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EC eCQMs
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Resolution: Answered
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Moderate
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None
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We plan to move forward with the changes this annual update, with modifications based upon feedback.
Brief Description of Measure:
CMS156: Use of High-Risk Medications in Older Adults:
Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications.
Description of Issue:
The eCQM standards team raised concern with the current approach of using "Medication, Order" relevantPeriod to calculate days duration for cumulative medication duration because an order could have a start with no stop time, which may lead to overcalculation.
NCQA agrees with the recommendation from this team that the approach of considering "Medication, Order" days supply is more aligned with the intent. The intent is to identify patients who had at least two orders where summed days supply exceeds the days supply criteria. As such, NCQA proposes revising the approach to caluclate cumulcative medication duration to assess the sum of days supply across all orders.
Summed days supply is calculated using this formula:
daysSupplied*(1+refills)
In the event that daysSupplied is not available, derive from supply/(dosage*frequency), as recommended by QDM v5.6 guidance. If no refill is available, a 0 refill is assumed.
QDM v5.6 guidance:https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf
Proposed Solution:
//Before
define "Two High Risk Medications with Prolonged Duration":
( "Cumulative Medication Duration"("AntiInfectives During Measurement Period")>= 90
and "More than One AntiInfective Order" )
define "AntiInfectives During Measurement Period":
["Medication, Order": "Anti Infectives, other"] AntiInfectives
where AntiInfectives.authorDatetime during "Measurement Period"
define "More than One AntiInfective Order":
//Anti Infectives, other
exists ( "More Than One of Same Medication Order"(["Medication, Order": "Anti Infectives, other"]))
define function "Cumulative Medication Duration"(Medication List<"Medication, Order"> ):
Sum((collapse(Medication.relevantPeriod))CumulativeDosages
return all duration in days of CumulativeDosages )
//After
define "Two High Risk Medications with Prolonged Duration":
Sum(("More Than One... Order"(["Medication, Order": "Anti Infectives, other"]))AntiInfectives
let DaysSupply: Coalesce(AntiInfectives.daysSupplied, AntiInfectives.supply.value /(AntiInfectives.dosage.value * CMD.ToDaily(AntiInfectives.frequency)))*(1 + Coalesce(AntiInfectives.refills, 0))
return all DaysSupply
)> 90
Rationale for Change:
The goal of this change is to bring the logic expression closer to the measure intent and header description.
- relates to
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CYPRESS-2353 CMS156v10 - NUMER Issue
- Closed