#442: Persistence of Beta-Blocker Treatment After a Heart Attack

Quality ID

442

NQF

0071

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Cardiology Family Medicine Internal Medicine

Measure Description

The percentage of patients 18 years of age and older during the measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who were prescribed persistent beta-blocker treatment for six months after discharge

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Include only patients that are discharged through June 30 of the performance period. This will allow the evaluation of at least 180 days after discharge within the performance year.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

Patients 18 years of age and older as of December 31 of the measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with diagnosis of AMI

Table PBH-D: Medications to Identify Exclusions (History of Asthma)

Description

Prescription

Bronchodilator combinations

Budesonide-formoterol
Fluticasone-vilanterol

Fluticasone-salmeterol
Mometasone-formoterol

 

Inhaled corticosteroids

Beclomethasone
Budesonide
Ciclesonide

Flunisolide 
Fluticasone 
Fluticasone CFC free

Mometasone

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years within measurement year

AND

Discharge(s) for AMI between July 1 of the year prior to the measurement year to June 30 of the measurement period: G9798

AND

Patient encounter(s) during performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with a diagnosis of Asthma, COPD, Obstructive chronic bronchitis, Chronic respiratory conditions due to fumes and vapors, Hypotension, heart block >1 or sinus bradycardia any time during the patient’s history through the end of the measurement period: J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998, I44.1, I44.2, I44.4, I44.5, I44.60, I44.69, I44.7, I45.0, I45.10, I45.19, I45.2, I45.3, I45.6, I49.5, I95.0, I95.1, I95.2, I95.3, I95.81, I95.89, I95.9, R00.1, J68.4, J44.0, J44.1, J44.9, T44.7X5A, T44.7X5D, T44.7X5S

OR

Patients with a medication dispensing event indicator of a history of asthma any time during the patient’s history through the end of the measure period: G9799

OR

Patients who are identified as having an intolerance or allergy to beta-blocker therapy: G9800

OR

Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis: G9801

OR

Patients who use hospice services any time during the measurement period: G9802

 

Numerator

Patients who had at least 135 days of treatment with beta-blockers post-discharge during the 180-day measurement interval

NUMERATOR NOTE: Performance for the measure is based on at least 135 days of beta-blocker treatment during the 180-day measurement interval post discharge for AMI. This allows gaps in medication treatment of up to a total of 45 days during the 180-day measurement interval.

Assess for active prescriptions and include days supply that fall within the 180-day measurement interval. For patients who were on beta-blockers prior to admission and those who were dispensed an ambulatory prescription during their inpatient stay, factor those prescriptions into adherence rates if the actual treatment days fall within the 180-day measurement interval.

Table: Beta-Blocker Medications

Description

Prescription

Noncardioselective betablockers

Carvedilol
Labetalol
Nadolol

Penbutolol
Pindolol
Propranolol

Timolol
Sotalol

Cardioselective beta-blockers

Acebutolol
Atenolol

Betaxolol
Bisoprolol

Metoprolol
Nebivolol

Antihypertensive combinations

Atenolol-chlorthalidone
Bendroflumethiazide-nadolol
Bisoprolol-hydrochlorothiazide

Hydrochlorothiazide-metoprolol Hydrochlorothiazide-propranolol

Numerator Options:

Performance Met: Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for AMI (G9803)

OR

Performance Not Met: Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for AMI (G9804)

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