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  2. CQM-5717

CRP: Evaluate options for excluding certain discharge situations

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    • Other
    • Resolution: Resolved
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      Brief description of measure
      CMS506: Safe Use of Opioids - Concurrent Prescribing:
      Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

      Description of issue
      Currently, the Safe Use of Opioids measure only excludes specific discharge situations, such as a patient discharged to hospice or to an acute care facility, but otherwise includes all other types of discharged patients with at least one opioid or benzodiazepine prescription in the denominator.

      The measure follows CDC guidelines for prescribing opioids for chronic pain, which is intended for patients in an outpatient setting. The Safe Use of Opioids measure aims to reduce adverse effects of concurrent opioids or opioid and benzodiazepines by reducing instances of respiratory depression.

      Patients discharged to acute care facilities were excluded from the measure because the guidelines are for settings where a patient is not closely monitored. The measure developer is trying to evaluate which option would be most appropriate, in addition to some specific questions:

      OPTION 1: Update to the denominator exclusions: should patients discharged to critical access hospitals (CAH), long-term acute care (LTAC), or other swing beds be excluded from the measure?
      OPTION 2: Update to the initial population: should the measure only include patients who are discharged to home?
      OPTION 3: Make no changes to the measure.

      Goal of review
      Obtain clinical feedback
      Show
      Brief description of measure CMS506: Safe Use of Opioids - Concurrent Prescribing: Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge Description of issue Currently, the Safe Use of Opioids measure only excludes specific discharge situations, such as a patient discharged to hospice or to an acute care facility, but otherwise includes all other types of discharged patients with at least one opioid or benzodiazepine prescription in the denominator. The measure follows CDC guidelines for prescribing opioids for chronic pain, which is intended for patients in an outpatient setting. The Safe Use of Opioids measure aims to reduce adverse effects of concurrent opioids or opioid and benzodiazepines by reducing instances of respiratory depression. Patients discharged to acute care facilities were excluded from the measure because the guidelines are for settings where a patient is not closely monitored. The measure developer is trying to evaluate which option would be most appropriate, in addition to some specific questions: OPTION 1: Update to the denominator exclusions: should patients discharged to critical access hospitals (CAH), long-term acute care (LTAC), or other swing beds be excluded from the measure? OPTION 2: Update to the initial population: should the measure only include patients who are discharged to home? OPTION 3: Make no changes to the measure. Goal of review Obtain clinical feedback
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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.
      Show
      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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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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