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  2. CQM-5846

Safe Use of Opioids and Den Exclusion implementation

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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    • Amy Asche
    • 515-250-6480
    • Tantus/PM3
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      ​​Thank you for your questions on CMS506 - Safe Use of Opioids - Concurrent Prescribing.

      For your first question, before a patient encounter can be excluded from the denominator, it must first be in the measure IPP. Under the eCQI resources (https://ecqi.healthit.gov/eh-cah?qt-tabs_eh=0), there is a zip file folder with flow charts indicating the order of steps needed to reach denominator exclusions, numerator, and remaining denominator encounters. The logic included in your question also shows the incorrect definition for patient encounter in the denominator exclusion section, which is likely causing confusion. The denominator exclusion logic uses

      "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge", not "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter"

      Incorrect logic:

        _or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter_| | _where exists InpatientEncounter.diagnoses Diagnosis_| | _where Diagnosis.code in "All Primary and Secondary Cancer"_| | _)_| | | | _or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter_| | _where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"_| | _or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"_| | _or InpatientEncounter.dischargeDisposition in "Patient Expired"_| | _)_

      Correct logic:

      Denominator Exclusions
      /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/
      "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
        where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer
            where Cancer.prevalencePeriod overlaps InpatientEncounter.relevantPeriod
        )
          or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
              where exists InpatientEncounter.diagnoses Diagnosis
                where Diagnosis.code in "All Primary and Secondary Cancer"
          )
          or exists ( "Intervention Palliative or Hospice Care" PalliativeOrHospiceCare
              where Coalesce(start of Global."NormalizeInterval"(PalliativeOrHospiceCare.relevantDatetime, PalliativeOrHospiceCare.relevantPeriod), PalliativeOrHospiceCare.authorDatetime)during Global."HospitalizationWithObservation" ( InpatientEncounter )
          )
          or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
              where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"
                or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"
                or InpatientEncounter.dischargeDisposition in "Patient Expired"

      For the second question, this is an encounter-based measure, so the unit we are looking at is the inpatient stay. A patient may have more than one relevant inpatient stay (discharged with at least one opioid or benzodiazepine) during a measurement period, and in these cases, each encounter should be counted separately. This is true for both 2022 and 2023 versions of the measure.

      Please let us know if you have additional questions.
      Show
      ​​Thank you for your questions on CMS506 - Safe Use of Opioids - Concurrent Prescribing. For your first question, before a patient encounter can be excluded from the denominator, it must first be in the measure IPP. Under the eCQI resources ( https://ecqi.healthit.gov/eh-cah?qt-tabs_eh=0), there is a zip file folder with flow charts indicating the order of steps needed to reach denominator exclusions, numerator, and remaining denominator encounters. The logic included in your question also shows the incorrect definition for patient encounter in the denominator exclusion section, which is likely causing confusion. The denominator exclusion logic uses "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge", not "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter" Incorrect logic:   _or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter_| | _where exists InpatientEncounter.diagnoses Diagnosis_| | _where Diagnosis.code in "All Primary and Secondary Cancer"_| | _)_| | | | _or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter_| | _where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"_| | _or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"_| | _or InpatientEncounter.dischargeDisposition in "Patient Expired"_| | _)_ Correct logic: Denominator Exclusions /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter   where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer       where Cancer.prevalencePeriod overlaps InpatientEncounter.relevantPeriod   )     or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter         where exists InpatientEncounter.diagnoses Diagnosis           where Diagnosis.code in "All Primary and Secondary Cancer"     )     or exists ( "Intervention Palliative or Hospice Care" PalliativeOrHospiceCare         where Coalesce(start of Global."NormalizeInterval"(PalliativeOrHospiceCare.relevantDatetime, PalliativeOrHospiceCare.relevantPeriod), PalliativeOrHospiceCare.authorDatetime)during Global."HospitalizationWithObservation" ( InpatientEncounter )     )     or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter         where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"           or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"           or InpatientEncounter.dischargeDisposition in "Patient Expired" For the second question, this is an encounter-based measure, so the unit we are looking at is the inpatient stay. A patient may have more than one relevant inpatient stay (discharged with at least one opioid or benzodiazepine) during a measurement period, and in these cases, each encounter should be counted separately. This is true for both 2022 and 2023 versions of the measure. Please let us know if you have additional questions.
    • CMS0506v5
    • CMS0506v4
    • Measure outcome for Safe Use of Opioid related to Denominator Exclusion.

      HQR HD received a question about implementation of Safe Use of Opioids and Den Exclusion. HQR is asking for clarification on what the expectation is for how it should be implemented. For these 2 exists statements (see below) since the measure uses the evaluation of 'Inpatient Encounter with Age Greater than or Equal to 18' within the exists, our understanding is that the measure evaluates if ANY encounter has one of these exclusions, then it will exclude the specific encounter being evaluated at the top of the Denominator Exclusion statement.  To summarize, if either of these exist statements below are met even once for a patient (including for encounters meeting 'Inpatient Encounter with Age Greater than or Equal to 18', but are NOT in the IPP) , then all 'Inpatient Encounter with Age Greater than or Equal to 18' will be evaluated as a denominator exclusion.
       
          or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
              where exists InpatientEncounter.diagnoses Diagnosis
                where Diagnosis.code in "All Primary and Secondary Cancer"
          )
       
          or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter
              where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"
                or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"
                or InpatientEncounter.dischargeDisposition in "Patient Expired"
          )

      After talking to the dev team for the HQR system, HQR has implemented the measure by looking at each individual of care episodes, which is causing the files that they are questioning to have two different outcomes. One outcome is meeting den exclusion, but the other encounter is showing numerator not met. After reviewing the measure further, the dev team does see how the submitter is questioning how it is getting implemented and we are needing some clarification on how this measure is supposed to be implemented.
      We compared the 2022 measure specification to 2023 measure specification and we believe the way we currently have it implemented is how it will be updated for 2023. 
      Any guidance with the implementation of this measure is appreciated. |

            JLeflore Mathematica EH eCQM Team
            aasche@tantustech.com Amy Asche (Inactive)
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