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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

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Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

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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

Release Notes

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

Last Updated: May 05, 2022