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  1. eCQM Issue Tracker
  2. CQM-6157

Can we consider brand names of the medications for eCQMs as the value set file only has generic names of the medications

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
    • Icon: Moderate Moderate
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    • Nancy Smith
    • 717-680-8500 ext. 812
    • CureMD
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      Hello. Thank you for your question on CMS347, Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. Per CMS’ Electronic Clinical Quality Measure Logic and Implementation Guidance (Version 6.0): “It is expected that health IT vendors or providers will report the drug entities in patient data using the generalized drug concepts included in the defined value sets. These accord with CMS’s guidance about the preferred use of generalized drug concepts. eCQM implementers should use the relationships found in RxNorm to support mapping between specific drug entities found in patient records to those found in the value sets provided.”

      Should you decide to map the brand name drugs to, you should maintain documentation in case of a CMS audit.
      Show
      ​ Hello. Thank you for your question on CMS347, Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. Per CMS’ Electronic Clinical Quality Measure Logic and Implementation Guidance (Version 6.0): “It is expected that health IT vendors or providers will report the drug entities in patient data using the generalized drug concepts included in the defined value sets. These accord with CMS’s guidance about the preferred use of generalized drug concepts. eCQM implementers should use the relationships found in RxNorm to support mapping between specific drug entities found in patient records to those found in the value sets provided.” Should you decide to map the brand name drugs to, you should maintain documentation in case of a CMS audit.
    • CMS0347v6
    • Not every provider prescribes the medications with their generic name (they prescribe the brand name medications) due to which the patients do not count for the numerator.

      We have a value set file that contains the generic names of the medications for every eCQM. The providers prescribe medications with brand names that are not present in the value set file. Only information that is present in the value set file is picked up for the measure. 

       

      For example: 

      Measure: CMS 347v6 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

      The provider prescribed "Lipitor 10 MG Oral Tablet" which is the brand name for Atorvastatin 10 MG Oral Tablet. Atorvastatin 10 MG Oral Tablet is present in the value set file. 

      Lipitor 10 MG Oral Tablet does get captured for the numerator. 

       

      My question is that if the brand names are prescribed, should we add them to our list so that the patients can be counted for the numerator?

       

       

            edave Mathematica EC eCQM Team
            Nsmith Nancy
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