2018 CMS Web Interface

Transcription

1 CMS Web Interface IVD-2 (NQF 0068): Ischemic Vascular Disease (IVD): Use f Aspirin r Anther Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 20 11/13/2017

2 Cntents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY SAMPLING... 4 NARRATIVE MEASURE SPECIFICATION... 5 DESCRIPTION:... 5 IMPROVEMENT NOTATION:... 5 INITIAL POPULATION:... 5 DENOMINATOR:... 5 DENOMINATOR EXCLUSIONS:... 5 DENOMINATOR EXCEPTIONS:... 5 NUMERATOR:... 5 NUMERATOR EXCLUSIONS:... 5 DEFINITIONS:... 5 GUIDANCE:... 5 SUBMISSION GUIDANCE... 6 PATIENT CONFIRMATION... 6 SUBMISSION GUIDANCE... 7 DENOMINATOR CONFIRMATION... 7 SUBMISSION GUIDANCE... 9 NUMERATOR REPORTING... 9 DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT CMS Web Interface V2.0 Page 2 f 20 11/13/2017

3 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The measure dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each measure dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. CMS Web Interface V2.0 Page 3 f 20 11/13/2017

4 CMS WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the CMS Web Interface Sampling Dcument, which will be made available during the perfrmance year at CMS.gv. CMS Web Interface V2.0 Page 4 f 20 11/13/2017

5 NARRATIVE MEASURE SPECIFICATION DESCRIPTION: Percentage f patients 18 years f age and lder wh were diagnsed with acute mycardial infarctin (AMI), crnary artery bypass graft (CABG) r percutaneus crnary interventins (PCI) in the 12 mnths prir t the measurement perid, r wh had an active diagnsis f ischemic vascular disease (IVD) during the measurement perid, and wh had dcumentatin f use f aspirin r anther antiplatelet during the measurement perid IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: Patients 18 years f age and lder with a visit during the measurement perid wh had an AMI, CABG, r PCI during the 12 mnths prir t the measurement year r wh had a diagnsis f IVD verlapping the measurement year DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Patients wh had dcumentatin f use f anticagulant medicatins verlapping the measurement year DENOMINATOR EXCEPTIONS: Nne NUMERATOR: Patients wh had an active medicatin f aspirin r anther antiplatelet during the measurement year DEFINITION: Nne GUIDANCE: Nne NUMERATOR EXCLUSIONS: Nt Applicable CMS Web Interface V2.0 Page 5 f 20 11/13/2017

6 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr reprting requires the fllwing: Guidance Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry, r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The CMS Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have been sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) CMS Web Interface V2.0 Page 6 f 20 11/13/2017

7 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient was diagnsed with acute mycardial infarctin (AMI), crnary artery bypass graft (CABG) r percutaneus crnary interventins (PCI) in the 12 mnths prir t the measurement perid, OR wh had an active diagnsis f ischemic vascular disease (IVD) during the measurement perid OR OR OR If the patient was diagnsed with AMI, CABG r PCI OR had an active diagnsis f IVD select Yes If yu are unable t cnfirm if the patient was diagnsed with AMI, CABG r PCI OR had an active diagnsis f IVD select Nt Cnfirmed - Diagnsis If there is a denminatr exclusin fr patient disqualificatin frm the measure select Denminatr Exclusin If there is an "ther" CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr and Denminatr Exclusin Drug cdes can be fund in the CMS Web Interface IVD Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Nt Cnfirmed-Diagnsis r Denminatr Exclusin r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be reprted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all CMS Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure, and reasn fr request in a CMS Quality Payment Prgram Service Desk inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm a CMS Apprved Reasn is selected will be skipped and anther patient must be reprted in their place, if available. CMS Web Interface V2.0 Page 7 f 20 11/13/2017

8 NOTE: Active Diagnsis is defined as a diagnsis that is either n the patient s prblem list, a diagnsis cde listed n the encunter, r is dcumented in a prgress nte indicating that the patient is being treated r managed fr the disease r cnditin during the denminatr identificatin measurement perid Denminatr Exclusin medicatins include the fllwing anticagulant medicatins (i.e., Apixaban, Argatrban, Bivalirudin, Dabigatran, Dalteparin, Desirudin, Edxaban, Enxaparin, Fndaparinux, Heparin, Lepirudin, Rivarxaban, Tinzaparin, Warfarin) CMS Web Interface V2.0 Page 8 f 20 11/13/2017

9 NUMERATOR SUBMISSION SUBMISSION GUIDANCE Determine if the patient has dcumented use f aspirin r anther antiplatelet during the measurement perid OR If the patient des nt use aspirin r anther antiplatelet select N If the patient uses aspirin r anther antiplatelet select Yes Numeratr Drug cdes can be fund in the CMS Web Interface IVD Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance NOTE: Numeratr - Oral therapy includes: Aspirin, clpidgrel r cmbinatin f aspirin and extended release dipyridamle, Prasugrel, Ticagrelr, and Ticlpidine, Ysprala - Dcumented use f aspirin r anther antiplatelet during the measurement perid may be cmpleted during a telehealth encunter CMS Web Interface V2.0 Page 9 f 20 11/13/2017

10 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the CMS Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Claims data cannt be used t cnfirm a diagnsis (DM, IVD, HTN, etc.,) used fr sampling purpses as claims are the riginal surce f the diagnsis sampling. Claims data can be used t prepare the CMS Web Interface Excel, but supprting medical recrd dcumentatin will be required t substantiate what is reprted in the event f an audit. CMS Web Interface V2.0 Page 10 f 20 11/13/2017

11 Appendix I: Perfrmance Calculatin Flw Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f "In Hspice", "Mved ut f Cuntry", "Deceased", r "HMO Enrllment", will nly need t be dne nce per patient. Start* Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Medical Recrd Fund Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Patient Qualified fr the Sample. IF NOT, Select the Reasn & Enter Date** Patient Became Ineligible fr Sample (In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment) Yes Cntinue t Measure Cnf *See the Measure Submissin Dcument fr further instructins n hw t submit this measure **If date is unknwn, enter 12/31/ CMS Web Interface V2.0 Page 11 f 20 11/13/2017

12 Measure Cnfirmatin Flw fr IVD-2 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Start* Cmplete fr cnsecutively ranked patients aged 18 years and lder at the beginning f the measurement perid** Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm perfrmance calculatins fr this measure. The patient will be skipped and replaced. N Patient had an AMI, CABG r PCI in the 12 Mnths Prir t the Measurement Perid OR Active Diagnsis f IVD During the Measurement Perid Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm perfrmance calculatins fr this measure. The patient will be skipped and replaced. N Patient Qualified fr Measure. IF NOT, Select: Denminatr Exclusin fr Patient Disqualificatin Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm perfrmance calculatin fr this measure. The patient will be skipped and replaced. N Patient Qualified fr the Measure. IF NOT, Select: N - Other CMS Apprved Reasn fr Patient Disqualificatin*** Yes Cntinue t Measure Flw *See the Measure Submissin Dcument fr further instructins n hw t submit this measure **Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the IVD-2 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. *** Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv CMS Web Interface V2.0 Page 12 f 20 11/13/2017

13 Measure Flw fr IVD-2 Start* The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatin. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the IVD Cding Dcument. Include Remainder f Patients Listed in CMS Web Interface that were Cnsecutively Cnfirmed and Cmpleted fr this Measure in the Denminatr (i.e., 110 Patients) d Patient Has Dcumented Use f Aspirin r Anther During the Measurement Perid Yes Perfrmance Met: Include in Perfrmance Numeratr (i.e., 96 Patients) a N Perfrmance Nt Met: D Nt Include in Numeratr Perfrmance Rate= Perfrmance Met (a=96 Patients) 96 Patients = 87.27% Denminatr (d=110 Patients) = 110 Patients CALCULATION MAY CHANGE PENDING PERFORMANCE MET ABOVE SAMPLE CALCULATION: *See the Measure Submissin Dcument fr further instructins n hw t submit this measure CMS Web Interface V2.0 Page 13 f 20 11/13/2017

14 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Please refer t the Measure Submissin Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample, cntinue t the Measure Cnfirmatin Flw fr IVD-2. CMS Web Interface V2.0 Page 14 f 20 11/13/2017

15 Measure Cnfirmatin Flw fr IVD-2 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr IVD-2. Cmplete fr cnsecutively ranked patients aged 18 years and lder at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the IVD-2 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient had an AMI, CABG, r PCI in the 12 mnths prir t the measurement perid OR has an active diagnsis f IVD during the measurement perid. a. If n, the patient des nt have an AMI, CABG, r PCI in the 12 mnths prir t the measurement perid OR an active diagnsis f IVD during the measurement perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient had an AMI, CABG, r PCI in the 12 mnths prir t the measurement OR an active diagnsis f IVD during the measurement perid, cntinue prcessing. 3. Check t determine if the patient qualifies fr the measure (Denminatr Exclusin). a. If n, the patient des nt qualify fr the measure select: Denminatr Exclusin fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 4. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue t IVD-2 measure flw. CMS Web Interface V2.0 Page 15 f 20 11/13/2017

16 Measure Flw fr IVD-2 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the IVD Cding Dcument. 1. Start prcessing IVD-2 (NQF 0068) Flw fr the patients that qualified fr the sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr IVD-2. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 110 patients). 2. Check t determine if the patient has dcumented use f Aspirin r Anther during the measurement perid a. If n, the patient des nt have a dcumented use f Aspirin r Anther during the measurement perid, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient des have a dcumented use f Aspirin r Anther during the measurement perid, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a categry (numeratr, i.e. 96 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (96 patients) Denminatr is categry d in measure flw (110 patients) 96 (Perfrmance Met) divided by 110 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.0 Page 16 f 20 11/13/2017

17 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the CMS Web Interface IVD Cding Dcument. * IVD-2: Ischemic Vascular Disease (IVD): Use f Aspirin r Anther Measure Cmpnent/Excel Data Element Variable Name Cding Tab Denminatr/Denminatr Cdes Denminatr Exclusin/Denminatr Exclusin Drug Cdes Numeratr/Numeratr Drug Ischemic Vascular Disease Diagnsis Anticagulant Medicatins IVD_DX_CODE AMI_CODE CABG_CODE PCI_CODE ANTICOAG_DRUG_CODE System(s) I9 I10 SNM I10 SNM C4 HCPCS SNM C4 HCPCS SNM RxNrm (Drug EX=Y) Aspirin/ ASA_DRUG_CODE RxNrm (Drug Cdes Therapy EX=N) *Fr EHR mapping, the cding within IVD-2 is cnsidered all-inclusive. The therapy drug cding is cnsidered all-inclusive CMS Web Interface V2.0 Page 17 f 20 11/13/2017

18 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: Cardivascular disease, including strke, is the leading cause f death in the United States. Mre than 85 millin American adults have ne r mre types f cardivascular disease. Specifically, mre than 15 millin adults (20 years and lder) have crnary heart disease (CHD), ver 8 millin adults have angina, mre than 7 millin adults have had a mycardial infarctin (MI), ver 6 millin adults have had a strke, and nearly 7 millin adults 40 years f age and lder have peripheral artery disease (Mzaffarian et al., 2015). It is estimated that by 2030 mre than 43 percent f Americans will have a frm f cardivascular disease (Heidenreich et al., 2011). In 2011, the ttal cst f cardivascular disease and strke in the United States was estimated t be $320 billin. This ttal includes direct csts such as the cst f physicians and ther health prfessinals, hspital services, prescribed medicatins and hme health care, as well as indirect csts due t lss f prductivity frm premature mrtality (Mzaffarian et al., 2015). By 2030, direct medical csts fr cardivascular disease are prjected t increase t nearly $918 billin (Heidenreich, 2011). medicatins, such as aspirin and clpidgrel, are drugs that inhibit platelets frm clumping tgether and frming clts. Their use in the secndary preventin f cardivascular events is well established. In patients wh are at high risk because they already have cclusive cardivascular disease, lng-term antiplatelet therapy reduces the yearly risk f serius vascular events (MI, strke, death) by abut twenty-five percent ( Trialists' Cllabratin, 1994; 2002; 2009). A mre recent systematic review f the literature cnfirmed the benefits f antiplatelet therapy in reducing death frm cardivascular causes, MI, r strke (Cheng, 2013). agents als have a beneficial effect in reducing all-cause mrtality and fatal cardivascular events in patients with peripheral arterial disease (Wng et al., 2011). CLINICAL RECOMMENDATION STATEMENTS: AHA/ACCF SECONDARY PREVENTION AND RISK REDUCTION THERAPY FOR PATIENTS WITH CORONARY AND OTHER ATHEROSCLEROTIC VASCULAR DISEASE: 2011 UPDATE: - Aspirin mg daily is recmmended in all patients with crnary artery disease unless cntraindicated. (Level f Evidence: A) Clpidgrel 75 mg daily is recmmended as an alternative fr patients wh are intlerant f r allergic t aspirin. (Level f Evidence: B) Class I - A P2Y12 receptr antagnist in cmbinatin with aspirin is indicated in patients after ACS r PCI with stent placement. (Level f Evidence: A) Fr patients receiving a bare-metal stent r drug-eluting stent during PCI fr ACS, clpidgrel 75 mg daily, prasugrel 10 mg daily, r ticagrelr 90 mg twice daily shuld be given fr at least 12 mnths. (Level f Evidence: A) Class I - Fr patients underging crnary artery bypass grafting, aspirin shuld be started within 6 hurs after surgery t reduce saphenus vein graft clsure. Dsing regimens ranging frm 100 t 325 mg daily fr 1 year appear t be efficacius. (Level f Evidence: A) Class I - In patients with extracranial cartid r vertebral athersclersis wh have had ischemic strke r TIA, treatment with aspirin alne ( mg daily), clpidgrel alne (75 mg daily), r the cmbinatin f aspirin plus extended-release dipyridamle (25 mg and 200 mg twice daily, respectively) shuld be started and cntinued. (Level f Evidence: B) Class I - Fr patients with symptmatic athersclertic peripheral artery disease f the lwer extremity, antiplatelet therapy with aspirin ( mg daily) r clpidgrel (75 mg daily) shuld be started and cntinued. (Level f Evidence: A) Class I CMS Web Interface V2.0 Page 18 f 20 11/13/2017

19 - therapy is recmmended in preference t anticagulant therapy with warfarin r ther vitamin K antagnists t treat patients with athersclersis. (Level f Evidence: A) Class I GUIDELINES FOR THE PREVENTION OF STROKE IN PATIENTS WITH STROKE AND TRANSIENT ISCHEMIC ATTACK: 2014: - Fr patients with nncardiemblic ischemic strke r TIA, the use f antiplatelet agents rather than ral anticagulatin is recmmended t reduce the risk f recurrent strke and ther cardivascular events (Class I; Level f Evidence A). - Aspirin ( mg/d) mntherapy (Class I; Level f Evidence A) r the cmbinatin f aspirin 25 mg and extended-release dipyridamle 200 mg twice daily (Class I; Level f Evidence B) is indicated as initial therapy after TIA r ischemic strke fr preventin f future strke. (Revised recmmendatin) - Clpidgrel (75 mg) mntherapy is a reasnable ptin fr secndary preventin f strke in place f aspirin r cmbinatin aspirin/dipyridamle (Class IIa; Level f Evidence B). This recmmendatin als applies t patients wh are allergic t aspirin. - Fr patients with nncardiemblic ischemic strke r TIA, the use f antiplatelet agents rather than ral anticagulatin is recmmended t reduce the risk f recurrent strke and ther cardivascular events (Class I; Level f Evidence A). CMS Web Interface V2.0 Page 19 f 20 11/13/2017

20 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT The measures and specificatins were develped by and are wned by the Natinal Cmmittee fr Quality Assurance ( NCQA ). NCQA hlds a cpyright in the measures and specificatins and may rescind r alter these measures and specificatins at any time. Users f the measures and specificatins shall nt have the right t alter, enhance r therwise mdify the measures and specificatins, and shall nt disassemble, recmpile r reverse engineer the measures and specificatins. Anyne desiring t use r reprduce the materials withut mdificatin fr a nn-cmmercial purpse may d s withut btaining any apprval frm NCQA. All cmmercial uses r requests fr alteratin f the measures and specificatins must be apprved by NCQA and are subject t a license at the discretin f NCQA. The measures and specificatins are nt clinical guidelines, d nt establish a standard f medical care and have nt been tested fr all ptential applicatins. The measures and specificatins are prvided as is withut warranty f any kind. NCQA makes n representatins, warranties r endrsements abut the quality f any prduct, test r prtcl identified as numeratr cmpliant r therwise identified as meeting the requirements f a measure r specificatin. NCQA als makes n representatins, warranties r endrsements abut the quality f any rganizatin r clinician wh uses r reprts perfrmance measures. NCQA has n liability t anyne wh relies n measures and specificatins r data reflective f perfrmance under such measures and specificatins Natinal Cmmittee fr Quality Assurance, all rights reserved. Perfrmance measures develped by NCQA fr CMS may lk different frm the measures slely created and wned by NCQA. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. NCQA disclaims all liability fr use r accuracy f any cding cntained in the specificatins. The American Medical Assciatin hlds a cpyright t the CPT cdes cntained in the measures specificatins. CMS Web Interface V2.0 Page 20 f 20 11/13/2017