070e
Description	Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy	Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF < 40% who were prescribed beta-blocker therapy	Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <=40% who were prescribed beta-blocker therapy	Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF <=40% who were prescribed beta-blocker therapy
Initial Population	All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period	All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period	All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease	All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease
Denominator	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%
Denominator Exclusions	None	None	None	None
Numerator	Patients who were prescribed beta-blocker therapy	Patients who were prescribed beta-blocker therapy	Patients who were prescribed beta-blocker therapy	Patients who were prescribed beta-blocker therapy
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).	Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).	Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).	Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
Measure Steward	PCPI(R) Foundation (PCPI[R])	American Heart Association-American Stroke Association	American Heart Association	American Heart Association
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure	Process measure
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Guidance	Beta-blocker therapy: - For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents - For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement. If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF < 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	Beta-blocker therapy: - For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents - For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than 40% threshold noted in the denominator logic. A range that is inclusive of or greater than 40% would not meet the measure requirement. If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF < 40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	Beta-blocker therapy: - For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents - For patients with prior LVEF <=40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	Beta-blocker therapy: - For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents - For patients with prior LVEF <=40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate The requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe." If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID	007	007	007	007
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS145v10	CMS145v11	CMS145v12	No Version Available
Previous Version	No Version Available	CMS145v9	CMS145v10	CMS145v11

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*Note: There is a known issue on CMS145v10. See issue EKI-12 on the ONC eCQM Known Issues Dashboard for details.

Data Element Repository

Data Elements contained within CMS145v10

Value Sets

Value Sets to be used with CMS145v10

Release Notes

CMS145v10-TRN.xlsx

Header

Updated the eCQM version number.

Measure Section: eCQM Version Number

Source of Change: Annual Update
Updated Measure Steward.

Measure Section: Measure Steward

Source of Change: Measure Lead
Updated Measure Developer.

Measure Section: Measure Developer

Source of Change: Measure Lead
Updated copyright.

Measure Section: Copyright

Source of Change: Annual Update
Updated disclaimer.

Measure Section: Disclaimer

Source of Change: Annual Update
Updated references.

Measure Section: Reference

Source of Change: Annual Update
Updated definition pertaining to Moderate to Severe LVSD to better align with logic.

Measure Section: Definition

Source of Change: Annual Update

Logic

Updated timing logic so that cardiac pacers in existence before the index encounter are considered for the denominator exception.

Measure Section: Denominator Exceptions

Source of Change: ONC Project Tracking System (Jira): QRDA-964
Updated Outpatient Encounter definitions to remove FaceToFaceEncounter language to signal broadening of encounter type.

Measure Section: Definitions

Source of Change: Annual Update
Changed the timing of the check for moderate or severe LVSD in the Qualifying CAD Encounter and Moderate or Severe LVSD definition from ends to starts to account for end dates not often being documented.

Measure Section: Multiple Sections

Source of Change: ONC Project Tracking System (Jira): CQM-3890
Removed timing logic (minus one day) from the Qualifying CAD Encounter and Prior MI definition as it is no longer required due to another logic change.

Measure Section: Multiple Sections

Source of Change: Annual Update
Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

Measure Section: Multiple Sections

Source of Change: Standards Update
Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

Measure Section: Multiple Sections

Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set Atrioventricular Block (2.16.840.1.113883.3.526.3.367): Added 4 SNOMED CT codes (102451000119107, 204383001, 284941000119107, 733125004) based on review by technical experts, SMEs, and/or public feedback. Added 3 ICD-10-CM codes (I44.0, I44.30, I44.39) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Cardiac Pacer in Situ (2.16.840.1.113883.3.526.3.368): Added 1 ICD-10-CM code (Z95.810) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Cardiac Surgery (2.16.840.1.113883.3.526.3.371): Added 3 SNOMED CT codes (67166004, 871496000, 871497009) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Replaced value set Left Ventricular Systolic Dysfunction (2.16.840.1.113883.3.526.3.1091) with direct reference code SNOMED CT code (134401001) based on applicability of a single code to represent clinical data.

Measure Section: Terminology

Source of Change: Annual Update
Value set Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174): Deleted 12 RxNorm codes (152916, 199277, 199494, 199495, 199717, 199786, 199787, 856713, 896983, 896987, 998693, 998695) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Coronary Artery Disease No MI (2.16.840.1.113883.3.526.3.369): Deleted 1 ICD-10-CM code (I24.1) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead