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 is based on 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain, which refers clinicians to NIH National Heart, Lung, and Blood Institute’s Evidence Based Management of Sickle Cell Disease Expert Panel Report for management of SCD, indicating that the guidelines may not apply to patients with SCD.
The measure does not currently exclude patients with sickle cell disease (SCD) or patients with SCD in crisis.​
However, during measure development, we found that patients with a primary diagnosis of sickle cell disease comprised a very small portion of the numerator across sites, ranging from 0 percent to 3.4 percent. As a result, the measure expert work group members recommended not to exclude single conditions, such as patients with sickle cell disease. The experts agreed that these patients are still at elevated risk of an adverse drug event. Given this feedback, the additional burden to exclude these patients, and the minimal impact on the measure score, the measure team did not previously exclude patients with SCD.
We are seeking additional input on whether stakeholders prefer to align with CDC guidelines and exclude these patients or not. If the measure should exclude patients with SCD, should it exclude all patients diagnosed with SCD, or only patients diagnosed with SCD in crisis?

Proposed Solution:

​If deemed appropriate to exclude patients with sickle cell disease (SCD) or SCD in crisis from the denominator population, the following headers, value sets, and logic are proposed to be added to the measure:
Proposed denominator exclusion language - two options are presented depending on whether SCD or SCD in crisis would be added as an exclusion: 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, patients diagnosed with sickle cell disease, and patients who expire during the inpatient stay.​
OR 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, patients diagnosed with sickle cell disease in crisis, and patients who expire during the inpatient stay.​​
 
Proposed value sets:
Sickle Cell Disease (2018v) (TJC)  (OID: 2.16.840.1.113883.3.3157.1004.22)
Sickle Cell Disease with Crisis (2021v) (TJC) (OID: 2.16.840.1.113762.1.4.1029.355)  
 
Proposed logic:
"Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
   where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer

       where Cancer.prevalencePeriod overlaps InpatientEncounter.relevantPeriod   )

     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter

         where exists ( ["Diagnosis": "Sickle Cell Disease"] SickleCell

         where SickleCell.prevalencePeriod overlaps InpatientEncounter.relevantPeriod   )

Rationale for Change:

The measure developer seeks input on whether patients with SCD or SCD in crisis should be excluded from the measure. If so, please comment on the header, logic and value sets for exclusion.