Functional Status Assessments for Congestive Heart Failure

Last updated: May 3, 2018

CMS Measure ID: CMS90v7
Version: 7
NQF Number: None
Measure Description:

Percentage of patients 18 years of age and older with congestive heart failure who completed initial and follow-up patient-reported functional status assessments

Initial Patient Population:

Patients 18 years of age and older who had two outpatient encounters during the measurement year and a diagnosis of congestive heart failure

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Exclude patients with severe cognitive impairment or patients with a diagnosis of cancer.

Exclude patients who were in hospice care during the measurement year.

Numerator Statement:

Patients with patient-reported functional status assessment results (eg, VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHRinfo-icon two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial functional status assessment

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare and Medicaid Services (CMS)
Domain: Person and Caregiver-Centered Experience and Outcomes
Next Version:
Previous Version:
Improvement Notation:

A higher score indicates better quality

Guidance:

A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity.

Initial Functional Status Assessment (FSA) and Encounter: The initial FSA is the first FSA during the measurement year that also occurs two weeks before or during the first encounter in the first 185 days of the measurement year.

Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA.

The same FSA instrument must be used for the initial and follow-up assessment.

Notes: Value Set content updated Sept 2017, TRNs updated Oct 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Expanded patient age range from 65 years and older to 18 years and older to be as inclusive as possible for this measure per clinical experts' recommendations.

    Measure Section: Description

    Source of Change: Expert Work Group

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Guidance.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Expanded patient age range from 65 years and older to 18 years and older to be as inclusive as possible for this measure per clinical experts' recommendations.

    Measure Section: Initial Populationinfo-icon

    Source of Change: Expert Work Group

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominatorinfo-icon. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Changed the timing of the follow-up FSA to be in relation to the initial FSA (at least 30 days but no more than 180 days after the initial FSA) to better meet the intent of the measure (previously the timing was in relation to the encounter).

    Measure Section: Numeratorinfo-icon

    Source of Change: Measure Lead

Logic

  • Expanded patient age in the Initial Population logic from '>=65 years(s)' to '>= 18 year(s)' to be as inclusive as possible for this measure per clinical experts' recommendations.

    Measure Section: Initial Population

    Source of Change: Expert Work Group

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Changed the logical operator in the Numerator to include patients who have results documented in the EHRinfo-icon for the follow-up FSA that is at least 30 days but no more than 180 days after the initial FSA (previously the timing was in relation to the encounter).

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Replaced the 'ends before end of' logical operator to address situations where time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'ends before or concurrent with end of'.

    Measure Section: Numerator

    Source of Change: JIRA (CQMinfo-icon-1936)

  • Replaced 'Functional Status, Performed' datatype with 'Assessment, Performed' datatype to conform with QDMinfo-icon 4.3 changes.

    Measure Section: Numerator

    Source of Change: QDM Standards

Value Setinfo-icon

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Added 85 ICD9CM codes and deleted 2 ICD9CM codes (154.2, 154.3). Added 261 ICD10CM codes and deleted 2 ICD10CM codes (C21.0, C21.1). Added 28 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Added 9 ICD10CM codes (I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Added 33 SNOMEDCT codes and deleted 3 SNOMEDCT codes (188651007, 421835000, 422052002). Added 4 ICD10CM codes (C96.20, C96.21, C96.22, C96.29).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources