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  2. CQM-2899

Possible deficiency of value set 2.16.840.1.113883.3.117.1.7.1.200 (Anticoagulant Therapy)

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    • ValueSet
    • Carlos Acosta
    • 787-504-5790
    • Sabiamed Corporation
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      ​Thank you for your question. You are correct, this value set does not contain the brand names medication codes, and that is intentional. The medication value sets developed for the program contain RxNorm codes that are Semantic Clinical Drugs (SCD) term type, generic, and prescribable. We explicitly exclude brand name drugs from the value sets. In order to satisfy the measure, you would need to map your local brand name drugs to an appropriate semantic clinical drug code found in the value set.
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      ​Thank you for your question. You are correct, this value set does not contain the brand names medication codes, and that is intentional. The medication value sets developed for the program contain RxNorm codes that are Semantic Clinical Drugs (SCD) term type, generic, and prescribable. We explicitly exclude brand name drugs from the value sets. In order to satisfy the measure, you would need to map your local brand name drugs to an appropriate semantic clinical drug code found in the value set.
    • CMS71v5/NQF0436
    • Possible understatement of Hospital Measured CMS-071 performance by entities evaluating submitted QRDA 1 files (CMS/Joint Comission).

      This issue/question is related to the contents of value set 2.16.840.1.113883.3.117.1.7.1.200 (Anticoagulant Therapy). That value set is involved in the logic that determines whether the patient is counted in the numerator (CMS-071). The issue we are seeing is that all medications included in the value set are "Generic drugs" and the RxNorm for the corresponding Brand drugs is not included in the value set. This will cause the calculated % Performance to be less that the real performance. For example, a patient given: Coumadin Oral Tablet 2 MG (RxNorm=855304) will not be included in the numerator, when Coumadin Oral Tablet 2 MG is equivalent to Warfarin Sodium 2 MG Oral Tablet (RxNorm=855302, which is contained within the value set). We believe this to be a deficiency within the Value Set definition itself and wanted to see whether this can be investigated or consulted with Joint Commission.

      Consult with Joint Commission re. possible deficiency of Value Set #2.16.840.1.113883.3.117.1.7.1.200, specifically whether the value set should be revised to include RxNorm codes for applicable brand drugs.

            JLeflore Mathematica EH eCQM Team
            cacosta Carlos Acosta (Inactive)
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