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Proposed solution
OPTION 1:
Current denominator exclusions:
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, and patients who expire during the inpatient stay
Proposed denominator exclusions:
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 acute care facility or critical access hospital, and patients who expire during the inpatient stay
OPTION 2:
Current initial population:
Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed one or more new or continuing opioid or benzodiazepine at discharge
Proposed initial population:
Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter, discharged home, and prescribed one or more new or continuing opioid or benzodiazepine at discharge
OPTION 3:
Retain the current denominator exclusions and initial population as-is.
Rationale for change
Patients discharged to acute care facilities are excluded from the measure denominator because applicable guidelines are for settings where a patient is not closely monitored. These guidelines were not intended to apply to patients who were discharged to acute care settings. Clinicians should not be penalized for evaluating risk of concurrent medications differently for these patients.
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Proposed solution
OPTION 1:
Current denominator exclusions:
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, and patients who expire during the inpatient stay
Proposed denominator exclusions:
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 acute care facility or critical access hospital, and patients who expire during the inpatient stay
OPTION 2:
Current initial population:
Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter and prescribed one or more new or continuing opioid or benzodiazepine at discharge
Proposed initial population:
Inpatient hospitalizations (inpatient stay less than or equal to 120 days) that end during the measurement period, where the patient is 18 years of age and older at the start of the encounter, discharged home, and prescribed one or more new or continuing opioid or benzodiazepine at discharge
OPTION 3:
Retain the current denominator exclusions and initial population as-is.
Rationale for change
Patients discharged to acute care facilities are excluded from the measure denominator because applicable guidelines are for settings where a patient is not closely monitored. These guidelines were not intended to apply to patients who were discharged to acute care settings. Clinicians should not be penalized for evaluating risk of concurrent medications differently for these patients.