Use of High-Risk Medications in Older Adults

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period	2026 Performance Period
Title	Use of High-Risk Medications in Older Adults	Use of High-Risk Medications in Older Adults	Use of High-Risk Medications in Older Adults	Use of High-Risk Medications in Older Adults
CMS eCQM ID	CMS156v11	CMS156v12	CMS156v13	CMS156v14
CBE ID*	Not Applicable	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	238	238	238	238
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Description	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2.... Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show more > Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show less	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2.... Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show more > Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show less	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2.... Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show more > Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show less	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2.... Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show more > Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Show less
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process	Process
Stratification	*See CMS156v11-v2.html	None	None	None
Risk Adjustment	*See CMS156v11-v2.html	None	None	None
Rationale	*See CMS156v11-v2.html	Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005).... Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show more > Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show less	Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005).... Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show more > Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show less	Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005).... Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show more > Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020). Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009). Show less
Clinical Recommendation Statement	*See CMS156v11-v2.html	The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an... updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show more > The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show less	The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in... 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show more > The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show less	The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in... 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show more > The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria. Show less
Improvement Notation	Lower score indicates better quality	Lower score indicates better quality	Lower score indicates better quality	Lower score indicates better quality
Definition	*See CMS156v11-v2.html	Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and... for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show more > Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show less	Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and... for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show more > Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show less	Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and... for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show more > Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following: a. A prescription for medications classified as high risk at any dose and for any duration. b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply. c. A prescription for medications classified as high risk exceeding average daily dose criteria. An order is identified by either a prescription order or a prescription refill. Show less
Guidance	The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a... high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a... high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a... high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a... high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less
Initial Population	Patients 65 years and older at the end of the measurement period who had a visit during the measurement period	Patients 65 years and older at the end of the measurement period who had a visit during the measurement period	Patients 65 years and older at the end of the measurement period who had a visit during the measurement period	Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
Numerator	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater... than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days. Total rate (the sum of the two previous numerators, deduplicated). Show more > Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days. Total rate (the sum of the two previous numerators, deduplicated). Show less	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater... than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show more > Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show less	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater... than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show more > Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show less	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater... than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show more > Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Total rate (the sum of the two previous numerators, deduplicated). Show less
Numerator Exclusions	Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. For... patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Show more > Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines. Show less	Not Applicable	Not Applicable	None
Denominator Exceptions	None	None	None	None
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS156v12	CMS156v13	CMS156v14	No Version Available
Previous Version	No Version Available	CMS156v11	CMS156v12	CMS156v13

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Specifications

There is a known issue on CMS156v11. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details.

Additional Resources for CMS156v11

CMS156v11-TRN-v2.xlsx

Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated the rationale to provide more recent evidence to support the measure.
Measure Section: Rationale
Source of Change: Measure Lead
Added language to the clinical recommendation statement to clarify measure intent.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead
Updated references.
Measure Section: Reference
Source of Change: Measure Lead
Added definition for 'order' to allow an order to be identified as a prescription order or a prescription refill to meet the measure requirement of two orders.
Measure Section: Definition
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 guidance to clarify that at least two high-risk medications 'from the same drug class' are required, not 'two of the same high-risk medications'.
Measure Section: Guidance
Source of Change: Measure Lead
Revised the palliative care exclusion language to clarify the timing requirement.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Added detail within the definition, guidance, and numerator narrative to reflect the addition of high-risk average daily dose criteria to Numerator 1 based on clinical recommendations.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated grammar and punctuation to improve readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the narrative to define acronyms at first use to improve readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Logic

Added QDM datatype Diagnosis to provide an alternate approach for identifying patients receiving palliative care.
Measure Section: Definitions
Source of Change: Measure Lead
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
Updated logic and terminology to align with the measure intent to require at least two high-risk medications 'from the same drug class' as opposed to 'two of the same high-risk medications'.
Measure Section: Definitions
Source of Change: Measure Lead
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
Updated the measure to look for refills counting towards numerator compliance by updating the function More Than One Order, and to look for orders occurring on different dates rather than at least 24 hours apart.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Revised the medication duration calculation method by replacing the approach of counting days during a Medication Order relevantPeriod to the approach of counting Medication Order days supply, which captures the medication duration more accurately.
Measure Section: Multiple Sections
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 Palliative Care Exclusion Library to v2.0.000.
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
Added Cumulative Medication Duration Library v1.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
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
Added logic and terminology to reflect the addition of high-risk average daily dose criteria to Numerator 1 based on clinical recommendations.
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 Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135): Added 3 SNOMED CT codes (305686008, 305824005, 441874000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Antipsychotic (2.16.840.1.113883.3.464.1003.196.12.1523): Added 8 RxNorm codes (2570392, 2570399, 2570402, 2570405, 2570418, 2570420, 991053, 991332) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Benzodiazepine (2.16.840.1.113883.3.464.1003.196.12.1522): Added 10 RxNorm codes (197653, 197654, 198183, 198317, 198318, 2541170, 2541171, 2569564, 2569573, 2569577) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Seizure Disorder (2.16.840.1.113883.3.464.1003.105.12.1206): Added 3 SNOMED CT codes (191714002, 230455006, 322112361000132104) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (68448003, 192992007, 77450009) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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
Added direct reference code RxNorm code (1000048) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000064) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000058) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Triprolidine (2.16.840.1.113883.3.464.1003.196.12.1408) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000070) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000076) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000097) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1000054) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Trimipramine (2.16.840.1.113883.3.464.1003.196.12.1285) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Methyldopa (2.16.840.1.113883.3.464.1003.196.12.1331) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Secobarbital (2.16.840.1.113883.3.464.1003.196.12.1521) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Scopolamine (2.16.840.1.113883.3.464.1003.196.12.1520) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Pyrilamine (2.16.840.1.113883.3.464.1003.196.12.1524) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Protriptyline (2.16.840.1.113883.3.464.1003.196.12.1509) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Propantheline (2.16.840.1.113883.3.464.1003.196.12.1519) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Promethazine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1367) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Phenobarbital (2.16.840.1.113883.3.464.1003.196.12.1348) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Pentobarbital (2.16.840.1.113883.3.464.1003.196.12.1518) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Paroxetine (2.16.840.1.113883.3.464.1003.196.12.1508) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Orphenadrine (2.16.840.1.113883.3.464.1003.196.12.1302) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Nortriptyline (2.16.840.1.113883.3.464.1003.196.12.1507) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Nifedipine (2.16.840.1.113883.3.464.1003.196.12.1353) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (104208) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Trihexyphenidyl (2.16.840.1.113883.3.464.1003.196.12.1334) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (1441565) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (307468000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (197606) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396111001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (229799001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (229798009) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396107007) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396108002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396109005) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (229797004) 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
Added direct reference code SNOMED CT code (307439001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (225752000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396125000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (307470009) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396127008) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (225754004) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396126004) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396139000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Methscopolamine (2.16.840.1.113883.3.464.1003.196.12.1525) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396143001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (225756002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396131002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (396140003) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (307469008) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (966793) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (966787) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (393245) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (245273) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (204504) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (198197) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (198196) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code RxNorm code (197604) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Methocarbamol (2.16.840.1.113883.3.464.1003.196.12.1370) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Estropipate (2.16.840.1.113883.3.464.1003.196.12.1319) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Meprobamate (2.16.840.1.113883.3.464.1003.196.12.1284) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Carisoprodol (2.16.840.1.113883.3.464.1003.196.12.1369) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Carbinoxamine (2.16.840.1.113883.3.464.1003.196.12.1306) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Butalbital (2.16.840.1.113883.3.464.1003.196.12.1514) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Butabarbital (2.16.840.1.113883.3.464.1003.196.12.1402) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Brompheniramine (2.16.840.1.113883.3.464.1003.196.12.1427) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Benztropine (2.16.840.1.113883.3.464.1003.196.12.1361) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Atropine (2.16.840.1.113883.3.464.1003.196.12.1274) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Amoxapine (2.16.840.1.113883.3.464.1003.196.12.1273) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Amitriptyline Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1373) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Endocrine system, sulfonylureas, long duration (2.16.840.1.113883.3.464.1003.1059) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Central nervous system, other (2.16.840.1.113883.3.464.1003.1057) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Endocrine system, estrogens with or without progestins (2.16.840.1.113883.3.464.1003.1058) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Central nervous system, barbiturates (2.16.840.1.113883.3.464.1003.1055) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Central nervous system, vasodilators (2.16.840.1.113883.3.464.1003.1056) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Cardiovascular, other (2.16.840.1.113883.3.464.1003.1053) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Central nervous system, antidepressants (2.16.840.1.113883.3.464.1003.1054) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Antithrombotic (2.16.840.1.113883.3.464.1003.1051) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Cardiovascular, alpha agonists, central (2.16.840.1.113883.3.464.1003.1052) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Antispasmodics (2.16.840.1.113883.3.464.1003.1050) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Anticholinergics, anti Parkinson agents (2.16.840.1.113883.3.464.1003.1049) based on change in measure requirements/measure specification.
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
Added value set Reserpine (2.16.840.1.113883.3.464.1003.1044) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Anticholinergics, first generation antihistamines (2.16.840.1.113883.3.464.1003.1043) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Doxepin (2.16.840.1.113883.3.464.1003.1067) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Digoxin (2.16.840.1.113883.3.464.1003.1065) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Pain medications, skeletal muscle relaxants (2.16.840.1.113883.3.464.1003.1062) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Pain medications, other (2.16.840.1.113883.3.464.1003.1063) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Endocrine system, other (2.16.840.1.113883.3.464.1003.1060) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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
Removed value set Chlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1352) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Metaxalone (2.16.840.1.113883.3.464.1003.196.12.1358) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Chlorpropamide (2.16.840.1.113883.3.464.1003.196.12.1303) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Clemastine (2.16.840.1.113883.3.464.1003.196.12.1308) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Meperidine (2.16.840.1.113883.3.464.1003.196.12.1351) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Megestrol (2.16.840.1.113883.3.464.1003.196.12.1342) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Meclizine (2.16.840.1.113883.3.464.1003.196.12.1506) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1272) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Ketorolac Tromethamine (2.16.840.1.113883.3.464.1003.196.12.1364) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Isoxsuprine (2.16.840.1.113883.3.464.1003.196.12.1422) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Indomethacin (2.16.840.1.113883.3.464.1003.196.12.1366) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Imipramine (2.16.840.1.113883.3.464.1003.196.12.1359) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Hyoscyamine (2.16.840.1.113883.3.464.1003.196.12.1501) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Hydroxyzine (2.16.840.1.113883.3.464.1003.196.12.1374) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Guanfacine (2.16.840.1.113883.3.464.1003.196.12.1341) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Glyburide (2.16.840.1.113883.3.464.1003.196.12.1368) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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
Removed value set Estradiol (2.16.840.1.113883.3.464.1003.196.12.1365) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Esterified Estrogens (2.16.840.1.113883.3.464.1003.196.12.1419) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Doxylamine (2.16.840.1.113883.3.464.1003.196.12.1515) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Disopyramide (2.16.840.1.113883.3.464.1003.196.12.1311) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Dipyridamole (2.16.840.1.113883.3.464.1003.196.12.1349) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Diphenhydramine (2.16.840.1.113883.3.464.1003.196.12.1293) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Dimenhydrinate (2.16.840.1.113883.3.464.1003.196.12.1500) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Dicyclomine (2.16.840.1.113883.3.464.1003.196.12.1279) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Dexchlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1300) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Dexbrompheniramine (2.16.840.1.113883.3.464.1003.196.12.1375) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Desipramine (2.16.840.1.113883.3.464.1003.196.12.1278) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Desiccated Thyroid (2.16.840.1.113883.3.464.1003.196.12.1354) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Cyproheptadine (2.16.840.1.113883.3.464.1003.196.12.1277) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Cyclobenzaprine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1372) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Conjugated Estrogens (2.16.840.1.113883.3.464.1003.196.12.1357) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Clomipramine (2.16.840.1.113883.3.464.1003.196.12.1336) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Chlorzoxazone (2.16.840.1.113883.3.464.1003.196.12.1362) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code ICD-10-CM code (Z51.5) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead