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Measure: CMS90

Functional Status Assessments for Congestive Heart Failure

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS90v13 2024 13.0.000 Functional Status Assessments for Heart Failure
CMS90v12 2023 12 Functional Status Assessments for Heart Failure
CMS90v11 2022 11.1.000 Functional Status Assessments for Heart Failure
CMS90v10 2021 10.2.000 Functional Status Assessments for Congestive Heart Failure
CMS90v9 2020 9.1.000 Functional Status Assessments for Congestive Heart Failure
CMS90v8 2019 8.3.000 Functional Status Assessments for Congestive Heart Failure
CMS90v7 2018 7.1.000 Functional Status Assessments for Congestive Heart Failure
CMS90v6 2017 6.2.000 Functional Status Assessments for Congestive Heart Failure

Description

Percentage of patients 18 years of age and older with congestive heart failure who completed initial and follow-up patient-reported functional status assessments

Guidance

A functional status assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. Initial FSA and encounter: The initial FSA is the first FSA during the measurement year that also occurs two weeks before or during the first encounter in the first 185 days of the measurement year. Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18 years of age and older who had two outpatient encounters during the measurement year and a diagnosis of congestive heart failureWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients with severe cognitive impairment that overlaps the measurement period. Exclude patients whose hospice care overlaps the measurement period.Webchart Instructions
NumeratorPatients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; PROMIS -10 Global Health, PROMIS-29) present in the EHR two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial functional status assessmentWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS90v9 90 2020 9.1.000 Not Applicable bb9b8ef7-0354-40e0-bec7-d6891b7df519
Steward Developer Endorsed By
National Committee for Quality Assurance Centers for Medicare & Medicaid Services (CMS)
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

None

Improvement Notation

A higher score indicates better quality

Rationale

Patients living with congestive heart failure (CHF) often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient's function and ability to complete desired activities of daily living (Hunt et al ., 2009). The American Heart Association has also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from CHF patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient's priorities (Allen et al., 2012; Rumsfeld et al., 2013).

Clinical Recommendation Statement

American College of Cardiology Foundation and American Heart Association (2013): Every patient with HF (heart failure) should have a clear, detailed, and evidence-based plan of care that ensures the achievement of GDMT (guideline-directed medical therapy) goals, effective management of comorbid conditions, timely follow-up with the health care team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient's health care team.
(Class of recommendation: I; Level of evidence: C ) 

Level C: Only consensus opinion of experts, case studies, or standard of care 
Class I: Procedure/treatment should be performed/administered

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Heart Failure 2.16.840.1.113883.3.526.3.376
Diagnosis Severe Dementia 2.16.840.1.113883.3.526.3.1025
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1

References

Allen, L. A., Stevenson, L. W., Grady, K. L., et al. (2012). Decision making in advanced heart failure: A scientific statement from the American Heart Association. Circulation, 125(15), 1928-1952. doi: 10.1161/CIR.0b013e31824f2173
Hunt, S. A., Abraham, W. T., Chin, M. H., et al. (2009). 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. Circulation, 119(14), e391-e479. doi: 10.1161/CIRCULATIONAHA.109.192065
Rumsfeld, J. S., Alexander, K. P., Goff, D. C., et al. (2013). Cardiovascular health: The importance of measuring patient-reported health status: A scientific statement from the American Heart Association. Circulation, 127(22), 2233-2249. doi: 10.1161/CIR.0b013e3182949a2e
American College of Cardiology Foundation & American Heart Association. (2013). Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 128(16), e240-e327. doi: 10.1161/CIR.0b013e31829e8776

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms90v9