Skip to main content

Hospital Risk-Standardized Complication Rate Following Implantation of Implantable Cardioverter-Defibrillator (ICD)

CBE ID
0694
Endorsement Status
E&M Committee Rationale/Justification

Endorsement was removed due to no consensus. The committee raised concern with the lack of updated data to determine whether a gap exists and for scientific acceptability. The measure is also not in use, which makes it challenging to know if the measure is improving over time.

1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
1.6 Measure Description

This measure provides hospital specific risk-standardized rates of procedural complications following the implantation of an Implantable Cardioverter-Defibrillator (ICD) in patients at least 65 years of age. The measure uses clinical data available in the National Cardiovascular Data Registry (NCDR) Electrophysiology Device Implant Registry (EPDI - formerly the ICD Registry) for risk adjustment linked with administrative claims data using indirect patient identifiers to identify procedural complications.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
Yes
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.10 Measure Rationale

Not applicable

1.20 Types of Data Sources
1.25 Data Source Details

This measure relies on claims data. As of Fall 2023 claims data use is currently restricted and unavailable to support performance measures. Legislation to change this has been introduced.  

 

The datasets used to create the measures are described below.  

  

(1) NCDR EP Device Implant Registry (EPDI - formerly ICD Registry) data  

The NCDR EP Device Implant Registry (EPDI - formerly ICD Registry) is a cardiovascular data registry which captures detailed information about patients at least 18 years of age undergoing ICD implantation. This includes demographics, comorbid conditions, cardiac status, and laboratory results. As of May 2015, the registry had collected data from 1,786 hospitals in the United States totaling over 1,330,000 implants (NCDR data outcome reports).   

  

The registry, launched on June 30, 2005, was developed through a partnership of the Heart Rhythm Society (HRS) and the (ACC) in response to CMS’ expanded ICD coverage decision for primary prevention ICD therapy. Data included in the registry are collected by hospitals and submitted electronically on a quarterly basis to NCDR. The patient records submitted to the registry focus on acute episodes of care, from admission to discharge. The NCDR does not currently link patient records longitudinally across episodes of care.   

  

The data collection form and the complete list of variables collected and submitted by hospitals can be found at www.ncdr.com. For more information on these data, please see the attached methodology report.  

  

Of note, hospitals are only required to submit data on all primary prevention ICDs implanted in Medicare patients, and, of the 159 data elements collected by the NCDR EP Device Implant Registry (EPDI - formerly ICD Registry), only 54 are forwarded to CMS by American College of Cardiology (ACC) to determine payment eligibility. Nevertheless, the majority of participating hospitals have opted to participate fully in the quality improvement aspect of the registry and submit all data elements on all patients undergoing ICD implantation.   

  

(2) Medicare Data  

 

IMPORTANT NOTE: ACC is not currently able to use this data source as Medicare claims are not currently available for performance measure reporting. This has limited our ability to update and report this measure.  

 

The model was developed in a population of Medicare FFS beneficiaries but can be expanded to all ICD patients at least 65 years of age. We used the administrative claims data to identify complications.  

  

(a) Part A inpatient and outpatient data: Part A data refers to claims paid for Medicare inpatient hospital care, outpatient hospital services, skilled nursing facility care, some home health agency services, and hospice care. For this measure, we used Part A data to identify ICDs implanted for admitted and non-admitted patients (i.e., hospital patients with observation status). For model development, we used 2007 Medicare Part A data to match patient stays associated with an ICD with comparable data from the NCDR EP Device Implant Registry (EPDI - formerly ICD Registry).   

  

(b) Medicare Enrollment Database (EDB): This database contains Medicare beneficiary demographic, benefit/coverage, and vital status information. This dataset was used to obtain information on several inclusion/exclusion indicators, such as Medicare status on admission, and provided the ability to retrieve 90 days follow-up, linking patient Health Insurance Claim (HIC) number to the Part A data. These data have previously been shown to accurately reflect patient vital status (Fleming Fisher et al. 1992).