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Functional Status Assessments for Congestive Heart Failure

Last updated: May 9, 2019

CMS Measure ID: CMS90v9
Version: 9
NQF Number: Not Applicable
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 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 (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; 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:
Measure Scoring: Proportion
Measure Type: Process
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 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: Functional Outcomes

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

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

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated guidance statement for clarity and to improve alignmentinfo-icon across measures.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated numeratorinfo-icon statement with addition of the KCCQ-12 tool to the list of functional status assessment tools to align with logic changes based on updated clinical guidelines.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA)info-icon: CQMinfo-icon-3182

  • Updated numerator statement with addition of the Minnesota Living with Heart Failure Questionnaire (MLHQF) tool to the list of functional status assessment tools to align with logic changes.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated multiple sections in header by defining acronyms and correcting grammatical errors for clarity.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (JIRA): CQM-3114

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Added logic to capture functional status assessments using the same tool for the initial and follow-up assessment to improve alignment with measure intent.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA): CQM-3114

  • Added logic to capture initial and follow-up functional status assessments using the KCCQ-12 tool to align with updated clinical guidelines.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA): CQM-3182

  • Added logic to capture initial and follow-up functional status assessments using the Minnesota Living with Heart Failure Questionnaire (MLHQF) tool to improve alignment with measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Replaced Numerator definitions 'Initial Congestive Heart Failure Functional Assessment' and 'Follow-up Congestive Heart Failure Functional Assessment' with 'Assessed Initial and Follow-up PROMIS10', 'Assessed Initial and Follow-up PROMIS29', 'Assessed Initial and Follow-up VR12 Oblique', 'Assessed Initial and Follow-up VR12 Orthogonal', 'Assessed Initial and Follow-up VR36 Oblique', 'Assessed Initial and Follow-up VR36 Orthogonal', 'Assessed Initial and Follow-up MLHFQ', 'Assessed Initial and Follow-up KCCQ12', and 'Assessed Initial and Follow-up KCCQ' to capture initial and follow-up functional status assessments using the same tool to improve alignment with measure intent.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-3114

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    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 setsinfo-icon.

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Heart Failure (2.16.840.1.113883.3.526.3.376): Deleted 4 ICD-10-CM codes (I50.810, I50.811, I50.812, I50.813). Added 33 SNOMED CT codes and deleted 10 SNOMED CT codes (10335000, 128404006, 277639002, 359617009, 367363000, 426012001, 5053004, 60856006, 66989003, 80479009).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set KCCQ Physical Limitation Score (2.16.840.1.113883.3.464.1003.118.12.1220) with direct reference code LOINC code (72195-1).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set KCCQ Self Efficacy Score (2.16.840.1.113883.3.464.1003.118.12.1221) with direct reference code LOINC code (72190-2).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set KCCQ Social Limitation Score (2.16.840.1.113883.3.464.1003.118.12.1222) with direct reference code LOINC code (72196-9).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set KCCQ Total Symptom Score (2.16.840.1.113883.3.464.1003.118.12.1223) with direct reference code LOINC code (72191-0).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 10 Global Mental Health Score (2.16.840.1.113883.3.464.1003.118.12.1138) with direct reference code LOINC code (71969-0).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 10 Global Physical Health Score (2.16.840.1.113883.3.464.1003.118.12.1139) with direct reference code LOINC code (71971-6).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Anxiety Score (2.16.840.1.113883.3.464.1003.118.12.1216) with direct reference code LOINC code (71967-4).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Depression Score (2.16.840.1.113883.3.464.1003.118.12.1215) with direct reference code LOINC code (71965-8).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Fatigue Score (2.16.840.1.113883.3.464.1003.118.12.1214) with direct reference code LOINC code (71963-3).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Pain Interference Score (2.16.840.1.113883.3.464.1003.118.12.1213) with direct reference code LOINC code (71961-7).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Physical Function Score (2.16.840.1.113883.3.464.1003.118.12.1212) with direct reference code LOINC code (71959-1).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Sleep Disturbance Score (2.16.840.1.113883.3.464.1003.118.12.1211) with direct reference code LOINC code (71955-9).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set PROMIS 29 Social Roles Score (2.16.840.1.113883.3.464.1003.118.12.1217) with direct reference code LOINC code (71957-5).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set VR 12 Mental Component T Score (2.16.840.1.113883.3.464.1003.118.12.1177) with direct reference code LOINC codes (72026-8, 72028-4).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set VR12 Physical Component T Score (2.16.840.1.113883.3.464.1003.118.12.1176) with direct reference code LOINC codes (72025-0, 72027-6).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set VR 36 Mental Component Summary (MCS) Score (2.16.840.1.113883.3.464.1003.118.12.1225) with direct reference code LOINC codes (71990-6, 72008-6).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced VR 36 Physical Component Summary (PCS) Score (2.16.840.1.113883.3.464.1003.118.12.1226) with direct reference code LOINC codes (71989-8, 72007-8).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (85609-6).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (86924-8).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (86923-0).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (85618-7).

    Measure Section: Terminology

    Source of Change: Measure Lead

External Resources