CMS135v12 – Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)	CMS135v12	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 ACE inhibitor or ARB or ARNI therapy during the measurement period.
– INITIAL POPULATION All patients aged 18 years and older with two qualifying encounters (at least one of which is a Heart Failure outpatient encounter) during the measurement period and a diagnosis of heart failure. A qualifying encounter can include any of the following: Office Visit Outpatient Consultation Nursing Facility Visit Care Services in Long Term Residential Facility Home Healthcare Services Patient Provider Interaction A qualifying heart failure outpatient encounter includes any of the following: Care Services in Long Term Residential Facility Home Healthcare Services Nursing Facility Visit Office Visit Outpatient Consultation – DENOMINATOR Patients aged 18 years and older with the following: Two qualifying encounters (at least one of which is a heart failure outpatient encounter) during the measurement period AND a diagnosis of heart failure AND current or prior LVEF ≤ 40% – DENOMINATOR EXCEPTIONS Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons). Documentation of patient reasons(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons). – DENOMINATOR EXCLUSIONS Patients with a history of heart transplant (or heart transplant related diagnosis) Patients with Left Ventricular Assist Device (or LVAD related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD. – NUMERATOR Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period. Note: The medication is to be ordered during the heart failure outpatient encounter.

APPLICATION WORKFLOW

For Denominator:

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

• To document a diagnosis for heart failure, navigate to Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the relevant diagnosis and add the diagnosis details. Then click ‘Save’.

• 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’.

• 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’.

For Numerator:

• To order ACEI, ARB, or ARNI therapy for a patient, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the relevant medication. Enter the prescription details as needed and once done, click ‘Prescribe’.

•  To document active medication, use the workflow Patient > Provider Note > Medications. Click ‘Add’ and search for the relevant medication. Enter the medication details and click ‘Save’.

For Denominator Exceptions:

• To record ‘Pregnancy’ or ‘Renal Failure Due to ACEI’, use the workflow Patient > Provider Note > Diagnoses or Patient > Provider Note > Evaluations. Click ‘Add’ and search for the relevant diagnosis and input the diagnosis details. Once done, click ‘Save & Accept/Sign & Accept’ or ‘Save’ depending on the workflow.

• To document a patient’s allergies or intolerance to ACEI or ARB therapy, head over to Patient > Provider Note > Allergies. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’.

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

For Denominator Exclusions:

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

• Heart transplant complications can be recorded through Patient > Provider Note > Diagnoses.