Measure Description
Percent of asymptomatic patients undergoing CAS who are discharged to home no later than post-operative day #2
Instructions
This measure is to be submitted each time a CAS is performed during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide services of CAS, as described in the measure, based on the services provided and the measure-specific denominator coding will submit this measure. This measure may be submitted by MIPS eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
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 aged 18 and older who are asymptomatic undergoing CAS
Denominator Criteria (Eligible Cases):
Patients aged 18 and older
AND
Patient procedure during performance period (CPT): 37215, 37216
AND NOT
DENOMINATOR EXCLUSIONS:
Symptomatic carotid stenosis: Ipsilateral carotid territory TIA or stroke less than 120 days prior to procedure: 9006F
OR
Other carotid stenosis: Ipsilateral TIA or stroke 120 days or greater prior to procedure or any prior contralateral carotid territory or vertebrobasilar TIA or stroke: 9007F
Numerator
Patients discharged to home no later than post-operative day 2 following CAS
Definition:
Home – For purposes of submitting this measure, home is the point of origin prior to hospital admission prior to procedure. For example, if the patient comes from a skilled facility and returns to the skilled facility, this would meet criteria for discharged to home.
Numerator Options:
Performance Met: Documentation of patient discharged to home no later than post-operative day 2 following CAS (G9255)
OR
Performance Not Met: Documentation of patient discharged to home later than post-operative day 2 following CAS (G9254)
Rationale
Surgeons performing CAS on asymptomatic patients must select patients at low risk for morbidity and perform the procedure with a very low complication rate in order to achieve benefit. Discharge to home within two days of the procedure is an indicator of patients who were not frail prior to the procedure and who did not experience a major complication (e.g., disabling stroke, myocardial infarction). The proposed measure will therefore serve as an indicator of both appropriateness and overall outcome
Clinical Recommendation Statements
Percutaneous carotid intervention is a rapidly emerging field. Published trial results have established carotid stenting (CAS) in high risk surgical patients to be an effective alternative to carotid endarterectomy (CEA). It is well established that CEA benefits patients with asymptomatic >60% stenosis only if performed with a high degree of technical proficiency on appropriately selected patients. The same is proposed to hold true for CAS. This is particularly important when considering an asymptomatic population where the relative risk reduction with intervention is narrow when compared to medical management. Numerous publications have noted variation in the combined endpoint of stroke and death following carotid angioplasty and stent placement with embolic protection (Percutaneous Transluminal Angioplasty, Cochrane Database Syst Rev 2007). Adoption of this outcome measure in the United States would likely disclose disparate results between hospitals and between providers, and lead to quality improvement when this information was provided to individual providers and participating centers. The SVS Vascular Registry has shown that outcome results are good for CAS, but variations exist between interventionalists and centers. Postoperative stroke or death is the accepted outcome parameter for this procedure, and its measurement and reporting would demonstrate variation and opportunity for improvement. CAS is an elective procedure in nearly all cases. Patients can be referred or transferred to a center with the personnel and experience to perform this procedure with a high level of competence and any procedure that has "stroke" as a potential risk should be performed only by individuals with appropriate training and experience. (Carotid Artery Angioplasty, J Vasc Interv Radiol 2003)