CMS145v12 – Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF ≤ 40%)
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF ≤ 40%)
CMS145v12
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF ≤ 40% who were prescribed beta-blocker therapy
INITIAL POPULATION
All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease.
A qualifying encounter in this case includes any of the following:
Office Visit
Outpatient Consultation
Nursing Facility Visit
Care Services in Long-Term Residential Facility
Home Healthcare Services
Patient Provider Interaction
Note: The Coronary Artery Disease (CAD) diagnosis should take place during one of the outpatient encounters.
– DENOMINATORAll patients aged 18 years and older with:
Two qualifying encounters during the measurement period
Diagnosis of coronary artery disease and
Prior (within the past 3 years) MI or a current or prior LVEF ≤ 40%.
Note: The Coronary Artery Disease (CAD) diagnosis should take place during one of the outpatient encounters. Furthermore, the patient should have a history of Cardiac Surgery prior to the encounter.
– NUMERATOR
Patients who were prescribed beta-blocker therapy.
– DENOMINATOR EXCEPTIONS
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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).
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
– APPLICATION WORKFLOW
For Denominator 1:
To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.
eSuperbill for Encounter
To document the diagnosis for CAD, use the workflow Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any necessary diagnosis details and once done, click ‘Save’.
Example of CAD Diagnosis
Documentation of the cardiac surgery procedure can be done via Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the relevant procedure. Add the procedure details and once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of Cardiac Surgery Procedure
It can also be done through Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant procedure. From the ‘Status’ drop-down select ‘Performed’ and once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of Cardiac Surgery via Evaluations
To document ‘Ejection Fraction’ diagnostic study and ‘Moderate or Severe LVSD’, use the workflow Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant intervention.
Example of Ejection Fraction Diagnostic Study
For Denominator 2:
To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
The diagnosis for ‘Myocardial Infarction’ can be recorded via Patient > Provider Note > Diagnoses. Click ‘Add’, search for the diagnosis, and add the diagnosis details. Then click ‘Save’.
Example of MI Diagnosis
To document cardiac surgery procedure, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’ or ‘Sign & Accept’
For Numerator:
To order beta blocker therapy, 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 Prescription
To document an active beta blocker therapy, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the relevant medication. Enter the medication details and click ‘Save’.
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 Note > Allergies. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’. Then click ‘Accept’ to add the allergy to the current provider note.
Example of Beta Blocker Allergy
The documentation of patient reasons for not prescribing beta-blocker 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.
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’.
