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 eCQM ID | CMS145v11 |
| 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 two qualifying encounters during the measurement period and a diagnosis of coronary artery disease |
| 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., 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). |
| Steward | American Heart 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 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. |
| 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 | 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 | |||
| Notes |
*There is a known issue on CMS145v9. See issue EKI-12 on the ONC eCQM Known Issues Dashboard for details. |
*There is a known issue on CMS145v10. See issue EKI-12 on the ONC eCQM Known Issues Dashboard for details. |
Data Element Repository
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
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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
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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
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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
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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