Optimal Vascular Care Specifications 2015 (01/01/2014 to 12/31/2014 Dates of Service) October 2014

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1 Summary of Changes Removal of LDL Component The LDL component has been removed for numerator calculation. Additional Ischemic Vascular Disease ICD-9 Codes Codes indicating atherosclerosis of bypass grafted vessels: to , 440.8, and See Table 1. Clarification of Eligible Providers All Advanced Practice Registered Nurses are eligible providers. This includes, but is not limited to, Certified Nurse Practitioner, Certified Nurse Specialist, and Certified Nurse Midwife. Description Methodology Rationale Composite ( optimal care) measure of the percentage of adult patients who have ischemic vascular disease (IVD) with optimally managed modifiable risk factors. Population identification is accomplished via a query of a practice management system or Electronic Medical Record (EMR) to identify the population of eligible patients (denominator). Data elements are either extracted from an EMR system or abstracted through medical record review. Full population data is required for clinics that had an EMR in place by 01/01/2013. According to the Minnesota Department of Health, vascular disease is a high impact clinical condition in Minnesota. More than 20% of all deaths in Minnesota are due to heart disease and more than 7% are due to stroke, making them the second and third leading causes of death, respectively, in the state behind cancer. Inpatient hospitalization charges alone in Minnesota were $1.7 billion for heart disease patients and $318 million for stroke patients in According to the American Heart Association, nearly 84 million Americans have cardiovascular disease. In every year since 1900 (except the 1918 influenza pandemic), cardiovascular disease accounted for more deaths than any other major cause of death in the United States. In 2006, cardiovascular disease claimed one of every 2.9 deaths in the United States. Measurement Period Measurement period will be a fixed 12-month period: 01/01/2014 to 12/31/2014. Page 1

2 Denominator Patients who meet each of the following criteria are included in the population: Patient was age 18 to 75 years at the start of the measurement period (date of birth was on or between 01/01/1939 to 01/01/1996). Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least two times during the last two measurement periods (01/01/2013 to 12/31/2014) with visits coded with an IVD ICD-9 diagnosis code (in any position, not only primary). Use this date of service range when querying the practice management or EMR system to allow a count of the visits within the measurement period. Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least one time during the measurement period (01/01/2014 to 12/31/2014) for any reason. This may or may not include a face-to-face IVD visit with a IVD ICD-9 diagnosis code. Diagnosis of Ischemic Vascular Disease; ICD-9 diagnosis codes include: to , to , 412, to 413.9, to , 414.2, 414.3, 414.8, 414.9, 429.2, to , to , 440.0, 440.1, to , to , 440.4, 440.8, 440.9, to 444.9, to See Table 1. Eligible specialties: Family Medicine, General Practice, Internal Medicine, Geriatric Medicine, Cardiology Allowable Exclusions Numerator Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Advanced Practice Registered Nurses (APRN) The following are allowable exclusions: Patient was a permanent nursing home resident home during the measurement period. Patient was in hospice at any time during the measurement period. Patient died prior to the end of the measurement period. Documentation that diagnosis was coded in error. The number of IVD patients who met ALL of the following targets: The most recent Blood Pressure in the measurement period has a systolic value of less than 140 and a diastolic value of less than 90 (both values must be less than). Patient is currently a non-tobacco user. Patient is on daily aspirin OR an accepted contraindication (any date). Page 2

3 Codes to Identify Patients who have Ischemic Vascular Disease (IVD) Table 1: ICD-9 Diagnosis Codes for Identifying Ischemic Vascular Disease AMI ANTEROLATERAL,UNSPEC AMI ANTEROLATERAL, INITIAL AMI ANTEROLATERAL,SUBSEQ AMI ANTERIOR WALL,UNSPEC AMI ANTERIOR WALL, INITIAL AMI ANTERIOR WALL,SUBSEQ AMI INFEROLATERAL,UNSPEC AMI INFEROLATERAL, INITIAL AMI INFEROLATERAL,SUBSEQ AMI INFEROPOST, UNSPEC AMI INFEROPOST, INITIAL AMI INFEROPOST, SUBSEQ AMI INFERIOR WALL,UNSPEC AMI INFERIOR WALL, INITIAL AMI INFERIOR WALL,SUBSEQ AMI LATERAL NEC, UNSPEC AMI LATERAL NEC, INITIAL AMI LATERAL NEC, SUBSEQ TRUE POST INFARCT,UNSPEC TRUE POST INFARCT, INITIAL TRUE POST INFARCT,SUBSEQ SUBENDO INFARCT, UNSPEC SUBENDO INFARCT, INITIAL SUBENDO INFARCT, SUBSEQ Page 3

4 AMI NEC, UNSPECIFIED AMI NEC, INITIAL AMI NEC, SUBSEQUENT AMI NOS, UNSPECIFIED AMI NOS, INITIAL AMI NOS, SUBSEQUENT POST MI SYNDROME INTERMED CORONARY SYND ACUTE COR OCCLSN W/O MI AC ISCHEMIC HRT DIS NEC 412 OLD MYOCARDIAL INFARCT ANGINA DECUBITUS PRINZMETAL ANGINA ANGINA PECTORIS NEC/NOS COR ATH UNSP VSL NTV/GFT CRNRY ATHRSCL NATVE VSSL CRN ATH ATLG VN BPS GRFT CRN ATH NONATLG BLG GRFT COR ATH ARTRY BYPAS GRFT COR ATH BYPASS GRAFT NOS COR ATH NATV ART TP HRT COR ATH BPS GRAFT TP HRT CHR TOT OCCLUS COR ARTRY COR ATH DUE TO LIPID RICH PLAQUE CHR ISCHEMIC HRT DIS NEC CHR ISCHEMIC HRT DIS NOS ASCVD OCL BSLR ART WO INFRCT Page 4

5 OCL BSLR ART W INFRCT OCL CRTD ART WO INFRCT OCL CRTD ART W INFRCT OCL VRTB ART WO INFRCT OCL VRTB ART W INFRCT OCL MLT BI ART WO INFRCT OCL MLT BI ART W INFRCT OCL SPCF ART WO INFRCT OCL SPCF ART W INFRCT OCL ART NOS WO INFRCT OCL ART NOS W INFRCT CRBL THRMBS WO INFRCT CRBL THRMBS W INFRCT CRBL EMBLSM WO INFRCT CRBL EMBLSM W INFRCT CRBL ART OC NOS WO INFRC CRBL ART OCL NOS W INFRC ATHEROSCLEROSIS OF AORTA RENAL ARTERY ATHEROSCLER ATHSCL EXTRM NTV ART NOS ATH EXT NTV AT W CLAUDCT ATH EXT NTV AT W RST PN ATH EXT NTV ART ULCRTION ATH EXT NTV ART GNGRENE ATHRSC EXTRM NTV ART OTH ATHRSC OF UNSPECIFIED BYPASS GRAFT OF THE EXTRM ATHRSC OF AUTOLOGOUS VEIN BYPASS GRAFT OF THE EXTRM ATHRSC OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT OF THE EXTRM Page 5

6 440.4 CHR TOT OCCL ART EXTREM ATHRSC OF OTHER SPECIFIED ARTERIES GENERALIZED AND NOS ATHRSC SADDLE EMBOLUS OF ABD AORTA OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABD AORTA THORACIC AORTIC EMBOLISM UPPER EXTREMITY EMBOLISM LOWER EXTREMITY EMBOLISM ILIAC ARTERY EMBOLISM ARTERIAL EMBOLISM NEC ARTERIAL EMBOLISM NOS ATHEROEMBOLISM,UPPER EXT ATHEROEMBOLISM,LOWER EXT ATHEROEMBOLISM, KIDNEY ATHEROEMBOLISM, SITE NEC Page 6