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  2. CQM-612

Question regarding cumulative medication logic

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    • McKesson
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      You are correct. A clearer formula for the days calculation would be total number of doses divided by the number of doses per day. Typically, the days' supply would be included on a dispensed medication.
      For your concern about the patient receiving the refills, CMS156 uses medication ordered to determine if the physician ordered a dose that was too high for an elderly patient. In this case, we are not measuring if the patient actually takes the medication, rather if the physician ordered it. For CMS128, the numerator is counting medications that were dispensed. Here the patient would have had to pick up the refills before you could count them. In this case, we are trying to determine retrospectively how long the person was on the medication.

      To clarify, this measure requires the EHR to capture whether the pharmacy has filled the prescription (not whether the patient has picked it up). We understand that not all EHRs are receiving dispensing information. To report this measure, this information would need to be captured by the EHR.
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      You are correct. A clearer formula for the days calculation would be total number of doses divided by the number of doses per day. Typically, the days' supply would be included on a dispensed medication. For your concern about the patient receiving the refills, CMS156 uses medication ordered to determine if the physician ordered a dose that was too high for an elderly patient. In this case, we are not measuring if the patient actually takes the medication, rather if the physician ordered it. For CMS128, the numerator is counting medications that were dispensed. Here the patient would have had to pick up the refills before you could count them. In this case, we are trying to determine retrospectively how long the person was on the medication. To clarify, this measure requires the EHR to capture whether the pharmacy has filled the prescription (not whether the patient has picked it up). We understand that not all EHRs are receiving dispensing information. To report this measure, this information would need to be captured by the EHR.
    • CMS136v1/NQF0108, CMS156v1/NQF0022

      This question regards logic for calculating cumulative medication.

      Plain text is from the measure specification. [[Double bracketed]] text is commentary.

      CUMULATIVE MEDICATION DURATION is the total number of days of a medication for an individual.

      Days of medication can be derived from number of doses per day divided by the frequency. [[The answer to this will always be “1”. We believe it should have been stated as, total number of doses divided by the number of doses per day. This would provide the correct answer for days. Ambulatory EHRs do not have prescription information at this level of detail.]]

      The cumulative duration can be calculated as the sum of the number of medication dispensed days x number of medication refills over a set period of time, excluding any gaps during which a medication was not dispensed. [[This would be OK, but Ambulatory EHRs don’t have enough detail to determine the number of days using the formula above.]]

      For example, if a medication was prescribed for 30 days with 3 refills, then a gap of 3 month, then prescribed again for 60 days with 2 refills, the cumulative medication duration for would be (30 x 3) + (60 x 2) = 210 days over the 10 month period. [[The problem with this method is that it could overstate the number of days a patient was on a particular medication. The reason is that if calculated as suggested above, refills could be counted toward CUMULATIVE MEDICATION DURATION, even if the patient has not yet gotten the refills or taken the medication.]]

      [[Is the intent of CUMULATIVE MEDICATION DURATION to determine retrospectively how long a patient has been on a particular drug, across multiple prescription/refill instances? ]]

            FEisenberg Floyd Eisenberg
            maggielohnes Maggie Lohnes (Inactive)
            Cindy Cullen, Minet Javellana (Inactive), Renee Rookwood, Saul Kravitz (Inactive)
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