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  1. eCQM Issue Tracker
  2. CQM-4926

Safe Use of Opioids Consult Orders/Clinical Events Question

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
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    • Peter Anderberg
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      Thank you for your question about eCQM CMS506v3 “Safe Use of Opioids-Concurrent Prescribing.” For the hospice and palliative care exclusion, a consultation or referral to palliative or hospice care is sufficient to exclude the patient from the denominator. We received a similar question in CQM-4426 and initially took the position that we would not include consults in exclusions, because as you said, a consult does not mean the patient received hospice or palliative care. However, we updated our answer to accept consultation for hospice and palliative care as an exclusionary event to align with how the STK-5/CMS72 measure handles hospice and palliative care exclusions. In addition to receipt of palliative or hospice care, the measure currently has an exclusion for an order or referral to palliative care, and an exclusion if a patient is discharged to hospice or discharged with a referral to hospice. Please see the highlighted logic below for clarification, and please let us know if you have any additional questions.​


       Denominator Exclusion


      /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/
      "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
        where exists

          or exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder
              where PalliativeOrHospiceCareOrder.authorDatetime during InpatientEncounter.relevantPeriod
          )
          or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
              where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"
                or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"
                or InpatientEncounter.dischargeDisposition in "Patient Expired"​
      Show
      Thank you for your question about eCQM CMS506v3 “Safe Use of Opioids-Concurrent Prescribing.” For the hospice and palliative care exclusion, a consultation or referral to palliative or hospice care is sufficient to exclude the patient from the denominator. We received a similar question in CQM-4426 and initially took the position that we would not include consults in exclusions, because as you said, a consult does not mean the patient received hospice or palliative care. However, we updated our answer to accept consultation for hospice and palliative care as an exclusionary event to align with how the STK-5/CMS72 measure handles hospice and palliative care exclusions. In addition to receipt of palliative or hospice care, the measure currently has an exclusion for an order or referral to palliative care, and an exclusion if a patient is discharged to hospice or discharged with a referral to hospice. Please see the highlighted logic below for clarification, and please let us know if you have any additional questions.​  Denominator Exclusion /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter   where exists     or exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder         where PalliativeOrHospiceCareOrder.authorDatetime during InpatientEncounter.relevantPeriod     )     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter         where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"           or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"           or InpatientEncounter.dischargeDisposition in "Patient Expired"​
    • CMS506v3/NQF3316e
    • False positives for Denominator Exclusion for patients receiving the "Consult To" Orderable/Clinical Event but not actually receiving the care associated to said order/event (Comfort Measures, Hospice, etc.).

      A client of mine noticed that within the value set for the safe use of opioids measure under Hospice and Palliative Care that Referrals are a part of said value set. Said Client has several "consult to" (Hospice, Palliative, and Comfort Measures) orderables/clinical Events that they would like to map for the denominator exclusion for the safe use of opioids measure. Client wants to know if based off of the referrals within the value set if these "consult to" orderables/clinical events are appropriate for the Denominator Exclusion for the safe use of opioids measure. Said "consult to" orderables and clinical events does not insure the patient receives the correlated care.

      In short can the orderable/clinical event be placed on the patient but the care not carried out and still fall into the denominator exclusion within the safe use of opioids measure of Hospice or Palliative care.

            JLeflore Mathematica EH eCQM Team
            pa061247 Peter K Anderberg III (Inactive)
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