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Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
Resolution: Answered
Priority: Blocker
Component/s: None
Labels:
None

Solution:

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Thank you for your question.

There are two steps to determine if the patient should be included in the numerator:

A) Is the medication listed on the medication discharge list? If medication 1014599 was administered on 2 Jan 2022, but the patient is not prescribed the medication to take after being discharged from the inpatient stay ending on 10 Jan 2022, the medication does not count towards the numerator.

Numerator Criteria states :
/*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/
( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
    where ( Count(["Medication, Discharge": "Schedule II & III Opioid Medications"] Opioids
          where Opioids.authorDatetime during InpatientEncounter.relevantPeriod
          return distinct Opioids.code
      )>= 2
    )
B) Is the RXNorm code the same? If the RXNorm codes for the two medications are identical, the medications are not considered distinct and would not count towards the numerator.

Numerator Criteria states :
/*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/
( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
    where ( Count(["Medication, Discharge": "Schedule II & III Opioid Medications"] Opioids
          where Opioids.authorDatetime during InpatientEncounter.relevantPeriod
          return distinct Opioids.code
      )>= 2
    )
Patient 1:-
Inpatient encounter - 1 jan 2022 - 10 jan 2022
has Medication code 1014599 authordatetime 2 jan 2022 and
has Medication code 1014599 authordatetime 2 jan 2022
Assuming 1014599 is present on the medication discharge list on 10 Jan 2022, this patient is in the denominator, but not the numerator. The two RXNorm codes are identical, so they are not distinct opioids.

Patient 2:-
Inpatient encounter - 1 jan 2022 - 10 jan 2022
has Medication code 1014599 authordatetime 4 jan 2022 and
has Medication code 1014615 authordatetime 2 jan 2022
Assuming these medications are present on the medication discharge list on 10 Jan 2022, this patient is in the numerator. The two RXNorm codes are different, so they are distinct opioids. We can also see that although both medications are oxycodone, the dosages of the medication are different - one is 5 MG (1014599) and one medication is 10 MG (1014615).

Please let us know if you have additional questions.

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Thank you for your question. There are two steps to determine if the patient should be included in the numerator: A) Is the medication listed on the medication discharge list? If medication 1014599 was administered on 2 Jan 2022, but the patient is not prescribed the medication to take after being discharged from the inpatient stay ending on 10 Jan 2022, the medication does not count towards the numerator. Numerator Criteria states : /*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge. */ ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter     where ( Count(["Medication, Discharge": "Schedule II & III Opioid Medications"] Opioids           where Opioids.authorDatetime during InpatientEncounter.relevantPeriod           return distinct Opioids.code       )>= 2     ) B) Is the RXNorm code the same? If the RXNorm codes for the two medications are identical, the medications are not considered distinct and would not count towards the numerator. Numerator Criteria states : /*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge. */ ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter     where ( Count(["Medication, Discharge": "Schedule II & III Opioid Medications"] Opioids           where Opioids.authorDatetime during InpatientEncounter.relevantPeriod           return distinct Opioids.code       )>= 2     ) Patient 1:- Inpatient encounter - 1 jan 2022 - 10 jan 2022 has Medication code 1014599 authordatetime 2 jan 2022 and has Medication code 1014599 authordatetime 2 jan 2022 Assuming 1014599 is present on the medication discharge list on 10 Jan 2022, this patient is in the denominator, but not the numerator. The two RXNorm codes are identical, so they are not distinct opioids. Patient 2:- Inpatient encounter - 1 jan 2022 - 10 jan 2022 has Medication code 1014599 authordatetime 4 jan 2022 and has Medication code 1014615 authordatetime 2 jan 2022 Assuming these medications are present on the medication discharge list on 10 Jan 2022, this patient is in the numerator. The two RXNorm codes are different, so they are distinct opioids. We can also see that although both medications are oxycodone, the dosages of the medication are different - one is 5 MG (1014599) and one medication is 10 MG (1014615). Please let us know if you have additional questions.
2023 Reporting Period EH/CAH eCQMs:

CMS0506v5

Hi Team,

Consider statements below from CMS506v5:

Numerator Definition states :

--Numerator criteria: Two or more unique orders for opioids, or an opioid and benzodiazepine at discharge

and

Numerator Criteria states :
/*Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/
( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
where ( Count(["Medication, Discharge": "Schedule II & III Opioid Medications"] Opioids
where Opioids.authorDatetime during InpatientEncounter.relevantPeriod
return distinct Opioids.code
)>= 2
)

Kindly help us understand whether below patient will qualify for the numerator or not.

Patient 1:-
Inpatient encounter - 1 jan 2023 - 10 jan 2023
has Medication code 1014599 authordatetime 2 jan 2023 and
has Medication code 1014599 authordatetime 2 jan 2023
Query:
1. Will this be considered as having two or more new or continuing opioids resulting in concurrent therapy at discharge?

Patient 2:-
Inpatient encounter - 1 jan 2023 - 10 jan 2023
has Medication code 1014599 authordatetime 4 jan 2023 and
has Medication code 1014615 authordatetime 2 jan 2023

Query:
1. Will this be considered as having two or more new or continuing opioids resulting in concurrent therapy at discharge?

Request you to provide us with the resolution urgently as our client deliverables are dependent on it.

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