| Measure Information | 2023 Performance Period |
|---|---|
| CMS eCQM ID | CMS135v11 |
| NQF Number | 0081e |
| MIPS Quality ID | 005 |
| Description |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period |
| Initial Population |
All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure |
| Numerator |
Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period |
| Numerator Exclusions |
Not Applicable |
| Denominator |
Equals Initial Population with a current or prior LVEF <= 40% |
| Denominator Exclusions |
Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD |
| Denominator Exceptions |
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons). |
| Steward | American Heart Association |
| Measure Scoring | Proportion measure |
| Measure Type | Process measure |
| Improvement Notation |
Higher score indicates better quality |
| Guidance |
This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. The requirement of two or more visits is used 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. Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Telehealth Eligible | Yes |
| Next Version | |
| Previous Version |
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| Measure Information | 2021 Performance Period | 2022 Performance Period | 2023 Performance Period | 2024 Performance Period |
|---|---|---|---|---|
| Title | Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
| CMS eCQM ID | CMS135v9 | CMS135v10 | CMS135v11 | CMS135v12 |
| NQF Number | 0081e | 0081e | 0081e | 0081e |
| Description |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period |
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) |
| Initial Population |
All patients aged 18 years and older with a diagnosis of heart failure |
All patients aged 18 years and older with a diagnosis of heart failure |
All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure |
All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure |
| Denominator |
Equals Initial Population with a current or prior LVEF < 40% |
Equals Initial Population with a current or prior LVEF < 40% |
Equals Initial Population with a current or prior LVEF <= 40% |
Equals Initial Population with a current or prior LVEF |
| Denominator Exclusions | None | None | Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD | Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD |
| Numerator |
Patients who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
Patients who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge |
Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period |
Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons). |
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., other system reasons). |
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons). |
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI 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 |
This eCQM is to be reported as patient-based or episode-based, depending on the clinical setting. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge. The requirement of two or more visits used in Population Criteria 1 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. Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
This eCQM is to be reported as patient-based or episode-based, depending on the clinical setting. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge. The requirement of two or more visits used in Population Criteria 1 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. Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. The requirement of two or more visits is used 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. Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period. The requirement of two or more visits is used 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." Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this 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 | 005 | 005 | 005 | 005 |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | CMS135v10 | CMS135v11 | CMS135v12 | No Version Available |
| Previous Version | No Version Available |
Data Element Repository
Header
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Updated name of measure steward.
Measure Section: Measure Steward
Source of Change: Measure Lead
-
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
-
Updated disclaimer.
Measure Section: Disclaimer
Source of Change: Standards/Technical Update
-
Updated rationale to align with most recent guidelines.
Measure Section: Rationale
Source of Change: Measure Lead
-
Update clinical recommendation statement to align with most recent guidelines.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead
-
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
-
Updated guidance to spell out first use of abbreviations for clarity and consistency.
Measure Section: Guidance
Source of Change: Measure Lead
-
Updated initial population statement to align with measure logic requiring at least two qualifying encounters.
Measure Section: Initial Population
Source of Change: Measure Lead
-
Updated the denominator statement to include patients with a left ventricular ejection fraction (LVEF) less than or equal to 40% to align with clinical guidelines.
Measure Section: Denominator
Source of Change: Measure Lead
-
Added denominator exclusions for patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD), because these patients were not included in clinical treatment trials for low LVEF heart failure.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
-
Updated the numerator statement to more closely align with measure logic.
Measure Section: Numerator
Source of Change: Measure Lead
-
Removed system reason denominator exception due to wide-availability of medications.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
-
Updated denominator exception statement to better align with specific medical conditions in the logic.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
-
Removed Population 2, the inpatient population, from the measure to address implementer feedback and keep measure intent contained to the outpatient setting.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Revised language to harmonize with other measures.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Logic
-
Updated the logic to include an LVEF less than or equal to 40% to align with clinical guidelines.
Measure Section: Denominator
Source of Change: Measure Lead
-
Added denominator exclusions to the logic excluding patients with a history of heart transplant or a Left Ventricular Assist Device (LVAD), heart transplant-related diagnoses, and LVAD-related diagnoses, because these patients were not included in clinical treatment trials for low LVEF heart failure.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
-
Removed system reason denominator exception due to wide-availability of medications.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
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Updated encounter logic definition name by adding 'History of' to align with intent of capturing patients with a history of left ventricular systolic dysfunction (LVSD).
Measure Section: Definitions
Source of Change: Measure Lead
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Removed Population 2, the inpatient population, from the measure to address implementer feedback and keep measure intent contained to the outpatient setting.
Measure Section: Multiple Sections
Source of Change: Measure Lead
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Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
-
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
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Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
-
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical 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.
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Value set Medical Reason (2.16.840.1.113883.3.526.3.1007): Deleted 1 SNOMED CT code (397745006) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
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Value set Ejection Fraction (2.16.840.1.113883.3.526.3.1134): Added 3 LOINC codes (93644-3, 93645-0, 93646-8) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
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Value set ACE Inhibitor or ARB Ingredient (2.16.840.1.113883.3.526.3.1489): Added 2 RxNorm codes (1091643, 1656328) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Value set ACE Inhibitor or ARB or ARNI (2.16.840.1.113883.3.526.3.1139): Added 7 RxNorm codes (1798281, 1806884, 251856, 251857, 401965, 401968, 1996254) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Removed value set System Reason (2.16.840.1.113883.3.526.3.1009) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Left Ventricular Assist Device Related Diagnoses (2.16.840.1.113762.1.4.1178.58) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Left Ventricular Assist Device Placement (2.16.840.1.113762.1.4.1178.61) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Heart Transplant Related Diagnoses (2.16.840.1.113762.1.4.1178.56) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Heart Transplant (2.16.840.1.113762.1.4.1178.33) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Removed value set Discharge Services - Hospital Inpatient (2.16.840.1.113883.3.464.1003.101.12.1007) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Renal Failure Due to ACE Inhibitor (2.16.840.1.113883.3.526.3.1151) with direct reference code SNOMED CT code (422593004) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead