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Potential Opioid Overuse

CMS Measure ID
CMS460v1
Version
1
NQF Number
Not Applicable
Measure Description

Percentage of patients aged 18 years or older who receive opioid therapy for 90 days or more with no more than a 7-day gap between prescriptions with a daily dosage of 90 morphine milligram equivalents (MME) or more

Initial Population

Patients 18 years of age and older prescribed a 90 day or longer supply of opioids with 7 days or less between each opioid prescription and who have a qualifying encounter during the measurement period

Denominator Statement
Denominator Exclusions

Patients receiving palliative or hospice care or having a diagnosis of sickle cell disease during or overlapping the measurement period.

Patients with a diagnosis of cancer one year or less prior to or during the measurement period.

Numerator Statement

Patients with a daily dosage of 90 morphine milligram equivalents or more prescribed during the measurement period

Numerator Exclusions

None

Denominator Exceptions

None

Measure Scoring
Measure Type
Improvement Notation

A lower rate indicates better quality

Guidance

Abbreviations used in this measure:

MME - morphine milligram equivalents (used in measure narrative and logic)

cmd - cumulative medication duration (used in measure logic)

scripts - prescriptions (used in the measure logic)

meds – medications (used in the measure logic)

Explanation of timings used in this measure:

period - time frames referring to the relevant period of the opioid medication or encounters during the measurement period and indicating the length of time between prescriptions (used in the measure logic)

Calculating the opioid timeframe is accomplished by either using the start and end dates for the prescription or if the end date is not provided for the prescription, the day supplied attribute is used to calculate the end date (e.g., start date plus days supplied- start date February 1 and days supplied 7 therefore the end date is February 8).

This measure allows for up to 7 days between prescriptions for long-term opioid users. If a patient has a gap between prescriptions of 7 days or less but takes one or more opioids listed below for at least 90 days, he or she will still be included in the measure’s denominator. In the logic, the approach to find the periods in which the patient has opioid medications, determines the gaps of more than 7 days to provide the boundaries in which to create a list of periods with allowed gaps.

For this measure, the numerator applies to patients in the initial population with a 90-day or more supply of opioids with no more than a 7-day gap between prescriptions of 90 MMEs or higher per day.

The daily dosage is derived by multiplying the single dose administration by the frequency for the day. The highest possible daily dosage will be used for the prescription period (e.g., Prescription is for 10 mg tabs; take 1 -2 tabs QID (four times a day) as needed for pain. The range would be 0 mg to 80 mg per day. 80 mg would be used for each day of that prescription period).

The numerator criteria of this measure are satisfied for all patients in the initial population with a 90-day or longer supply of the following specified opioids at a 90 MME or more average daily dose:

-Butorphanol

-Codeine

-Dihydrocodeine

-Fentanyl

-Hydrocodone

-Hydromorphone

-Levorphanol

-Meperidine (Pethidine)

-Methadone

-Morphine

-Nalbuphine

-Opium

-Oxycodone

-Oxymorphone

-Pentazocine

-Tapentadol

-Tramadol

The omission of buprenorphine is intentional.

MME for each opioid used in measure calculation is based on conversion factors provided by the CDC. Providers can access these values through CDC’s opioid guideline mobile app (available here for download: https://www.cdc.gov/drugoverdose/prescribing/app.html). For more details on how to calculate daily dose, please review CDC's "Guideline for Prescribing Opioids for Chronic Pain--United States, 2016;" a two-page quick reference guide is also available here: https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf

Current technical specifications require use of a lengthy opioid data library within this measure to capture specific drug ingredient information.The opioid data library is used in several measures and as such in order to harmonize, there are intentional discrepancies between the opioid data library and the opioid medication value set used in the measure. The differences do not effect the measures' intent. Efforts to resolve this technical limitation are being explored for future versions of this measure.

Notes

Pre-rulemaking

Specifications

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Last Updated: Oct 10, 2019