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Use of High-Risk Medications in Older Adults

Compare Versions of: "Use of High-Risk Medications in Older Adults"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

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Measure Information 2022 Performance Period 2023 Performance Period 2024 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
CMS eCQM ID CMS156v10 CMS156v11 CMS156v12
NQF Number Not Applicable Not Applicable Not Applicable
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).

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).

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).

Initial Population

Patients 65 years and older 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

Denominator Exclusions Exclude patients who are in hospice care for any part of the measurement period.Exclude patients receiving palliative care during 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.

Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines).

Total rate (the sum of the two previous numerators, deduplicated).

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).

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).

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 Index Prescription Start Date (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.

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.

Not Applicable

Denominator Exceptions

None

None

None

Measure Steward National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Lower score indicates better quality

Lower score indicates better quality

Lower score indicates better quality

Guidance

The intent of the measure is to assess if the patient has been ordered at least two of the same high-risk medication prescriptions from the same medication 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 for them.

This eCQM is a patient-based measure.

 

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

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.

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.

MIPS Quality ID 238 238 238
Telehealth Eligible Yes Yes Yes
Next Version No Version Available
Previous Version No Version Available
Notes

*There is a known issue on CMS156v10. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details.

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

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Removed the Numerator Exclusions criterion and converted to a Numerator negative inclusion criterion for the second population rate based on vendor feedback and measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Removed the Numerator Exclusions criterion and converted to a Numerator negative inclusion criterion for the second population rate based on vendor feedback and measure intent.

    Measure Section: Numerator Exclusions

    Source of Change: Measure Lead

Logic

  • Removed the Numerator Exclusions criterion and converted to a Numerator negative inclusion criterion for the second population rate based on vendor feedback and measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Removed the Numerator Exclusions criterion and converted to a Numerator negative inclusion criterion for the second population rate based on vendor feedback and measure intent.

    Measure Section: Numerator Exclusions

    Source of Change: Measure Lead

  • Updated the version number of the Palliative Care Exclusion ECQM Library to v3.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the version number of the Cumulative Medication Duration Library to v2.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Replaced direct reference code 'Encounter with palliative care' with 'Palliative Care Diagnosis' value set in the PalliativeCare.Has Palliative Care in the Measurement Period definition to organize capture of patients receiving palliative care, per standards expert input.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added QDM datatype 'Diagnosis' to the Hospice.'Has Hospice Services' definition referencing a new value set containing SNOMED finding codes to provide an additional approach for identifying patients receiving hospice care.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'day of' specificity to the palliative care expressions for consistency.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'day of' specificity to hospice expressions for consistency.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Condensed relevant definitions into 'First Antipsychotic Medication Ordered' and 'First Benzodiazepine Medication Ordered' for simplification and improved readability.

    Measure Section: Definitions

    Source of Change: Measure Lead

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

    Measure Section: Definitions

    Source of Change: Standards/Technical Update

  • Updated the version number of the Palliative Care Exclusion ECQM Library to v3.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

  • Updated the version number of the Cumulative Medication Duration Library to v2.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

  • Updated the 'CodeToDaily' function so that highest dose is calculated consistently.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated numerator to capture patients with two orders of the same high-risk medication placed on the same day but with different start dates to meet measure intent.

    Measure Section: Functions

    Source of Change: Expert Work Group Review

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Replaced direct reference code ICD-10-CM code (Z51.5) with value set Palliative Care Diagnosis (2.16.840.1.113883.3.464.1003.1167) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Anticholinergics, first generation antihistamines (2.16.840.1.113883.3.464.1003.1043): Added 13 RxNorm codes based on review by technical experts, SMEs, and/or public feedback. Deleted 4 RxNorm codes (1116173, 1245374, 359329, 860151) 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): Deleted 1 RxNorm code (1791691) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Antispasmodics (2.16.840.1.113883.3.464.1003.1050): Deleted 2 RxNorm codes (1048147, 1598634) 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 2 RxNorm codes (2594600, 2608698) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Benzodiazepine Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1208): Deleted 1 SNOMED CT code (361150008) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1157) with value set Bipolar Disorder (2.16.840.1.113883.3.67.1.101.1.128) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Central nervous system, barbiturates (2.16.840.1.113883.3.464.1003.1055): Deleted 1 RxNorm code (1048147) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Endocrine system, estrogens with or without progestins (2.16.840.1.113883.3.464.1003.1058): Deleted 1 RxNorm code (728118) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Deleted 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003): Added 2 SNOMED CT codes (305911006, 385765002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089): Added 4 CPT codes (98980, 98981, 99444, 99457) based on review by technical experts, SMEs, and/or public feedback. Added 3 HCPCS codes (G2250, G2251, G2252) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Ophthalmologic Services (2.16.840.1.113883.3.464.1003.101.11.1206) with value set Ophthalmological Services (2.16.840.1.113883.3.526.3.1285) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set Other Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1204) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Pain medications, skeletal muscle relaxants (2.16.840.1.113883.3.464.1003.1062): Added 1 RxNorm code (2611794) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135): Deleted 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 Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Schizophrenia (2.16.840.1.113883.3.464.1003.105.12.1205): Added 1 SNOMED CT code (1204417003) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (191530008, 191538001, 191539009) 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 21 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024