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Safe Use of Opioids - Concurrent Prescribing

eCQMs for 2022 Reporting Period

General eCQM Information

CMS Measure ID CMS506v4
NQF Number 3316e
Measure 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 one or more new or continuing opioid or benzodiazepine at discharge
Denominator Statement

Initial Population

Denominator Exclusions

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 Statement

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 Type Process
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. 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.

Meaningful Measure Prevention and Treatment of Opioid and Substance Use Disorders

Release Notes

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Revised definition of opioid for brevity.

    Measure Section: Definition

    Source of Change: Measure Lead

  • ​Added guidance that each medication on the discharge list is considered unique for clarification.

    Measure Section: Guidance

    Source of Change: Annual Update

  • Added clarifying language to the guidance section of episode-based measures to define the episode.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Revised the Initial Population statement to clarify number of new or continuing opioids or benzodiazepines at discharge.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated Denominator Exclusions statement for patients discharged to another inpatient care facility or who expire during the inpatient stay to align with the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (Jira): CQM-4030

  • Revised denominator exclusion statement to clarify exclusion of patients with a cancer diagnosis that begins prior to or during the inpatient stay.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Added logic to Denominator Exclusions for patients with a discharge disposition to an acute facility or expired to align with the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (Jira): CQM-4030

  • Updated denominator exclusion logic for hospice care referral or admission at discharge.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (Jira): CQM-4073

  • ​Updated the Denominator exclusion logic to return the Encounter, Performed, to better align with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Annual Update

  • ​Updated Numerator logic to return distinct opioid codes to prevent counting an opioid multiple times.

    Measure Section: Numerator

    Source of Change: Annual Update

  • Updated Global.'Inpatient Encounter' definition by adding 'day of' to ensure all cases within the measurement period are captured and evaluated in the initial population.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated value set name to Schedule II & III Opioid Medications to avoid confusion with other opioid value sets.

    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 All Primary and Secondary Cancer (2.16.840.1.113762.1.4.1111.161): Added 75 SNOMED CT codes based on terminology update. Deleted 49 SNOMED CT codes based on terminology update and review by technical experts, SMEs, and/or public feedback. Removed ​SNOMED CT code 7403002 'Orthodontic (qualifier value)' that was erroneously included in the value set.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Schedule IV Benzodiazepines (2.16.840.1.113762.1.4.1125.1): Added 3 RxNorm codes (2272613, 2272626, 2272632) based on terminology update. Deleted 5 RxNorm codes (199275, 199975, 204892, 312133, 312135) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165): Added 14 RxNorm codes based on terminology update and review by technical experts, SMEs, and/or public feedback. Deleted 28 RxNorm codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added value sets Discharge To Acute Care Facility (2.16.840.1.113883.3.117.1.7.1.87) and Patient Expired (2.16.840.1.113883.3.117.1.7.1.309) to exclude patients discharged to an acute care facility or who expire prior to discharge to align with the measure intent.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-4030

  • Added value set Hospice Care Referral or Admission (2.16.840.1.113762.1.4.1116.365) to identify patients receiving palliative or hospice care for denominator exclusion.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-4073

  • Renamed value set Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165) to avoid confusion with other opioid value sets.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Dec 01, 2021