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CMS156v11 - Provider Attribution For Average Daily Dose Criteria

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    • Ashish Trivedy
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      ​Thank you for your inquiry for CMS156v11 (2023 performance period), Use of High-Risk Medications in Older Adults. Per measure logic, numerator criteria is met for the reporting provider (e.g., Provider B) if the patient had a qualifying encounter with the reporting provider (e.g., Provider B) during the measurement period and if the patient was prescribed at least two orders of high-risk medications during the measurement period both exceeding average daily dose for the medication regardless of providers. The measure as currently designed represents a stricter patient safety standpoint. We appreciate your question and will consider revising the measure guidance in a future version to provide more clarity.
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      ​Thank you for your inquiry for CMS156v11 (2023 performance period), Use of High-Risk Medications in Older Adults. Per measure logic, numerator criteria is met for the reporting provider (e.g., Provider B) if the patient had a qualifying encounter with the reporting provider (e.g., Provider B) during the measurement period and if the patient was prescribed at least two orders of high-risk medications during the measurement period both exceeding average daily dose for the medication regardless of providers. The measure as currently designed represents a stricter patient safety standpoint. We appreciate your question and will consider revising the measure guidance in a future version to provide more clarity.
    • CMS0156v11

      I would like to get clarification for numerator criteria below: 
       
      c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.
       
      High Risk Medications with Average Daily Dose Criteria
      exists ( "More Than One Order"(["Medication, Order": "Reserpine"] ReserpineOrdered
      where "Average Daily Dose"(ReserpineOrdered)> 0.1 'mg/d'))
       
      or exists ( "More Than One Order"(["Medication, Order": "Digoxin"] DigoxinOrdered
      where "Average Daily Dose"(DigoxinOrdered)> 0.125 'mg/d'))
       
      or exists ( "More Than One Order"(["Medication, Order": "Doxepin"] DoxepinOrdered
      where "Average Daily Dose"(DoxepinOrdered)> 6 'mg/d'))
       
      Based on the guidance given "The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them." So should provider B in below scenario also meet numerator for average daily dose even though Provider B has given medication not exceeding average daily dose
       
      Example: Testing for doxepin average daily dose > 6 mg/d
       
      1. Provider A ordered 2 high-risk medications exceeding average daily dose for both medications. 
           Order 1: Supply 125 ML, Days Supply 12.5, Strength 10 mg/ML 
                  125 * 10 / 12.5 = 100 mg/d average dose
       
      Order 2: Supply 175 ML, Days Supply 22, Strength 10 mg/ML 
                  175 * 10 / 22 = 80 mg/d average dose
       
      2. Provider B also orders 1 high-risk medication from same drug class on different day but the average is less than 6 mg/d. 
       
           Order 1: Supply 50 ML, Days Supply 100, Strength 10 mg/ML 
                  50 * 10 / 100 = 5 mg/d average dose
       
      Provider A will meet numerator but should Provider B also meet numerator in this case? 

            edave Mathematica EC eCQM Team
            ashishtrivedy Ashish Trivedy
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