CMS and Joint Commission to retire Beta-Blocker at Arrival (AMI-6) as of April 1, 2009 Discharges

The Centers for Medicare and Medicaid Services (CMS) announced today ( that it plans to retire one of the quality measures it collects under the Agency’s hospital quality pay-for-reporting program. As of April 1, 2009, CMS plans to retire measure AMI-6, known as, “Acute myocardial infarction patients without beta-blocker contraindications who received a beta-blocker within 24 hours after hospital arrival.” Hospitals will see a change in their reporting requirements as of April 1, 2009, and consumers will also notice changes to the information available to them on the Hospital Compare website.


Hospitals that participate in the RHQDAPU program will no longer be required to submit data on the measure, beginning with discharges dated April 1, 2009 or after. Until then, CMS encourages hospitals to use the “Reason for No Beta-Blocker on Arrival” exclusion in order to remove high-risk patients from the measure. CMS is working to remove the AMI-6 measure from the website, and hopes to complete the measure removal on the site by early spring 2009.

The Joint Commission will suppress the measure from Quality Check starting with the posting of July-September 2008 data in April 2009.

According to the CMS document and rationale and reporting requirements outlined in the Iowa Foundation for Medical Care Quality Improvement Organization document “Change in Composition of the National Hospital Quality Acute Myocardial Infarction Set,” the current evidence base for the administration of oral versus intravenous (IV) beta-blockers differs. The new guideline recommends that early intravenous beta blockers should specifically be avoided in some patient populations. Based on new studies that showed different clinical effectiveness of IV and oral beta blockers, the ACC/AHA Task Force on Performance Measures has removed this measure from their list of supported performance measures as of November 10, 2008. Although performance measures are not intended to be used as practice standards, many endusers interpret them in this manner. For AMI-6, there is a potential unintended consequence that clinicians or providers may attempt to treat patients with beta blockers despite the presence of clinical contraindications and despite the ability to exclude these cases from the current measure through appropriate documentation.

Although the American College of Cardiology/American Heart Association (ACC/AHA) have recommended the retirement of the performance measure assessing rates of use of beta blockers within 24 hours of presentation for patients with AMI, there remain many clinical circumstances where beta blockers are recommended therapy for patients with both acute and chronic coronary artery disease, including early use in some patients with AMI.


(SOURCES: University Healthsystem Consortium CDI Insider,, January 8, 2009; Center for Medicare and Medicaid Services,, accessed January 9, 2009)