Brief description of measure: CMS506: Safe Use of Opioids - Concurrent Prescribing 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. Description of issue: The measure currently excludes patients who are receiving or have an order for palliative and hospice care. Several JIRA users ( CQM-4030 , CQM-3979 ) have noted that discharge disposition codes are the primary way clinicians indicate that a patient will receive hospice or palliative care and asked the eCQM team to add discharge disposition codes to the measure as an alternate way to capture this denominator exclusion. Goal of review: Obtain clinical and technical feedback.

Proposed solution: ​The eCQM team explored using discharge disposition codes to identify patients discharged to palliative or hospice care. However, upon review of the available coding that could be applied to the measure, as well as different terminologies that contain relevant coding, the existing tools for measure development do not support adding discharge disposition codes for palliative and hospice care. Alternatively, we could add the following SNOMEDCT codes indicating discharge or referral to discharge for hospice which organizations can map their disposition codes to:   - Referral to hospice (procedure) - 306205009   - Admission to hospice (procedure) - 305336008   - Urgent admission to hospice (procedure) - 183919006   - Routine admission to hospice (procedure) - 183920000   - Discharge to home for hospice care (procedure) - 428361000124107   - Discharge to healthcare facility for hospice care (procedure) - 428371000124100   - Admission to hospice for respite (procedure) - 183921001 The addition of these codes may serve as a suitable alternative, per the requests of the Jira inquiries received thus far. However, this will also introduce another way to capture palliative and hospice care that may not ncessarily align with how these concepts are represented in other measures. If the proposed change as noted above is deemed appropriate, additional logic would be added to the definition used to define the exclusion of patients receiving or who have an order for palliative or hospice care. Rationale for change: To provide for multiple ways to capture patients discharged to palliative or hospice care.