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  2. CQM-3216

Medication measures for eCQMs

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      Thank you for your inquiry. The drug ingredient, strength and dose form should be taken into account when determining whether or not the measure criteria are met. The strength and dose form may have clinical significance and are considered when determining which drugs are included in the value set. In addition, whether or not the specific strength and dose form is available to be prescribed during the measurement period is considered. Fluoxetine 15 mg was identified as a non-prescribable medication and removed from the value set during the 2017 Coding Addendum. Therefore, this would dosage would not meet the follow-up requirements of the measure. For CMS2, in order to meet the numerator requirements, positive screening results should lead to a follow up plan, which the specification defines (definitions) as including one of the following options:
      - Additional evaluation for depression
      - Suicide Risk Assessment
      - Referral to a practitioner who is qualified to diagnose and treat depression
      - Pharmacological interventions
      - Other interventions or follow-up for the diagnosis or treatment of depression.
       
      If the provider chooses a pharmacological intervention, the appropriate medication and dosage must be selected from the appropriate provided depression medication value set:
       
      - Adolescent (2.16.840.1.113883.3.600.469)
      - Adult (2.16.840.1.113883.3.600.470)
       
      The dosage is of importance to meet the numerator, not the frequency of administration. In your example, Fluoxetine 40 mg as the intervention would meet the follow up requirements of the measure.
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      Thank you for your inquiry. The drug ingredient, strength and dose form should be taken into account when determining whether or not the measure criteria are met. The strength and dose form may have clinical significance and are considered when determining which drugs are included in the value set. In addition, whether or not the specific strength and dose form is available to be prescribed during the measurement period is considered. Fluoxetine 15 mg was identified as a non-prescribable medication and removed from the value set during the 2017 Coding Addendum. Therefore, this would dosage would not meet the follow-up requirements of the measure. For CMS2, in order to meet the numerator requirements, positive screening results should lead to a follow up plan, which the specification defines (definitions) as including one of the following options: - Additional evaluation for depression - Suicide Risk Assessment - Referral to a practitioner who is qualified to diagnose and treat depression - Pharmacological interventions - Other interventions or follow-up for the diagnosis or treatment of depression.   If the provider chooses a pharmacological intervention, the appropriate medication and dosage must be selected from the appropriate provided depression medication value set:   - Adolescent (2.16.840.1.113883.3.600.469) - Adult (2.16.840.1.113883.3.600.470)   The dosage is of importance to meet the numerator, not the frequency of administration. In your example, Fluoxetine 40 mg as the intervention would meet the follow up requirements of the measure.
    • High Impacting question with medication measures.

      We have noticed instances where there are medications listed in the value set that provide certain strengths as a part of the value set list however, is deleting same medication with different strength. We would like to get the clarification on what is the expectation from CMS as far as counting the medications for a measure is concerned. Please see below example: 

      A patient has been taking medication Fluoxetine 15 MG Oral Tablet which is in the medical record of the patient and counts towards numerator of CMS2 measure. This medication was part of the initial value set that was released on 05/05/2017 and was removed from the value set when 2018 addendum came out on 09/29/2017. Now in this scenario, the patient was technically on Fluoxetine , however since the strength of the medication that patient is taking is removed, should this patient count towards the numerator of the measure or against the numerator of the measure. Please provide the intent when it comes to calculation of measures in such scenario. 

      We are also getting questions on certain scenarios where providers are prescribing a medication with 40 mg strength, that the patient is supposed to take twice a day, making the cumulative strength 80 mg. However, if the value set is only including 40 mg and not 80 mg, how should this type of situation be handled?? Should we count the patient as meeting the measure requirement because the medication is prescribed?? or Should we NOT COUNT the patient as meeting the measure requirement as 80 mg strength is not part of the value set?? 

            edave Mathematica EC eCQM Team
            saileshdixit Sailesh
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