Kidney Health Evaluation

Compare Versions of: "Kidney Health Evaluation"

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period
Title	Kidney Health Evaluation	Kidney Health Evaluation	Kidney Health Evaluation
CMS eCQM ID	CMS951v1	CMS951v2	CMS951v3
CBE ID*	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	488	488	488
Measure Steward	National Kidney Foundation	National Kidney Foundation	National Kidney Foundation
Description	Percentage of patients aged 18-75 years with a diagnosis of diabetes who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the measurement period	Percentage of patients aged 18-75 years with a diagnosis of diabetes who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the measurement period	Percentage of patients aged 18-85 years with a diagnosis of diabetes who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the measurement period
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS951v1.html	None	None
Risk Adjustment	*See CMS951v1.html	None	None
Rationale	*See CMS951v1.html	Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk (National Kidney Foundation [NKF], 2019), with an estimated population... prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030 (Saran et al., 2019; Hoerger et al., 2015). Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran et al., 2019; Nichols et al., 2020). In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions (Bowe et al., 2018). Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD (Saran et al., 2019). CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death (Hoerger et al., 2015; Bowe et al., 2018). This public health issue is driven largely by the impact of diabetes—the most common comorbid risk factor for CKD (Saran et al., 2019; Bowe et al., 2018). The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using eGFR and uACR is recommended by clinical practice guidelines (ADA, 2022; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2020 (United States Renal Data System, 2018). However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8%) and private insurers (49.0%) (Saran et al., 2019; Alfego et al., 2021; Stempneiwicz et al., 2021). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al., 2014). Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis (Saran et al., 2019; Centers for Disease Control and Prevention, 2019). Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years (Hoerger et al., 2015). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes. Show more > Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk (National Kidney Foundation [NKF], 2019), with an estimated population prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030 (Saran et al., 2019; Hoerger et al., 2015). Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran et al., 2019; Nichols et al., 2020). In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions (Bowe et al., 2018). Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD (Saran et al., 2019). CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death (Hoerger et al., 2015; Bowe et al., 2018). This public health issue is driven largely by the impact of diabetes—the most common comorbid risk factor for CKD (Saran et al., 2019; Bowe et al., 2018). The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using eGFR and uACR is recommended by clinical practice guidelines (ADA, 2022; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2020 (United States Renal Data System, 2018). However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8%) and private insurers (49.0%) (Saran et al., 2019; Alfego et al., 2021; Stempneiwicz et al., 2021). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al., 2014). Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis (Saran et al., 2019; Centers for Disease Control and Prevention, 2019). Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years (Hoerger et al., 2015). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes. Show less	Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk (National Kidney Foundation [NKF], 2022), with an estimated population... prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030 (Saran et al., 2019; Hoerger et al., 2015). Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran et al., 2019; Nichols et al., 2020). In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions (Bowe et al., 2018). Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD (Saran et al., 2019). CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death (Hoerger et al., 2015; Bowe et al., 2018). This public health issue is driven largely by the impact of diabetes—the most common comorbid risk factor for CKD (Saran et al., 2019; Bowe et al., 2018). The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using eGFR and uACR is recommended by clinical practice guidelines (American Diabetes Association, 2022; de Boer, 2022; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2030 (Healthy People 2030, 2023). However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8%) and private insurers (49.0%) (Saran et al., 2019; Alfego et al., 2021; Stempneiwicz et al., 2021). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al., 2014). Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis (Saran, et al., 2019; Centers for Disease Control and Prevention, 2023). Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years (Hoerger et al., 2015). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes. Show more > Chronic Kidney Disease (CKD) is a major driver of morbidity, mortality and high healthcare costs in the United States. Currently, 37 million American adults have CKD and millions of others are at increased risk (National Kidney Foundation [NKF], 2022), with an estimated population prevalence growing to nearly 17% among Americans aged 30 years and older by the year 2030 (Saran et al., 2019; Hoerger et al., 2015). Total Medicare spending in 2016 on both CKD and End-Stage Renal Disease (ESRD) was over $114 billion, comprising 23% of total Medicare fee-for-service spending overall with costs increasing exponentially with advancing CKD (Saran et al., 2019; Nichols et al., 2020). In the US from 2002-2016, the burden of CKD, defined as years of life lost, years living with disability, disability-adjusted life years, and deaths, outpaced changes in the burden of disease for other conditions (Bowe et al., 2018). Patients with CKD are readmitted to the hospital more frequently than those without diagnosed CKD (Saran et al., 2019). CKD is the 9th leading cause of death in the US and is the fastest growing non-communicable disease in terms of in burden largely due to death (Hoerger et al., 2015; Bowe et al., 2018). This public health issue is driven largely by the impact of diabetes—the most common comorbid risk factor for CKD (Saran et al., 2019; Bowe et al., 2018). The intent of this process measure is to improve rates of guideline-concordant kidney health evaluation in patients with diabetes to more consistently identify and potentially treat or delay progression of CKD in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using eGFR and uACR is recommended by clinical practice guidelines (American Diabetes Association, 2022; de Boer, 2022; NKF, 2007; NKF, 2012) and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2030 (Healthy People 2030, 2023). However, performance of these tests in patients with diabetes remains low, with rates that vary across Medicare (41.8%) and private insurers (49.0%) (Saran et al., 2019; Alfego et al., 2021; Stempneiwicz et al., 2021). Low rates of detection of CKD in a population of patients with diabetes have been demonstrated to be associated with low patient awareness of their own kidney health status (Szczech et al., 2014). Indeed, 90% of individuals with CKD are unaware of their condition due to under-recognition and under-diagnosis (Saran, et al., 2019; Centers for Disease Control and Prevention, 2023). Currently, an individual’s lifetime probability of developing CKD is relatively high, reaching 54% for someone currently aged 30-49 years (Hoerger et al., 2015). Regular kidney health evaluations, utilizing both eGFR and uACR, provide an opportunity to improve identification and potential reversal of worsening kidney function, particularly in high risk populations, such as those with diabetes. Show less
Clinical Recommendation Statement	*See CMS951v1.html	The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable: At least once a year, assess urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate in patients with type 1... diabetes with duration of >= 5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension. B (American Diabetes Association Professional Practice Committee, 2019) Patients with diabetes should be screened annually for Diabetic Kidney Disease (DKD). Initial screening should commence: - 5 years after the diagnosis of type 1 diabetes; (A) or - From diagnosis of type 2 diabetes. (B) Screening should include: - Measurements of urinary albumin-creatinine ratio (ACR) in a spot urine sample; (B) - Measurement of serum creatinine and estimation of GFR. (B) (NKF, 2007; NKF, 2012) Show more > The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable: At least once a year, assess urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate in patients with type 1 diabetes with duration of >= 5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension. B (American Diabetes Association Professional Practice Committee, 2019) Patients with diabetes should be screened annually for Diabetic Kidney Disease (DKD). Initial screening should commence: - 5 years after the diagnosis of type 1 diabetes; (A) or - From diagnosis of type 2 diabetes. (B) Screening should include: - Measurements of urinary albumin-creatinine ratio (ACR) in a spot urine sample; (B) - Measurement of serum creatinine and estimation of GFR. (B) (NKF, 2007; NKF, 2012) Show less	The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable: At least annually, urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate should be assessed in people with... type 1 diabetes with duration of ≥5 years and in all people with type 2 diabetes regardless of treatment. B (American Diabetes Association Professional Practice Committee, 2023) Patients with diabetes should be screened annually for Diabetic Kidney Disease (DKD). Initial screening should commence: - 5 years after the diagnosis of type 1 diabetes; (A) or - From diagnosis of type 2 diabetes. (B) Screening should include: - Measurements of urinary albumin-creatinine ratio (ACR) in a spot urine sample; (B) - Measurement of serum creatinine and estimation of GFR. (B) (NKF, 2007; NKF, 2012) Show more > The following evidence statements are quoted verbatim from the referenced clinical guidelines and other sources, where applicable: At least annually, urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate should be assessed in people with type 1 diabetes with duration of ≥5 years and in all people with type 2 diabetes regardless of treatment. B (American Diabetes Association Professional Practice Committee, 2023) Patients with diabetes should be screened annually for Diabetic Kidney Disease (DKD). Initial screening should commence: - 5 years after the diagnosis of type 1 diabetes; (A) or - From diagnosis of type 2 diabetes. (B) Screening should include: - Measurements of urinary albumin-creatinine ratio (ACR) in a spot urine sample; (B) - Measurement of serum creatinine and estimation of GFR. (B) (NKF, 2007; NKF, 2012) Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*See CMS951v1.html	None	None
Guidance	This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-75. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 75 years of age). 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. Show more > This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-75. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 75 years of age). 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. Show less	This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-75. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 75 years of age). 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. Show more > This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-75. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 75 years of age). 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. Show less	This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-85. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 85 years of age). 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. Show more > This measure assesses performance of a comprehensive kidney evaluation in adults aged 18-85. This measure does not preclude or discourage the use of regular laboratory testing for CKD in patients outside of the age range (patients under 18 years and those over 85 years of age). 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. Show less
Initial Population	All patients aged 18-75 years with a diagnosis of diabetes at the start of the measurement period with a visit during the measurement period	All patients aged 18-75 years with a diagnosis of diabetes at the start of the measurement period with a visit during the measurement period	All patients aged 18-85 years with a diagnosis of diabetes at the start of the measurement period with a visit during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Patients with a diagnosis of End Stage Renal Disease (ESRD); Patients with a diagnosis of Chronic Kidney Disease (CKD) Stage 5; Patients who have an order for or are receiving hospice or palliative care	Patients with a diagnosis of ESRD; Patients with a diagnosis of CKD Stage 5; Patients who have an order for or are receiving hospice or palliative care	Patients with a diagnosis of ESRD active during the measurement period; Patients with a diagnosis of CKD Stage 5 active during the measurement period; Patients who have an order for or are receiving hospice or palliative care
Numerator	Patients who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the measurement period	Patients who received a kidney health evaluation defined by an eGFR AND uACR within the measurement period	Patients who received a kidney health evaluation defined by an eGFR AND uACR within the measurement period
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Telehealth Eligible	Yes	Yes	Yes
Next Version	No Version Available	CMS951v3	No Version Available
Previous Version	No Version Available	CMS951v1	CMS951v2

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There is a known issue on CMS951v3. See issue EKI-32 on the ONC eCQM Known Issues Dashboard for details.

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CMS951v3-TRN.xlsx

Header

Updated the eCQM version number.
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eCQM Version Number
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Annual Update
Changed all references from NQF to CBE to identify the consensus-based entity role.
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CBE Number
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Updated copyright.
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Copyright
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Updated disclaimer.
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Disclaimer
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Updated clinical recommendation statement to reflect the 2023 American Diabetes Association professional practice guidelines and to maintain alignment with measure intent.
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Clinical Recommendation Statement
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Measure Lead
Added denominator exclusion language, clarifying the timing of diagnosis overlap that would exclude a patient from the measure.
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Denominator Exclusions
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Annual Update
Updated age range for initial population, harmonizing measure with HEDIS and MIPS measures.
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Updated grammar, wording, and/or formatting to improve readability and consistency.
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Updated references and measure header to reflect current evidence and new or updated literature.
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Logic

Updated initial population age, expanding range to align with HEDIS and MIPS measure criteria.
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Initial Population
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Measure Lead
Added language to clarify timing of denominator exclusion criteria to include diagnosis overlap and the receipt of hospice or palliative care.
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Denominator Exclusions
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Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
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Annual Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
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Standards/Technical Update
Added language to clarify timing of denominator exclusion criteria to include diagnosis overlap and the receipt of hospice or palliative care.
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Annual Update
Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.
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Standards/Technical Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
Measure Section:
Functions
Source of Change:
Annual 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 Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240): Added 3 SNOMED CT codes (86013001, 90526000, 866149003) based on review by technical experts, SMEs, and/or public feedback. Added 1 HCPCS code (G0402) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 1 SNOMED CT code (314904008) based on review by technical experts, SMEs, and/or public feedback.
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Value set Estimated Glomerular Filtration Rate (2.16.840.1.113883.3.6929.3.1000): Added 4 LOINC codes (88293-6, 88294-4, 94677-2, 98980-6) based on review by technical experts, SMEs, and/or public feedback.
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Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Deleted 1 CPT code (99343) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Added 2 SNOMED CT codes (170935008, 170936009) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (385765002) based on review by technical experts, SMEs, and/or public feedback.
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Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Deleted 2 SNOMED CT codes (30346009, 37894004) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 CPT code (99201) based on review by technical experts, SMEs, and/or public feedback.
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Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 CPT code (99241) based on review by technical experts, SMEs, and/or public feedback.
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Value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090): Added 3 SNOMED CT codes (305686008, 305824005, 441874000) based on review by technical experts, SMEs, and/or public feedback.
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Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update

Compare Versions of: "Kidney Health Evaluation"

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