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

General eCQM Information

CMS Measure ID CMS145v9
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 a diagnosis of coronary artery disease seen within a 12-month period
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., 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])
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 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.

Quality ID 7
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards Update

  • Updated references to align with American Psychological Association (APA)  formatting.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Added text to identify the Quality Data Model (QDM) version used in the measure specification.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Added text to indicate whether the measure is patient-based or episode-based.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Revised guidance related to patients who have had both myocardial infarction within the past 3 years and LVEF < 40% to clarify how these patients should be counted in the measure.

    Measure Section: Guidance

    Source of Change: Measure Lead

Logic

  • Revised Clinical Quality Language (CQL) definition related to myocardial infarction by applying additional constraints to ensure patients will only meet the population 2 denominator criteria if they do not also have LVEF < 40%.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Added a new data element using the Allergy/Intolerance QDM category and datatype to capture the substance related to beta blocker as a potential allergen to align with measure intent and interoperability standards.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • ​Updated CQL definition names used to more closely align with clinical concept intent or create consistency of naming across measures.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Revised CQL definition construction to reduce the overall complexity of the measure logic without changing the intent and/or application of data element. These revisions were intended to make the definition logic less complex, easier to understand, and more meaningful.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised measure timings to improve alignment with the intent of the measure requirements.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

    Measure Section: Multiple Sections

    Source of Change: Standards 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.

  • Added direct reference code SNOMED CT Code (373254001) based on expert review and/or public feedback to align with interoperability standards.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 SNOMED CT code (17436001) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Added 3 CPT codes (99315, 99316, 99318) based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Medical Reason (2.16.840.1.113883.3.526.3.1007): Deleted 5 SNOMED CT codes (216952002, 274512008, 371133007, 416406003, 445528004) based on expert review and/or public feedback. Removed codes due to intent of concepts which do not indicate a medical contraindication, but rather a provider decision to discontinue something or change a course of treatment.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Patient Provider Interaction (2.16.840.1.113883.3.526.3.1012): Deleted 1 SNOMED CT code (11797002) 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): Deleted 3 RxNorm codes (245854, 245855, 998694) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Intolerance to Beta Blocker Therapy (2.16.840.1.113883.3.526.3.1178): Deleted 1 SNOMED CT code (292429003) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Asthma (2.16.840.1.113883.3.526.3.362): Deleted 14 ICD-9-CM codes. Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant. Added 1 SNOMED CT code (782520007) and deleted 1 SNOMED CT code (30352005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Arrhythmia (2.16.840.1.113883.3.526.3.366): Deleted 2 ICD-9-CM codes (427.89, 427.9). Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Atrioventricular Block (2.16.840.1.113883.3.526.3.367): Deleted 3 ICD-9-CM codes (426.0, 426.12, 426.13). Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Cardiac Pacer in Situ (2.16.840.1.113883.3.526.3.368): Deleted 1 ICD-9-CM code (V45.01). Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Hypotension (2.16.840.1.113883.3.526.3.370): Deleted 6 ICD-9-CM codes (458.0, 458.1, 458.21, 458.29, 458.8, 458.9). Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Bradycardia (2.16.840.1.113883.3.526.3.412): Deleted 2 ICD-9-CM codes (427.81, 427.89). Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Coronary Artery Disease No MI (2.16.840.1.113883.3.526.3.369): Deleted 21 ICD-9-CM codes. Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Cardiac Surgery (2.16.840.1.113883.3.526.3.371): Deleted 6 CPT codes (33517, 33518, 33519, 33521, 33522, 33523) based on coding guidelines.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Myocardial Infarction (2.16.840.1.113883.3.526.3.403): Deleted 1 ICD-9-CM code (412) based on expert review and/or public feedback to align with value set intent. Deleted 2 ICD-10-CM codes (I24.1, I25.2) based on expert review and/or public feedback to align with value set intent. Deleted 10 SNOMED CT codes (161502000, 161503005, 1755008, 233839009, 233840006, 233841005, 233842003, 275905002, 308065005, 399211009) based on expert review and/or public feedback to align with value set intent.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Removed ICD-9-CM extensional value sets from applicable Groupings due to ICD-9-CM no longer being maintained and the measure not requiring historical lookback, with the exception of the 'Myocardial Infarction' value set that is reused in another measure which requires an indefinite lookback period.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Dec 18, 2020