Brief Description of Measure:
​CMS249: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture:
Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

Description of Issue:
​​This measure currently uses ​the value set "Average Number of Drinks per Drinking Day (OID: 2.16.840.1.113883.3.464.1003.106.12.1018)", which contains a single code. To align with best practices, we propose to replace this single-code value set with a LOINC direct reference code (DRC) of 11287-0 - 'Alcoholic drinks per drinking day - Reported'.

Proposed Solution:
​//Terminology

//Before
valueset "Average Number of Drinks per Drinking Day": 'urn:oid:2.16.840.1.113883.3.464.1003.106.12.1018'

//After
code "Alcoholic drinks per drinking day - Reported": '11287-0' from "LOINC" display 'Alcoholic drinks per drinking day - Reported'

//Logic

//Before
define "First Average Number of Drinks Assessments Indicating More Than Two Per Day":
...(["Assessment, Performed": "Average Number of Drinks per Drinking Day"] AverageDrinks
   ...

//After
...(["Assessment, Performed": "Alcoholic drinks per drinking day - ReportedAverage Number of Drinks per Drinking Day"] AverageDrinks
    ...

Rationale for Change:
The eCQM Logic and Guidance v5 (May 2021) Section 5.3 states, "the use of direct reference codes prevents using an alternative identifier for a code system concept and eliminates additional implementation work to unpack the value set". 
Therefore, we propose to replace the value set "Average Number of Drinks per Drinking Day (2.16.840.1.113883.3.464.1003.106.12.1018)" with a DRC to align with current best practices.