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Appropriate Treatment for Upper Respiratory Infection (URI)

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Measure Information 2023 Performance Period
CMS eCQM ID CMS154v11
NQF Number Not Applicable
MIPS Quality ID 065
Description

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order
Initial Population

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older
Numerator

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions

Not Applicable
Denominator

Equals Initial Population
Denominator Exclusions

Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.

Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter.

Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date.

Exclude URI episodes when the patient had hospice care for any part of the measurement period.
Denominator Exceptions

None
Steward National Committee for Quality Assurance
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality
Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
Telehealth Eligible Yes
Next Version
CMS154v12
Previous Version
CMS154v10

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Measure Information 2021 Performance Period 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI)
CMS eCQM ID CMS154v9 CMS154v10 CMS154v11 CMS154v12
NQF Number Not Applicable Not Applicable Not Applicable Not Applicable
Description

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order
Initial Population

Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older

Outpatient visits, telephone visits, online assessments (i.e., e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older
Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Equals Initial Population
Denominator Exclusions Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care overlapping with the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. Exclude URI episodes when the patient had hospice care for any part of the measurement period.Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date.Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date.
Numerator

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or three days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Not Applicable
Denominator Exceptions

None

None

None

None
Measure Steward National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance
Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality
Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is a episode-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.

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

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

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

This is an episode of care measure that examines all eligible episodes for the patient.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection from January 1 to December 28 of the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID 065 065 065 065
Telehealth Eligible Yes Yes Yes Yes
Next Version CMS154v10 CMS154v11 CMS154v12 No Version Available
Previous Version No Version Available
CMS154v9
CMS154v10
CMS154v11
Notes
Download XML
Download CSV
Specifications
Attachment Size
CMS154v11.html 78.03 KB
CMS154v11.zip 83.89 KB
CMS154v11-TRN.xlsx 22.51 KB

Data Element Repository

Value Sets
Value Sets to be used with CMS154v11
CMS154v11-TRN.xlsx

Header

  • Revised the description to use 'order' instead of 'dispense' to align with the measure logic.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the clinical recommendation statement based on literature review.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Updated the denominator exclusion language to align with the measure logic.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-4749

  • Updated grammar and punctuation to improve readability.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Revised the logic to exclude patients with an antibiotic that is active before the encounter but is still active the same day of the encounter date.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-4749

  • Added QDM datatypes Encounter, Performed and Assessment, Performed and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429).

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical 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/Technical Update

  • Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v4.0.000.

    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.

  • Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Added 136 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 55 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 ICD-10-CM code (A04.7) based on validity of code during timing of look back period.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added 8 SNOMED CT codes (1092771000119104, 1144499001, 1149259003, 1153413001, 1153415008, 15984271000119108, 16016231000119109, 16016311000119107) based on review by technical experts, SMEs, and/or public feedback. Deleted 9 SNOMED CT codes (266355005, 77690003, 34320001, 186231006, 203271005, 25042006, 418750009, 59190009, 724502006) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 11 RxNorm codes (1291986, 1650198, 1809083, 2099768, 2122343, 309042, 351121, 757968, 758019, 853019, 861416) based on review by technical experts, SMEs, and/or public feedback. Deleted 94 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1026): Renamed to Preventive Care Services Individual Counseling based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1002): Renamed to Initial Hospital Observation Care based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1023): Renamed to Preventive Care Services Initial Office Visit, 18 and Up based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1025): Renamed to Preventive Care Services Established Office Visit, 18 and Up based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1027): Renamed to Preventive Care Services Group Counseling based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: May 02, 2023