CMS144v11 – Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

– INITIAL POPULATION

All patients aged 18 years and older with two qualifying encounters (one of which is a heart failure outpatient encounter) during the measurement period along with a diagnosis of heart failure.

The other qualifying encounter in this case can include any of the following:

• Care Services in Long Term Residential Facility
• Home Healthcare Services
• Nursing Facility Visit
• Office Visit
• Outpatient Consultation
• Patient Provider Interaction

– DENOMINATOR

All patients aged 18 years and older with:

• Two qualifying encounters, one of which is a heart failure outpatient encounter, during the measurement period
• Diagnosis of heart failure
• Current or prior LVEF ≤ 40% (Indicating Moderate to Severe LSVD).

Note: The findings of moderate to severe LSVD are to be taken during a heart failure outpatient encounter. 

– DENOMINATOR EXCLUSIONS

• Patients with a history of heart transplant (or heart transplant related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD.
• Patients with Left Ventricular Assist Device Implanted (or LVAD related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD.

– DENOMINATOR EXCEPTIONS

• Documentation of medical reason(s) for not prescribing beta-blocker therapy. Examples of these medical reasons can include the following:
  • Arrhythmia
  • Asthma
  • Bradycardia
  • Hypotension
  • Patients with atrioventricular block without cardiac pacer
  • Observation of consecutive heart rates < 50
  • Allergy
  • Intolerance
  • Other medical reasons.

• Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).

– NUMERATOR

Patients who were prescribed or already taking beta-blocker therapy during the measurement period.

The beta-blocker therapy should be prescribed or active medication should be documented during a heart failure outpatient encounter.

For Denominator:

• To record the encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.

• To document the heart failure diagnosis, navigate to Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once all relevant details are added, click ‘Save’.

• An LVEF (Left Ventricular Ejection Fraction) diagnostic study can be recorded via Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the relevant procedure. From the ‘Status’ drop-down select ‘Performed’ and in the result field, input a numeric result. Once done, click ‘Save & Accept’ or ‘Sign & Accept.

• Documentation of the LVSD diagnosis can be done through Patient > Provider Notes > Evaluations. Here, search for ‘Severe Left Ventricular Systolic Dysfunction (disorder)’ or ‘Moderate Left Ventricular Systolic Dysfunction (disorder)’. From the ‘Status’ drop-down select ‘Active’ and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

For Numerator:

• To order a beta blocker therapy for LVSD, navigate to Patient > Provider Notes > Prescription. Click ‘Add’ and search for the relevant prescription. Enter the medication details and click ‘Prescribe’.

• To document an active beta blocker therapy for LVSD, navigate to Patient > Provider Notes > Medications. Click ‘Add’ and search for the relevant medication. Enter the medication details and click ‘Save’.

• To document a heart failure patient encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.

For Denominator Exclusions:

• To document a history of Heart Transplant or Left Ventricular Assist Device, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the relevant procedure. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

A history of Heart Transplant can also be recorded via Patient > Clinical > History > + Surgical. Here, search for heart transplant and fill out the required details. Once done, click ‘Save’.

• The documentation of Moderate or Severe LSVD (Left Ventricular Systolic Dysfunction) can be done via Patient > Provider Notes > Evaluations. 

For Denominator Exceptions:

• To document:
  • Arrhythmia
  • Asthma
  • Hypotension
  • Atrioventricular Block
  • Bradycardia
  • Cardiac Pacer in Situ

use the workflow Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once all details have been filled, click ‘Save’.

• To document an allergy or intolerance to beta-blocker therapy, head over to Patient > Provider Notes > Allergies. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’.

• The documentation of patient reasons for not prescribing beta-blocker therapy can be done via Patient > Provider Notes > Medications > Current > Discontinue. Here, the reason for discontinuing an active medication is to be selected from the drop-down.