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Safe Use of Opioids - Concurrent Prescribing

Compare Versions of: "Safe Use of Opioids - Concurrent Prescribing"

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.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

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Table Options
Measure Information 2025 Reporting Period
Title Safe Use of Opioids - Concurrent Prescribing
CMS eCQM ID CMS506v7
CBE ID* 3316e
Measure Steward Centers for Medicare & Medicaid Services (CMS)
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

Measure Scoring Proportion measure
Measure Type Process
Stratification

None

Risk Adjustment

None

Rationale

Unintentional opioid overdose fatalities have become a major public health concern in the United States (Rudd et al., 2016). Reducing the number of unintentional overdoses has become a priority for numerous federal organizations including, but not limited to, the Centers for Disease...

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Clinical Recommendation Statement

The CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 recommends that clinicians should:

- “[Use strategies minimizing] opioid use…for both opioid-naïve and opioid-tolerant patients with acute pain when possible. If patients receiving long-term opioid...

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Improvement Notation

Improvement noted as a decrease in the rate

Definition

For the purpose of this measure, the following are defined as:

- Opioid: Schedule II, III and IV Opioid Medications that do not include naloxone.

- Benzodiazepine: Schedule IV benzodiazepine medications.

- Medications for Opioid Use Disorder: Methadone, buprenorphine and buprenorphine in...

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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...

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Initial Population

Inpatient hospitalizations 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

Equals Initial Population

Denominator Exclusions

Inpatient hospitalizations where patients have cancer pain that begins prior to or during the encounter or are ordered or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department...

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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

Next Version No Version Available
Previous Version
Specifications

There is a known issue on CMS506v7. See issue EKI-31 on the ONC eCQM Known Issues Dashboard for details.

Header

  • Updated the eCQM version number.

    Measure Section:

    eCQM Version Number

    Source of Change:

    Annual Update

  • Changed all references from NQF to CBE to identify the consensus-based entity role.

    Measure Section:

    CBE Number

    Source of Change:

    Annual Update

  • Updated copyright.

    Measure Section:

    Copyright

    Source of Change:

    Annual Update

  • Added definition of schedule IV opioids to reflect the new group of applicable opioids for measure criteria.

    Measure Section:

    Definition

    Source of Change:

    Expert Work Group Review

  • Updated header definition to include 'Medications for Opioid Use Disorder: Methadone, buprenorphine and buprenorphine in combination with naloxone' to align with measure updates.

    Measure Section:

    Definition

    Source of Change:

    Measure Lead

  • Added exclusion for patients who left against medical advice to reduce potential burden.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    ONC Project Tracking System (JIRA): CQM-4418

  • Added exclusion for patients with opioid use disorder or taking medications for opioid use disorder because use of concurrent opioids at discharge could be important for ongoing care.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added exclusion for patients with sickle cell disease (SCD) or patients with SCD in crisis to align with the CDC guidelines for prescribing opioids.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Updated language in the Denominator Exclusions to align with the addition of the 'Cancer Related Pain' value set, which replaced the 'All Primary and Secondary Cancer' value set.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Updated references and measure header to reflect current evidence and new or updated literature.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

Logic

  • Replaced 'All Primary and Secondary Cancer' value set with 'Cancer Related Pain' value set.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added exclusion for patients with opioid use disorder or taking medications for opioid use disorder because use of concurrent opioids at discharge could be important for ongoing care.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added exclusion for patients with sickle cell disease (SCD) or patients with SCD in crisis to align with the CDC guidelines for prescribing opioids.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added 'day of' to measure logic to improve precision in timing.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added exclusion for patients who left against medical advice to reduce potential burden.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    ONC Project Tracking System (JIRA): CQM-4418

  • Added 'day of' to measure logic to improve precision in timing.

    Measure Section:

    Numerator

    Source of Change:

    Measure Lead

  • Added schedule IV opioids to reflect the new group of applicable opioids for measure criteria.

    Measure Section:

    Numerator

    Source of Change:

    Expert Work Group Review

  • Updated Numerator logic by removing the second reference to inpatient encounters, so that there is no longer repetition of the numerator population, and data from different encounters is not pulled in.

    Measure Section:

    Numerator

    Source of Change:

    Measure Lead

  • Added schedule IV opioids to reflect the new group of applicable opioids for measure criteria.

    Measure Section:

    Definitions

    Source of Change:

    Expert Work Group Review

  • Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.

    Measure Section:

    Definitions

    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:

    Definitions

    Source of Change:

    Standards/Technical Update

  • 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.'

    Measure Section:

    Definitions

    Source of Change:

    Annual Update

  • 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.'

    Measure Section:

    Functions

    Source of Change:

    Annual 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.

  • Replaced value set All Primary and Secondary Cancer (2.16.840.1.113762.1.4.1111.161) with value set Cancer Related Pain (2.16.840.1.113762.1.4.1111.180) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Left Against Medical Advice (2.16.840.1.113883.3.117.1.7.1.308) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Medications for Opioid Use Disorder (MOUD) (2.16.840.1.113762.1.4.1046.269) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Opioid Medication Assisted Treatment (MAT) (2.16.840.1.113762.1.4.1111.177) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Opioid Use Disorder (2.16.840.1.113762.1.4.1111.171) based on change in measure requirements/measure specification.

    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

  • Replaced value set Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165) with value set Schedule II, III and IV Opioid Medications (2.16.840.1.113762.1.4.1046.241) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Value set Schedule IV Benzodiazepines (2.16.840.1.113762.1.4.1125.1): Added 1 RxNorm code (2383946) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Sickle Cell Disease with and without Crisis (2.16.840.1.113762.1.4.1111.175) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

Last Updated: Jan 31, 2025