Functional Status Assessment for Complex Chronic Conditions

Last updated: May 17, 2016

CMS Measure ID: CMS90v5
Version: 5
NQF Number: None
Measure Description:

Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments

Initial Patient Population:

Adults aged 65 years and older who had two outpatient encounters during the measurement year and an active diagnosis of heart failure.

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Patients with severe cognitive impairment or patients with an active diagnosis of cancer

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 EHR within two weeks before or during the initial encounter and the follow-up encounter during the measurement year.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services
National Quality Strategy Domain: Person and Caregiver-Centered Experience Outcomes
Next Version: Functional Status Assessments for Congestive Heart Failure
Previous Version: Functional Status Assessment for Complex Chronic Conditions
Measure Score: Proportion
Improvement Notation:

A higher score indicates better quality

Guidance:

Initial encounter: The first encounter during the first 185 days of the measurement year.

Follow-up encounter: The last encounter that is at least 30 days but no more than 180 after the initial encounter.

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.

The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced variables $CCInitialEncounter and $CCFollowupEncounter to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced 'ends before or during' (EBOD) with 'ends before end of' (EBE). As necessary, edited the associated number of (days, months, years) to maintain the same time period to accommodate the new timing operator.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set All Cancer (OID 2.16.840.1.113883.3.464.1003.108.12.1011): Added 350 ICD10CM codes.

External Resources