Use of High-Risk Medications in Older Adults

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Measure Information	2022 Performance Period	2023 Performance Period	2024 Performance Period	2025 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	CMS156v10	CMS156v11	CMS156v12	CMS156v13
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).	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).
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process	Process
Stratification	*See CMS156v10.html	*See CMS156v11-v2.html	None	None
Risk Adjustment	*See CMS156v10.html	*See CMS156v11-v2.html	None	None
Rationale	*See CMS156v10.html	*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).	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).
Clinical Recommendation Statement	*See CMS156v10.html	*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.	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.
Improvement Notation	Lower score indicates better quality	Lower score indicates better quality	Lower score indicates better quality	Lower score indicates better quality
Definition	*See CMS156v10.html	*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.	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.
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.	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.
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	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 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.	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).	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	Not Applicable
Denominator Exceptions	None	None	None	None
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS156v11	CMS156v12	CMS156v13	No Version Available
Previous Version	No Version Available	CMS156v10	CMS156v11	CMS156v12

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CMS156v13-TRN.xlsx

Header

Updated the eCQM version number.
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eCQM Version Number
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Changed all references from NQF to CBE to identify the consensus-based entity role.
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CBE Number
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Updated copyright.
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Copyright
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Updated language to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria.
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Clinical Recommendation Statement
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Measure Lead
Updated language to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria.
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Reference
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Updated grammar, wording, and/or formatting to improve readability and consistency.
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Updated references and measure header to reflect current evidence and new or updated literature.
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Logic

Updated the version number of the Palliative Care Exclusion Library to v4.0.000 and the library name from 'PalliativeCareExclusionECQM' to 'PalliativeCareQDM.'
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Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
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Updated the version number of the Hospice Library to v6.0.000 and the library name from 'Hospice' to 'HospiceQDM.'
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Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.
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Updated the following definitions to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria: 'Antipsychotic Index Prescription Start Date', 'Benzodiazepine Index Prescription Start Date', 'High Risk Medications with Average Daily Dose Criteria', 'More than One Antipsychotic Order', 'More than One Benzodiazepine Order', 'Same High Risk Medications Ordered on Different Days', and 'Two High Risk Medications with Prolonged Duration.'
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Updated the value set name for 'Online Assessments' to 'Virtual Encounter' for a more accurate description.
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Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
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Functions
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Updated the following functions to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria: 'MedicationStrengthPerUnit.'
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Functions
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Updated the version number of the Cumulative Medication Duration Library to v3.0.000 and the library name from 'CumulativeMedicationDuration' to 'CumulativeMedicationDurationQDM.'
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Functions
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Value Set

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

Removed ICD-9 extensional value sets from select grouping value sets, leaving codes from active terminologies (ICD-10 and SNOMED), to reduce implementer burden.
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Value set Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240): Added 3 SNOMED CT codes (86013001, 90526000, 866149003) based on review by technical experts, SMEs, and/or public feedback. Added 1 HCPCS code (G0402) based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Antihistamines for Older Adults (2.16.840.1.113883.3.464.1003.1043): Added 45 RxNorm codes based on review by technical experts, SMEs, and/or public feedback. Deleted 103 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Gastrointestinal Antispasmodics for Older Adults (2.16.840.1.113883.3.464.1003.1050): Added 1 RxNorm code (2637557) based on review by technical experts, SMEs, and/or public feedback. Deleted 8 RxNorm codes (1111171, 1190793, 198165, 198207, 312104, 312107, 314088, 403914) based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Benzodiazepines for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1522): Added 4 RxNorm codes (1366192, 199450, 246172, 427538) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 RxNorm codes (1298088, 1298091, 198183) based on review by technical experts, SMEs, and/or public feedback.
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Value set Benzodiazepine Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1208): Deleted 1 SNOMED CT code (10028000) based on review by technical experts, SMEs, and/or public feedback.
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Value set Bipolar Disorder (2.16.840.1.113883.3.67.1.101.1.128): Deleted 40 ICD-9-CM codes based on applicability of value set and/or OID.
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Removed value set Cardiovascular, alpha agonists, central (2.16.840.1.113883.3.464.1003.1052) based on review by technical experts, SMEs, and/or public feedback.
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Value set Nifedipine Medications (2.16.840.1.113883.3.464.1003.1053): Deleted 4 RxNorm codes (309958, 309960, 636793, 636794) based on review by technical experts, SMEs, and/or public feedback.
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Value set Care Services in Long Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014): Deleted 9 CPT codes (99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337) based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Antidepressants for Older Adults (2.16.840.1.113883.3.464.1003.1054): Deleted 5 RxNorm codes (313496, 313498, 313499, 905168, 905172) based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Barbiturates for Older Adults (2.16.840.1.113883.3.464.1003.1055): Added 6 RxNorm codes (198150, 2624719, 2671204, 2671207, 328176, 96304) based on review by technical experts, SMEs, and/or public feedback. Deleted 4 RxNorm codes (1251614, 238090, 308170, 312914) based on review by technical experts, SMEs, and/or public feedback.
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Replaced value set Central nervous system, vasodilators (2.16.840.1.113883.3.464.1003.1056) with direct reference code RxNorm code (318179) based on applicability of a single code to represent clinical data.
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Terminology
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Value set (2.16.840.1.113883.3.464.1003.1060): Renamed to Desiccated Thyroid Medications based on recommended value set naming conventions.
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Value set Digoxin Medications (2.16.840.1.113883.3.464.1003.1065): Deleted 1 RxNorm code (1441565) based on review by technical experts, SMEs, and/or public feedback.
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Value set (2.16.840.1.113883.3.464.1003.1065): Renamed to Digoxin Medications based on recommended value set naming conventions.
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Value set (2.16.840.1.113883.3.464.1003.1051): Renamed to Dipyridamole Medications based on recommended value set naming conventions.
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Value set (2.16.840.1.113883.3.464.1003.1067): Renamed to Doxepin Medications based on recommended value set naming conventions.
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Terminology
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Annual Update
Value set Desiccated Thyroid Medications (2.16.840.1.113883.3.464.1003.1060): Deleted 4 RxNorm codes (577154, 860215, 860221, 860225) based on review by technical experts, SMEs, and/or public feedback.
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Value set Potentially Harmful Sulfonylureas for Older Adults (2.16.840.1.113883.3.464.1003.1059): Deleted 2 RxNorm codes (197495, 197496) based on review by technical experts, SMEs, and/or public feedback.
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Value set Generalized Anxiety Disorder (2.16.840.1.113883.3.464.1003.105.12.1210): Added 2 SNOMED CT codes (268669006, 71959007) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (238976006) based on review by technical experts, SMEs, and/or public feedback.
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Source of Change:
Measure Lead
Added value set Guanfacine Medications (2.16.840.1.113883.3.464.1003.196.11.1252) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Deleted 1 CPT code (99343) 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): Added 2 SNOMED CT codes (170935008, 170936009) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (385765002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Added value set Megestrol Medications (2.16.840.1.113883.3.464.1003.1247) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Added value set Meperidine Medications (2.16.840.1.113883.3.464.1003.1248) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1057): Renamed to Meprobamate Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1053): Renamed to Nifedipine Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Deleted 1 CPT code (99318) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Deleted 2 SNOMED CT codes (30346009, 37894004) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 CPT code (99201) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Virtual Encounter (2.16.840.1.113883.3.464.1003.101.12.1089): Deleted 2 CPT codes (98969, 99444) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 HCPCS codes (G2061, G2062, G2063) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Potentially Harmful Pain Medications for Older Adults (2.16.840.1.113883.3.464.1003.1063): Deleted 18 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Potentially Harmful Skeletal Muscle Relaxants for Older Adults (2.16.840.1.113883.3.464.1003.1062): Added 1 RxNorm code (2627781) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 RxNorm code (197945) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090): 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 (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1054): Renamed to Potentially Harmful Antidepressants for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1043): Renamed to Potentially Harmful Antihistamines for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1481): Renamed to Potentially Harmful Antiinfectives for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Antiinfectives for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1481): Added 1 RxNorm code (422434) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1049): Renamed to Potentially Harmful Antiparkinsonian Agents for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1523): Renamed to Potentially Harmful Antipsychotics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Antipsychotics for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1523): Added 9 RxNorm codes (2636033, 2636041, 2636043, 2636045, 2636047, 2636049, 2636051, 2636637, 2636645) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1055): Renamed to Potentially Harmful Barbiturates for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1522): Renamed to Potentially Harmful Benzodiazepines for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1058): Renamed to Potentially Harmful Estrogens for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Estrogens for Older Adults (2.16.840.1.113883.3.464.1003.1058): Added 1 RxNorm code (2632844) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1050): Renamed to Potentially Harmful Gastrointestinal Antispasmodics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1480): Renamed to Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1480): Added 1 RxNorm code (2637353) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1063): Renamed to Potentially Harmful Pain Medications for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1062): Renamed to Potentially Harmful Skeletal Muscle Relaxants for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1059): Renamed to Potentially Harmful Sulfonylureas for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Removed value set Reserpine (2.16.840.1.113883.3.464.1003.1044) 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 4 ICD-10-CM codes (G40.C01, G40.C09, G40.C11, G40.C19) based on review by technical experts, SMEs, and/or public feedback. Added 5 SNOMED CT codes (1231737000, 1237417007, 1237619001, 1254960008, 80651009) based on review by technical experts, SMEs, and/or public feedback. Deleted 13 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set (2.16.840.1.113883.3.464.1003.101.12.1089): Renamed to Virtual Encounter based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Removed direct reference code RxNorm code (1441565) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Removed direct reference code RxNorm code (198196) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Removed direct reference code RxNorm code (198197) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead