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Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

General eCQM Information

CMS Measure ID CMS347v4
NQF Number Not Applicable
Measure Description

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR

*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

Initial Population All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period
Denominator Statement

All patients who meet one or more of the following criteria (considered at "high risk" for cardiovascular events, under ACC/AHA guidelines):

1) Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD diagnosis

2) Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

Denominator Exclusions

Patients who have a diagnosis of pregnancy

Patients who are breastfeeding

Patients who have a diagnosis of rhabdomyolysis

Numerator Statement

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

Numerator Exclusions

Not Applicable

Denominator Exceptions

Patients with adverse effect, allergy, or intolerance to statin medication

Patients who are receiving palliative or hospice care

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Domain Effective Clinical Care
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality

Guidance

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure. There is only one performance rate calculated for this measure; the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

Denominator Guidance:

The denominator covers three distinct populations. Use the following process to prevent counting patients more than once.

Denominator Population 1:

Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD

-If YES, meets Denominator Population 1 risk category

-If NO, screen for next risk category

Denominator Population 2:

Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

-If YES, meets Denominator Population 2 risk category

-If NO, screen for next risk category

Denominator Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with a LDL-C result of 70 -189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

-If YES, meets Denominator Population 3 risk category

-If NO, patient does NOT meet Denominator criteria and is NOT eligible for measure inclusion

Denominator Guidance for Encounter:

-In order for the patient to be included in the denominator, the patient must have ONE denominator-eligible visit, defined as follows:

--Outpatient encounter visit type

--Encounter, performed: initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented fasting or direct LDL-C level recorded as follows:

To meet Denominator Population 1:

There is no LDL-C result required.

To meet Denominator Population 2:

If a patient has ANY previous fasting or direct laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Denominator Population 3:

If a patient has more than one LDL-C result during the measurement period or during the two years before the start of the measurement period, report the highest level recorded during either time. The Denominator Exception, "Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy" applies only to Denominator Population 3.

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2013 ACC/AHA Guidelines (Stone et al., 2014) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

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 438
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
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Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated the measure developer field.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • 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

Logic

  • Added hospice care as new data element to the Clinical Quality Language (CQL) definition for palliative and hospice care to align with the measure language, as well as the logic construction used in other measures using similar data elements.

    Measure Section: Denominator Exceptions

    Source of Change: ONC Project Tracking System (Jira): CQM-3172

  • Added 'Max' operator in the CQL definition related to low-density lipoproteins (LDL) to identify the highest LDL level for better alignment with population criteria 3 denominator intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'Procedure, Performed' QDM category and datatype with relevant data elements to allow for alternate options to capture atherosclerotic cardiovascular disease (ASCVD).

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (Jira): CQM-3464

  • ​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.

  • Value set Liver Disease (2.16.840.1.113762.1.4.1047.42): Deleted 6 SNOMED CT codes (186634008, 235868007, 235870003, 276668008, 406584008, 406585009) based on terminology update. Deleted 27 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 End Stage Renal Disease (2.16.840.1.113883.3.526.3.353): Deleted 1 ICD-9-CM code (585.6). 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

  • Replaced RxNorm value set High Intensity Statin Therapy (2.16.840.1.113762.1.4.1047.97) with grouping value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572): Added 2 RxNorm codes (2167565, 2167569) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced RxNorm value set Moderate Intensity Statin Therapy (2.16.840.1.113762.1.4.1047.98) with grouping value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575): Added 2 RxNorm codes (2167557, 2167573) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced RxNorm value set Low Intensity Statin Therapy (2.16.840.1.113762.1.4.1047.107) with grouping value set Low Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1574) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Hypercholesterolemia (2.16.840.1.113762.1.4.1047.100): Deleted 1 ICD-9-CM code (272.0). 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 (2.16.840.1.113883.3.600.1.1623): Renamed to Pregnancy or Other Related Diagnoses to align with best practices and value set intent, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Pregnancy or Other Related Diagnoses (2.16.840.1.113883.3.600.1.1623): Added 31 SNOMED CT codes and deleted 1 SNOMED CT code (69532007) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Atherosclerosis and Peripheral Arterial Disease (2.16.840.1.113762.1.4.1047.21): Deleted 1 SNOMED CT code (238793001) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113762.1.4.1047.44): Renamed to Cerebrovascular Disease, Stroke, TIA to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113762.1.4.1047.46): Renamed to Ischemic Heart Disease or Other Related Diagnoses to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 3 SNOMED CT codes (314772004, 421164006, 314894004) 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): 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

  • Replaced HCPCS value set Annual Wellness Visit (2.16.840.1.113883.3.526.2.1363) with grouping value set Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240) to align with best practices, based on expert review and/or public feedback. This includes 2 SNOMED CT codes (444971000124105, 456201000124103).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced CPT value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.11.1040) with grouping value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008) to align with best practices, based on expert review and/or public feedback. This includes 2 SNOMED CT codes (281036007, 77406008).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced CPT value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.11.1115) with grouping value set Preventive Care Services-Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced CPT value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.11.1125) with grouping value set Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced LOINC value set LDL-c (2.16.840.1.113883.3.117.1.7.1.215) with grouping value set LDL Cholesterol (2.16.840.1.113883.3.526.3.1573) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced CPT value set Office Visit (2.16.840.1.113883.3.464.1003.101.11.1005) with grouping value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001) to align with best practices, based on expert review and/or public feedback. This includes 7 SNOMED CT codes (185463005, 185464004, 185465003, 30346009, 3391000175108, 37894004, 439740005).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced SNOMED CT value set Outpatient Encounters for Preventive Care (2.16.840.1.113762.1.4.1047.9) with grouping value set Outpatient Encounters for Preventive Care (2.16.840.1.113883.3.526.3.1576) to align with best practices, based on expert review and/or public feedback.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced SNOMED CT value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15) with grouping value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) to align with best practices, based on expert review and/or public feedback.

    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, except for data elements which have an indefinite lookback period. .

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added grouping value set CABG, PCI Procedure (2.16.840.1.113762.1.4.1138.566) to the measure to allow for alternate options to capture atherosclerotic cardiovascular disease (ASCVD).

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-3464

  • Replaced ICD-10-CM value set Palliative care encounter (2.16.840.1.113883.3.600.1.1575) with direct reference code ICD-10-CM code (Z51.5) to align with best practices for replacing single code value sets with direct reference codes.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: May 05, 2021