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

Measure Information	2023 Performance Period
CMS Measure ID	CMS145v11
NQF Number	0070e
Measure 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 two qualifying encounters during the measurement period and a diagnosis of coronary artery disease
Denominator Statement	Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%
Denominator Exclusions	None
Numerator Statement	Patients who were prescribed beta-blocker therapy
Numerator Exclusions	Not Applicable
Denominator Exceptions	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).
Measure Steward	American Heart Association
Quality Domain	Effective Clinical Care
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 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.
MIPS Quality ID	007
Meaningful Measure	Management of Chronic Conditions
Telehealth Eligible	Yes
Next Version	No Version Available
Previous Version	CMS145v10

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
CMS Measure ID	CMS145v9	CMS145v10	CMS145v11
NQF Number	0070e	0070e	0070e
Measure 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
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
Denominator Statement	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
Numerator Statement	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
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).
Measure Steward	PCPI(R) Foundation (PCPI[R])	American Heart Association-American Stroke Association	American Heart Association
Quality Domain	Effective Clinical Care	Effective Clinical Care	Effective Clinical Care
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure
Improvement Notation	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 (https://ecqi.healthit.gov/qdm) 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.
MIPS Quality ID	007	007	007
Meaningful Measure	Management of Chronic Conditions	Management of Chronic Conditions	Management of Chronic Conditions
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS145v10	CMS145v11	No Version Available
Previous Version	No Version Available	CMS145v9	CMS145v10

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Specifications

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CMS145v11.html	125.43 KB
CMS145v11.zip	108.12 KB
CMS145v11-TRN.xlsx	22.28 KB

Value Sets

Value Sets to be used with CMS145v11

Release Notes

CMS145v11-TRN.xlsx

Header

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 references.

Measure Section: Reference

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 Initial Population header statement to align with measure logic.

Measure Section: Initial Population

Source of Change: Measure Lead
Updated initial population statement to align with measure logic requiring at least two qualifying encounters.

Measure Section: Denominator

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

Logic

Updated denominator logic for Population 2 so that patients with left ventricular systolic dysfunction (LVSD) will not be captured in the denominator.

Measure Section: Denominator

Source of Change: ONC Project Tracking System (JIRA): CQM-4638
Updated the logic to include 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
Replaced 'Device, Applied' with 'Procedure, Performed' in Cardiac Pacer Implanted expression to align with current QDM.

Measure Section: Denominator Exceptions

Source of Change: Measure Lead
Replaced timing operator 'overlaps after' with 'starts before end of' to allow use of 'NormalizeInterval' function, where applicable.

Measure Section: Denominator Exceptions

Source of Change: Measure Lead
Updated encounter logic definition name by adding 'History of' to align with intent of capturing patients with a history of LVSD.

Measure Section: Definitions

Source of Change: Measure Lead
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
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
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
Added the 'NormalizeInterval' function to 'Procedure, Performed', 'Physical Exam, Performed', and 'Diagnosis' to decrease implementation burden due to variable use of timing attributes.

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

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 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
Value set Myocardial Infarction (2.16.840.1.113883.3.526.3.403): Added 23 SNOMED CT codes based on terminology update. Deleted 1 SNOMED CT code (371068009) 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): Added 7 SNOMED CT codes (15960341000119104, 15960461000119105, 876856005, 876857001, 876858006, 876859003, 896690007) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Cardiac Surgery (2.16.840.1.113883.3.526.3.371): Added 29 SNOMED CT codes based on terminology update. Deleted 12 SNOMED CT codes based on terminology update. Deleted 6 CPT codes (92980, 92981, 92982, 92984, 92995, 92996) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1174): Added 8 RxNorm codes (1234256, 1999031, 1999033, 1999035, 1999037, 856443, 896771, 904630) based on review by technical experts, SMEs, and/or public feedback. Added 4 RxNorm codes (2477889, 2479564, 2479566, 2479567) based on terminology update. Deleted 1 RxNorm code (1191185) based on terminology update.

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 SNOMED CT code (443325000) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Bradycardia (2.16.840.1.113883.3.526.3.412): Added 2 SNOMED CT codes (1142110005, 1142111009) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Beta Blocker Therapy Ingredient (2.16.840.1.113883.3.526.3.1493): Added 2 RxNorm codes (31555, 9947) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Asthma (2.16.840.1.113883.3.526.3.362): Added 1 SNOMED CT code (762521001) based on terminology update. Deleted 2 SNOMED CT codes (304527002, 708038006) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Arrhythmia (2.16.840.1.113883.3.526.3.366): Added 26 SNOMED CT codes based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
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
Removed value set Cardiac Pacer (2.16.840.1.113883.3.526.3.1193) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Cardiac Pacer (2.16.840.1.113762.1.4.1178.53) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Beta Blocker Therapy for LVSD (2.16.840.1.113883.3.526.3.1184): Added 4 RxNorm codes (1999031, 1999033, 1999035, 1999037) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
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