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      CMS144v13: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

      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

      Numerator

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

      • Note: the medication needs to be on the patient's current medication list. The clinician does not have to be the proscribing provider. 

      Denominator

      The patient must meet ALL of the following criteria to be counted in the denominator:

      • Two qualifying encounters during the measurement period
        • The appropriate office visit code needs to be entered into the superbill for those visits
      • Has Left Ventricular Ejection Fraction (LVEF)equal to or under 40%, recorded in the Review of Systems or Tracked Data sections:
        • Text in Chart: Record any of the following phrases in the Review of Systems, Physical Exam, or Assessment section of the note: 
          • 'LVEF = 40' or 'LVEF 40' (or any other number between 0 and 40)
          • 'EF = 40' or 'EF 40' (or any other number between 0 and 40)
          • 'Ejection Fraction = 40' or 'Ejection Fraction 40' (or any other number between 0 and 40)
          • 'Left Ventricular Ejection Fraction = 40' or 'Left Ventricular Ejection Fraction 40' (or any other number between 0 and 40)
          • 'Left Ventricular Ejection Fraction <= 40'
          • 'LVEF <= 40'
          • 'EF <= 40'
          • 'Ejection Fraction <= 40'
        • Tracked Data: Record in the Tracked Data section in the Summary Sheet: 
          • From the patient’s chart, select “Summary Sheet” tab at the top of the chart
          • The “Tracked Data” section will be on the right of the page. Click “Add/Edit”
          • Enter the items name as “LVEF” or “EF”
          • Enter the Value
            • Note: The value entered must be 40 or less to count for this measure
          • Enter the date collected
          • Select “Move Data To Grid” and then click “Ok”
          • Select “Save and Close”
      • Diagnosis: Heart Failure diagnosis on or before at least one qualifying encounter: have an appropriate diagnosis in the patients problem list.

      Denominator Exceptions

      Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmias, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).

      • DX of Arrhythmia, Hypotension, Asthma, or Bradycardia in patient's problem list
      • Allergy to beta blockers listed in the allergy section of the chart.
      • Free Text in the plan or assessment either "Patient not prescribed beta blocker" or "intolerance to beta blocker"

      Denominator Exclusions

      • Patients with a history of heart transplant
        • In the Past Medical History, Assessment, or Plan section; include the phrase "Heart Transplant"
        • Diagnosis of "Heart Transplant" added to the problem list
      • Patients with a Left Ventricual Asssist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD
        • Text in Chart: In the Past Medical History, Assessment, or plan section; include any of the following phrases:
          • Left Ventricle Assist Device
          • LVAD