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Functional Status Assessments for Congestive Heart Failure

Last updated: September 14, 2018

CMS Measure ID: CMS90v8
Version: 8
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 that overlaps the measurement period.

Exclude patients whose hospice care overlaps the measurement period.

Numerator Statement:

Patients with patient-reported functional status assessment results (ie, VR-12; VR-36; 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 & Medicaid Services (CMS)
Domain: Person and Caregiver-Centered Experience and Outcomes
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.

Quality ID: 377
Meaningful Measure: Patient Reported Functional Outcomes

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated measure header rationale to align with most recent literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement to align with current recommendations.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Removed cancer diagnosis denominator exclusioninfo-icon to align with an eCQMinfo-icon under development.

    Measure Section: Denominator Exclusionsinfo-icon

    Source of Change: Measure Lead

  • Revised the Denominator Exclusions statement for severe cognitive impairment timing to better align with measure logic and intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the Denominator Exclusion statement for patients in hospice care to better align with the logic.

    Measure Section: Denominator Exclusions

    Source of Change: JIRAinfo-icon (CQMinfo-icon-2815)

  • Replaced 'eg' with 'ie' in the numeratorinfo-icon statement to indicate that the list is complete.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Removed cancer diagnosis denominator exclusion to align with an eCQM under development.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Replaced 'Discharge status' attribute with 'Admission Source' and 'Discharge Disposition' attributes for 'Encounter, Performed' and 'Encounter, Active' datatypes to align with QDMinfo-icon 5.3 changes.

    Measure Section: Denominator Exclusions

    Source of Change: Standards Update

  • Revised the numerator logic to ensure the entire functional status assessment is completed to better align with the measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Removed the 'Face-To-Face Interaction' data element and added relevant SNOMED codes to the Encounter Grouping value setsinfo-icon to better align between the SNOMED and CPT encounter codes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

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

  • Value set KCCQ Physical Limitation Score (2.16.840.1.113883.3.464.1003.118.12.1220): Added KCCQ Physical Limitation Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set KCCQ Self Efficacy Score (2.16.840.1.113883.3.464.1003.118.12.1221): Added KCCQ Self Efficacy Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set KCCQ Social Limitation Score (2.16.840.1.113883.3.464.1003.118.12.1222): Added KCCQ Social Limitation Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set KCCQ Total Symptom Score (2.16.840.1.113883.3.464.1003.118.12.1223): Added KCCQ Total Symptom Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1264) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Deleted 2 SNOMEDCT codes (359620001, 77737007).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS-10 Global Mental Health Score (2.16.840.1.113883.3.464.1003.118.12.1138): Added PROMIS-10 Global Mental Health Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS-10 Global Physical Health Score (2.16.840.1.113883.3.464.1003.118.12.1139): Added PROMIS-10 Global Physical Health Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-12 Mental Component T-Score (2.16.840.1.113883.3.464.1003.118.12.1177): Added VR-12 Mental Component T-Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-12 Physical Component T-Score (2.16.840.1.113883.3.464.1003.118.12.1176): Added VR-12 Physical Component T-Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Anxiety Score (2.16.840.1.113883.3.464.1003.118.12.1216): Added PROMIS 29 Anxiety Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Depression Score (2.16.840.1.113883.3.464.1003.118.12.1215): Added PROMIS 29 Depression Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Fatigue Score (2.16.840.1.113883.3.464.1003.118.12.1214): Added PROMIS 29 Fatigue Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Pain Interference Score (2.16.840.1.113883.3.464.1003.118.12.1213): Added PROMIS 29 Pain Interference Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Physical Function Score (2.16.840.1.113883.3.464.1003.118.12.1212): Added PROMIS 29 Physical Function Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Sleep Disturbance Score (2.16.840.1.113883.3.464.1003.118.12.1211): Added PROMIS 29 Sleep Disturbance Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS 29 Social Roles Score (2.16.840.1.113883.3.464.1003.118.12.1217): Added PROMIS 29 Social Roles Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-36 Mental Component Summary (MCS) Score (2.16.840.1.113883.3.464.1003.118.12.1225): Added VR-36 Mental Component Summary (MCS) Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-36 Physical Component Summary (PCS) Score (2.16.840.1.113883.3.464.1003.118.12.1226): Added VR-36 Physical Component Summary (PCS) Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set All Cancer (2.16.840.1.113883.3.464.1003.108.12.1011): Removed All Cancer.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Removed Face-to-Face Interaction.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Functional Status Assessment for Heart Failure (2.16.840.1.113883.3.464.1003.118.12.1031): Removed Functional Status Assessment for Heart Failure.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced LOINC single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources