eCQM Title

Functional Status Assessments for Congestive Heart Failure

eCQM Identifier (Measure Authoring Tool) 90 eCQM Version number 8.3.000
NQF Number Not Applicable GUID bb9b8ef7-0354-40e0-bec7-d6891b7df519
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer National Committee for Quality Assurance
Endorsed By None
Percentage of patients 18 years of age and older with congestive heart failure who completed initial and follow-up patient-reported functional status assessments
This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
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Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
Patients living with congestive heart failure (CHF) often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al. 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al. 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from CHF patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al. 2012; Rumsfeld et al. 2013).
Clinical Recommendation Statement
American College of Cardiology Foundation/American Heart Association (2013): Every patient with HF (heart failure) should have a clear, detailed, and evidence-based plan of care that ensures the achievement of GDMT (guideline-directed medical therapy) goals, effective management of comorbid conditions, timely follow-up with the health care team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient's health care team.
(Class of recommendation: I; Level of evidence: C) 
Level C: Only consensus opinion of experts, case studies, or standard of care 
Class I: Procedure/treatment should be performed/administered
Improvement Notation
A higher score indicates better quality
Allen, L.A., L.W. Stevenson, K.L. Grady, et al. "Decision Making in Advanced Heart Failure: A Scientific Statement from the American Heart Association." Circulation, vol. 125, 2012, pp. 1928-1952. doi: 10.1161/CIR.0b013e31824f2173.
Hunt, S.A., W.T. Abraham, et al. "2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults." Circulation, vol. 119, 2009, pp. e391-e479. doi: 10.1161/CIRCULATIONAHA.109.192065.
Rumsfeld, J.S., K.P. Alexander, D.C. Goff, et al. "Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status: A Scientific Statement from the American Heart Association." Circulation, vol. 127, no. 22, 2013, pp. 2233-2249. doi: 10.1161/CIR.0b013e3182949a2e.
American College of Cardiology Foundation/American Heart Association. "Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines." Circulation, vol. 128, 2013, pp. e240-e327. doi: 10.1161/CIR.0b013e31829e8776.
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.
Transmission Format
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
Equals Initial Population
Denominator Exclusions
Exclude patients with severe cognitive impairment that overlaps the measurement period.

Exclude patients whose hospice care overlaps the measurement period.
Patients with patient-reported functional status assessment results (ie, VR-12; VR-36; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR 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
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set