CMS144v12 – Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) CMS144v12 Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) ≤ 40% who were prescribed or already taking beta-blocker therapy during the measurement period.

– 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. 

– NUMERATOR

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

Note: The beta-blocker therapy should be prescribed or active medication should be documented 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).
– APPLICATION WORKFLOW

 

For Denominator:

  • To record the encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.
eSuperbill for Encounter
  • To document the heart failure diagnosis, navigate to Patient > Provider Note > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once all relevant details are added, click ‘Save’.
Example of Heart Failure Diagnosis
  • An LVEF (Left Ventricular Ejection Fraction) diagnostic study can be recorded via Patient > Provider Note > 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.
Example of LVEF Diagnostic Study
  • Documentation of the LVSD diagnosis can be done through Patient > Provider Note > 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’.
Example of LVSD Diagnosis

For Numerator:

  • To order beta blocker therapy for LVSD, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the relevant prescription. Enter the medication details and click ‘Prescribe’.
Example of Beta Blocker Therapy
  • To document active beta blocker therapy for LVSD, navigate to Patient > Provider Note > 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’.
Example of LVAD Procedure
  • The documentation of Moderate or Severe LSVD (Left Ventricular Systolic Dysfunction) can be done via Patient > Provider Note > Evaluations
Documentation of Moderate or Severe LVSD

For Denominator Exceptions:

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

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

Example of Arrhythmia Diagnosis
  • 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’.
Example of Beta Blocker Allergy
  • 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.
Documenting Reasons for Discontinuing Medication
  • The heart rate can be documented through Patient > Provider Note > Vitals. Click ‘Add’ and in the ‘Pulse’ field, enter the pulse rate while specifying the position in which it was taken. Once done, click ‘Accept’.
Documenting Heart Rate via Vitals