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Safe Use of Opioids - Concurrent Prescribing

Measure Information 2021 Reporting Period
CMS eCQM ID CMS506v3
NQF Number 3316e
Description

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

Initial Population

Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed a new or continuing opioid or benzodiazepine at discharge

Denominator

Initial Population

Denominator Exclusions

Inpatient hospitalizations where patients have cancer that overlaps the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter

Numerator

Inpatient hospitalizations where the patient is prescribed or continuing to take two or more opioids or an opioid and benzodiazepine at discharge

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

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

Improvement noted as a decrease in the rate

Guidance

Clinician judgement, clinical appropriateness, or both may indicate concurrent prescribing of two unique opioids or an opioid and benzodiazepine is medically necessary, thus the measure is not expected to have a zero rate.

Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population.

Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator.

This eCQM is an episode-based measure.

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

MIPS Quality ID
Meaningful Measure Prevention and Treatment of Opioid and Substance Use Disorders
Next Version
Previous Version No Version Available

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Measure Information 2021 Reporting Period 2022 Reporting Period 2023 Reporting Period
Title Safe Use of Opioids - Concurrent Prescribing Safe Use of Opioids - Concurrent Prescribing Safe Use of Opioids - Concurrent Prescribing
CMS eCQM ID CMS506v3 CMS506v4 CMS506v5
Short Name N/A
NQF Number 3316e 3316e 3316e
Description

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

Initial Population

Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed a new or continuing opioid or benzodiazepine at discharge

Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed one or more new or continuing opioid or benzodiazepine at discharge

Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed one or more new or continuing opioid or benzodiazepine at discharge

Denominator

Initial Population

Initial Population

Initial Population

Denominator Exclusions Inpatient hospitalizations where patients have cancer that overlaps the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay. Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay
Numerator

Inpatient hospitalizations where the patient is prescribed or continuing to take two or more opioids or an opioid and benzodiazepine at discharge

Inpatient hospitalizations where the patient is prescribed or continuing to take two or more opioids or an opioid and benzodiazepine at discharge

Inpatient hospitalizations where the patient is prescribed or continuing to take two or more opioids or an opioid and benzodiazepine at discharge

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator Exceptions

None

None

None

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

Improvement noted as a decrease in the rate

Improvement noted as a decrease in the rate

Improvement noted as a decrease in the rate

Guidance

Clinician judgement, clinical appropriateness, or both may indicate concurrent prescribing of two unique opioids or an opioid and benzodiazepine is medically necessary, thus the measure is not expected to have a zero rate.

Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population.

Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator.

This eCQM is an episode-based measure.

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

Clinician judgement, clinical appropriateness, or both may indicate concurrent prescribing of two unique opioids or an opioid and benzodiazepine is medically necessary, thus the measure is not expected to have a zero rate.

Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population.

Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator. Each benzodiazepine and opioid included on the medication discharge list is considered a unique prescription.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Clinician judgement, clinical appropriateness, or both may indicate concurrent prescribing of two unique opioids or an opioid and benzodiazepine is medically necessary, thus the measure is not expected to have a zero rate.

Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population.

Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator. Each benzodiazepine and opioid included on the medication discharge list is considered a unique prescription.

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

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

Meaningful Measure Prevention and Treatment of Opioid and Substance Use Disorders Prevention and Treatment of Opioid and Substance Use Disorders Prevention and Treatment of Opioid and Substance Use Disorders
Next Version CMS506v4 CMS506v5 No Version Available
Previous Version No Version Available

Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Standards Update

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

    Measure Section: Guidance

    Source of Change: Measure Lead

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

    Measure Section: Guidance

    Source of Change: Standards Update

Logic

  • Updated the denominator exclusions logic to reflect changes to the value sets by removing the Palliative Care extensional value set and the Hospice Care extensional value set and replacing them with the Palliative or Hospice Care grouping value set.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

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

    Measure Section: Multiple Sections

    Source of Change: Standards Update

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

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

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

    Measure Section: Terminology

    Source of Change: Measure Lead

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

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced extensional value set Schedule II and Schedule III Opioids (2.16.840.1.113762.1.4.1125.2) with a new grouping value set, Schedule II and III Opioid Medications (2.16.840.1.113762.1.4.1111.165), to harmonize with other measures where possible, and to exclude Schedule V opioids.

    Measure Section: Terminology

    Source of Change: Expert Work Group Review

  • Value set Schedule IV Benzodiazepines (2.16.840.1.113762.1.4.1125.1): Added 7 RxNorm codes (1807452, 1807459, 2120550, 2173494, 2058253, 2058254, 2058255) and deleted 4 RxNorm codes (199273, 199278, 199775, 618737) based on review by technical experts, SMEs, and/or public feedback and terminology updates to better capture relevant benzodiazepines.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Aug 29, 2022