eCQMs for 2020 Performance Period CMS2v9 CMS22v8 CMS50v8 CMS56v8 CMS66v8 CMS68v9 CMS69v8 CMS74v9 CMS75v8 CMS90v9 CMS117v8 CMS122v8 CMS124v8 CMS125v8 CMS127v8 CMS128v8 CMS129v9 CMS130v8 CMS131v8 CMS133v8 CMS134v8 CMS135v8 CMS136v9 CMS137v8 CMS138v8 CMS139v8 CMS142v8 CMS143v8 CMS144v8 CMS145v8 CMS146v8 CMS147v9 CMS149v8 CMS153v8 CMS154v8 CMS155v8 CMS156v8 CMS157v8 CMS159v8 CMS161v8 CMS165v8 CMS177v8 CMS249v2 CMS347v3 CMS349v2 CMS645v3 CMS771v1 CMS Measure ID CMS249v2 Version 2 NQF Number Not Applicable Measure Description Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period Initial Population Female patients ages 50 to 64 years with an encounter during the measurement period Denominator Statement Equals Initial Population Denominator Exclusions Exclude patients with a combination of risk factors (as determined by age) or one of the independent risk factors Ages: 50-54 (>=4 combination risk factors) or 1 independent risk factor Ages: 55-59 (>=3 combination risk factors) or 1 independent risk factor Ages: 60-64 (>=2 combination risk factors) or 1 independent risk factor COMBINATION RISK FACTORS [The following risk factors are all combination risk factors; they are grouped by when they occur in relation to the measurement period]: The following risk factors may occur any time in the patient's history but must be active during the measurement period: White (race) BMI <= 20 kg/m2 (must be the first BMI of the measurement period) Smoker (current during the measurement period) Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor)) The following risk factor may occur any time in the patient's history and must not start during the measurement period: Osteopenia The following risk factors may occur at any time in the patient's history or during the measurement period: Rheumatoid arthritis Hyperthyroidism Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption Chronic liver disease Chronic malnutrition The following risk factors may occur any time in the patient's history and do not need to be active at the start of the measurement period: Documentation of history of hip fracture in parent Osteoporotic fracture Glucocorticoids (>= 5 mg/per day ) [cumulative medication duration >= 90 days] INDEPENDENT RISK FACTORS (The following risk factors are all independent risk factors; they are grouped by when they occur in relation to the measurement period): The following risk factors may occur at any time in the patient's history and must not start during the measurement period: Osteoporosis The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period: Gastric bypass FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent Aromatase inhibitors The following risk factors may occur at any time in the patient's history or during the measurement period: Type I Diabetes End stage renal disease Osteogenesis imperfecta Ankylosing spondylitis Psoriatic arthritis Ehlers-Danlos syndrome Cushing's syndrome Hyperparathyroidism Marfan syndrome Lupus Numerator Statement Female patients who received an order for at least one DXA scan in the measurement period Numerator Exclusions Not Applicable Denominator Exceptions None Measure Steward Centers for Medicare & Medicaid Services (CMS) Domain Efficiency and Cost Reduction Previous Version CMS249v1 Measure Scoring Proportion Measure Type Process Improvement Notation Lower score indicates better quality Guidance There are two ways that a patient can be excluded from the measure: 1. The patient has a specific number of "combination" risk factors (the number of risk factors varies by age). 2. The patient has one or more of the "independent" risk factors, including a 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX. Quality ID 472 Meaningful Measure Appropriate Use of Healthcare Specifications Attachment Size CMS249v2.html 89.88 KB CMS249v2.zip 114.07 KB CMS249v2-TRN.xlsx 23.32 KB Data Element Repository Data Elements contained within CMS249v2 Release Notes Header Updated eCQM version number. Measure Section: eCQM Version number Source of Change: Measure Lead Updated copyright. Measure Section: Copyright Source of Change: Annual Update Updated rationale. Measure Section: Rationale Source of Change: Measure Lead Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines. Measure Section: Clinical Recommendation Statement Source of Change: Measure Lead Updated clinical recommendation statement. Measure Section: Clinical Recommendation Statement Source of Change: Measure Lead Updated references to align with American Psychological Association (APA) style. Measure Section: Reference Source of Change: Measure Lead Updated references. Measure Section: Reference Source of Change: Measure Lead Updated guidance statement with removal of cumulative medication duration as it was outdated. Measure Section: Guidance Source of Change: ONC Project Tracking System (JIRA): CQM-3153 Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines. Measure Section: Guidance Source of Change: Measure Lead Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines. Measure Section: Denominator Exclusions Source of Change: Measure Lead Updated parenthetical citations to align with American Psychological Association (APA) style. Measure Section: Multiple Sections Source of Change: Measure Lead Logic Added logic for glucocorticoid average daily dosing to improve alignment with measure intent. Measure Section: Denominator Exclusions Source of Change: Measure Lead Added the unit 'drinks/day' to express the average number of drinks per day as a quantity rather than an integer for clarity and to improve alignment with measure intent. Measure Section: Denominator Exclusions Source of Change: Measure Lead Changed the probability assessment result from 9.3% to 8.4% in the 'Osteoporosis Fracture Probability Assessment' definition to align with updated clinical guidelines. Measure Section: Denominator Exclusions Source of Change: Measure Lead Changed definition name from 'Average of More Than Two Drinks Per Drinking Day' to 'First Average Number of Drinks Assessments Indicating More Than Two Per Day' to better align with the measure intent. Measure Section: Definitions Source of Change: Measure Lead Changed the probability assessment result from 9.3% to 8.4% in the 'Osteoporosis Fracture Probability Assessment' definition to align with updated clinical guidelines. Measure Section: Definitions Source of Change: Measure Lead Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with CQL Style Guide. Measure Section: Definitions and Functions Source of Change: Standards Update Added new CQL library for day and month timing (DayMonthTimings-1.2.000). Measure Section: Multiple Sections Source of Change: Measure Lead Updated Clinical Quality Language (CQL) expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 3 (CQL 1.3). Measure Section: Multiple Sections Source of Change: Standards Update Updated definitions and functions in the Measure Authoring Tool (MAT) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays. Measure Section: Multiple Sections Source of Change: Standards Update Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000). Measure Section: Multiple Sections Source of Change: Standards Update Value Set The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets. Value set Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.12.1035): Added 9 SNOMED CT codes (737202006, 767809001, 767810006, 768006009, 768125005, 768126006, 768127002, 768288001, 768289009). Measure Section: Terminology Source of Change: Annual Update Value set Glucocorticoids (oral only) (2.16.840.1.113883.3.464.1003.196.12.1266): Deleted 2 RxNorm codes (197543, 197545). Measure Section: Terminology Source of Change: Annual Update Value set Marfan's Syndrome (2.16.840.1.113883.3.464.1003.113.12.1048): Added 1 SNOMED CT code (763839005). Measure Section: Terminology Source of Change: Annual Update Value set Type 1 Diabetes (2.16.840.1.113883.3.464.1003.103.12.1020): Added 24 SNOMED CT codes. Measure Section: Terminology Source of Change: Annual Update Value set Ten-year probability of all major osteoporosis related fracture (2.16.840.1.113883.3.464.1003.118.12.1081): Removed Ten-year probability of all major osteoporosis related fracture. Measure Section: Terminology Source of Change: Annual Update Value set Osteoporosis (2.16.840.1.113883.3.464.1003.113.12.1038): Added 1 SNOMED CT code (203657009). Measure Section: Terminology Source of Change: Annual Update Replaced Ten year probability of hip fracture (2.16.840.1.113883.3.464.1003.118.11.1095) with direct reference code LOINC code (90265-0). Measure Section: Terminology Source of Change: Annual Update Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable. Measure Section: Terminology Source of Change: Annual Update Standardized purpose statement language in value sets across eCQMs. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files. Measure Section: Terminology Source of Change: Measure Lead Value set Replaced Ten year probability of hip fracture (2.16.840.1.113883.3.464.1003.118.11.1095) with direct reference code LOINC code (90265-0). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (307469008)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396140003)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396131002)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (225756002)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396143001)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (307468000)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396139000)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396126004)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (225754004)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396127008)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (307470009)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396125000)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (225752000)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (307439001)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (229797004)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396109005)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396108002)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396107007)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (229798009)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (229799001)). Measure Section: Terminology Source of Change: Measure Lead Added direct reference code (SNOMED CT code (396111001)). Measure Section: Terminology Source of Change: Measure Lead External Resources United States Health Information Knowledgebase NLM Value Set Authority Center (VSAC)