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Potential Opioid Overuse

eCQMs for pre-rulemaking Period

Specifications
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General eCQM Information

CMS Measure ID CMS460v2
NQF Number 0000
Measure Description

Percentage of patients aged 18 years and older who receive opioid therapy for 90 days or longer 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

Equals Initial Population

Denominator Exclusions

Patients receiving hospice or palliative care or who have a diagnosis of sickle cell disease in the measurement period.

Patients with a diagnosis of cancer two years or less before the end of the measurement period.

Numerator Statement

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

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

A lower rate indicates better quality

Guidance

Abbreviations used in this measure:

CMD/cmd- cumulative medication duration (used in measure logic)

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

Scripts/scripts - prescriptions (used in the measure logic)

Explanation of timings used in this measure:

Period/period(s) - time frames referring to the relevant period of the opioid medication(s) or encounter(s) during the measurement period and indicating the length of time between prescription(s) (used in the measure logic).

The logic calculates the opioid medication time frame by assuming that the prescription is filled on the day of the order and using a stop time determined by the days supplied attribute (e.g., start time plus number of days supplied- start date February 1 and days supplied 7 therefore the end date is February 8). If the days supplied cannot be calculated, then the logic defaults to using the start and stop times of the prescription. If a stop time is not included in the order and the prescription is not discontinued, the measure algorithm assumes the ordered medication remains active. If the prescription includes refills, the measure assumes the patient requested all refills of the medication.

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 impact the measures' intent. Efforts to resolve this technical limitation are being explored for future versions of this measure.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Meaningful Measure Prevention and Treatment of Opioid and Substance Use Disorders
Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated measure developer name from 'The Lewin Group' to 'Mathematica'.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the clinical recommendation statement to align with CDC Guideline updates and to improve clarity.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Added text to identify the Quality Data Model (QDM) version used in the measure specification.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Added text to indicate whether the measure is patient-based or episode-based.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Corrected typographical errors and spacing issues in the Guidance.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Spelled out measurement period (MP) and medication(s)/(med(s))to align with the Clinical Quality Language (CQL) Style Guide.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Revised the guidance regarding the relevant period for opioid medications to align with the logic change.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated the cancer exclusion narrative to better align with the timing of the measure logic.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the palliative and hospice care exclusion narrative to align with changes to the measure logic and value sets.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the numerator header statement to clarify the measure intent and more closely align with the measure logic.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Condensed the timing logic of the cancer exclusion by replacing the starts 1 year or less before start of and starts during with 'starts 2 years or less before end of 'Measurement Period'.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the Palliative and Hospice Care logic by creating a new define statement using 'Palliative or Hospice Care' grouping value set and removing the datatype intervention recommended to harmonize logic and value set with other measures.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the 'MedicationRelevantPeriod' function's logic to calculate the opioid medication relevant period using the prescription start date plus the days supplied, otherwise calculate using the prescription start and stop dates to more closely capture the highest possible dose.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Replaced the 'DayMonthTimings' Library by using the new expand operator in the 'CalculateDailyMMEPerMedicaion' function to condense the overall measure logic.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Revised the Opioid Medication Period function by adding 'sort by' to ensure the collapsed period intervals are returned in ascending order.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Spelled out measurement period (MP) and medication(s) (med(s)) to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL Library version update: Updated version number of the OpioidData Library (OpioidData-3.1.000) and harmonized with other opioid measures.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • CQL Library version update: Updated version number of the Potential Opioid Overuse Library (PotentialOpioidOveruse-2.1.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised inline comment within the 'Gaps in Active Opioid Periods' to more accurately describe what the logic executes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised the EnsureMicrogramQuantity function by replacing the 'mcg' with UCUM unit 'ug' and corrected the inline comment by replacing 'milligrams' with 'micrograms' to ensure accuracy of the statement.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • CQL Library version update: Updated version number of the ConversionLogic Library (ConversionLogic -3.1.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

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 Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Deleted 1 SNOMED CT code (17436001) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Opioid Medications (2.16.840.1.113883.3.3157.1004.26): Added 22 RxNorm codes and deleted 17 RxNorm codes based on terminology updates and harmonized opioid ingredient value sets with other opioid measures where possible.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set All Primary and Secondary Cancer (2.16.840.1.113762.1.4.1111.161): Added 335 SNOMED CT codes and deleted 2 SNOMED CT codes (716654007, 690801000119108) based on expert review or public feedback and terminology updates, to ensure patients with primary or secondary cancers are excluded.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced extensional value sets Palliative Care (2.16.840.1.113762.1.4.1111.162) and Hospice Care (2.16.840.1.113883.3.3157.1004.20) with grouping value set Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579) based on expert review or public feedback to harmonize with other measures.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jun 24, 2020