CMS347v5 – Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure, before the end of the measurement period.

Equals initial population 1

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period.

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Equals initial population 2

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period.

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.

Equals initial population 3

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period.

• Patients who have a diagnosis of pregnancy at any time during the measurement period
• Patients who are breastfeeding at any time during the measurement period
• Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period

– DENOMINATOR EXCEPTIONS:

• Patients with statin-associated muscle symptoms or an allergy to statin medication
• Patients who are receiving palliative or hospice care
• Patients with active liver disease or hepatic disease or insufficiency
• Patients with end-stage renal disease (ESRD)

For Denominator – 1:

All patients who fulfil the following criteria are included in denominator 1:

• Patients who had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.

• Patient had ASCVD diagnosis or procedure before the end of the measurement period.
  • To record the ASCVD diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the ASCVD diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.

• • To document ASCVD procedure, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hovers over ‘Sign & Accept’, then click ‘Complete’.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.  

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button.  

For Denominator – 2: 

All patients who fulfil the following criteria are included in denominator 2:

• Patient is aged >= 21 and had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• Patient has a diagnosis for hypercholesterolemia or has a current/prior LDL result greater than or equal to 190 before the end of the measurement period.
  • To record the hypercholesterolemia diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the hypercholesterolemia diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
  • To perform a ‘LDL Cholesterol’ laboratory test, navigate to Patient > Clinical > Orders & Result > Labs and click on the ‘+ Add Order’ button. Select a Laboratory and search for a ‘LDL Cholesterol’ test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’.

Next, click on the ‘Mark as received’ button.

On the lab result screen, add the observations and click on the ‘Save’ button.

Note:

For LOINC Code Based Labs: Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

For CPT Code Based Labs: When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’.  

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

• Patient does not have a record of ASCVD diagnosis or procedure before the end of the measurement period.

For Denominator – 3:

All patients who fulfil the following criteria are included in denominator 3:

• Patient is aged >= 40 and <= 75, and had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• Patient has a diagnosis for diabetes during the measurement period. To record the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diabetes diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
• Patient does not have a diagnosis for hypercholesterolemia or a current/prior LDL result greater than or equal to 190 before the end of the measurement period.
• Patient does not have a record of ASCVD diagnosis or procedure before the end of the measurement period.

For Numerator:

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period.

• Currently taking statin therapy through the end of the measurement period. To document current statin therapy, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Add the dosage information and click ‘Save. The medication is added to the provider note.

• Statin therapy ordered during the measurement period. To document current statin therapy, navigate to Patient > Provider Note > Prescriptions. Click ‘Add’ and search for the prescription. Add the dosage information and click ‘Save. The prescription is added to the provider note.

For Denominator Exceptions:

All patients who fulfil any of the following criteria are included in denominator exceptions:

• Patients with adverse reaction, allergy, or intolerance to statin medication during the measurement year.
  • To document statin allergy intolerance, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and click ‘Save’.

• • To document statin reaction, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and select a reaction from the ‘Reactions’ dropdown. Then click ‘Save’.
• Patients with a diagnosis for liver disease or hepatitis disease or insufficiency during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients with a diagnosis for end-stage renal disease (ESRD) during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients with a diagnosis of ‘Statin Associated Muscle Symptoms’ overlapping the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients receiving palliative care during the measurement period.
  • To record the ‘Palliative Care Encounter’ performed, use the workflow Patient > Provider Note > eSuperbill.
  • To record the ‘Palliative Care Intervention’ performed, use the workflow Patient > Clinical > Evaluations.
  • To record the ‘Functional Assessment of Chronic Illness Therapy’ assessment performed, navigate to Patient > Clinical > Evaluations.

• Patients who received hospice care during the measurement year. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations 

For Denominator Exclusions: 

All patients who fulfil any of the following criteria are excluded from the denominator.

• Patients who have a diagnosis of pregnancy or rhabdomyolysis during the measurement period.
• Patients who are breastfeeding during the measurement period.

To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.