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  1. eCQM Issue Tracker
  2. CQM-6855

Safe Use of Opioids eCQM - Inpatient Status

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    • Holly Mcnary
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      Thank you for your question regarding CMS506v6, Safe Use of Opioids - Concurrent Prescribing.

      This measure uses the values found in the “Encounter, Inpatient” (2.16.840.1.113883.3.666.5.307) value set. You can reference the applicable codes found within this value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/. Click on the “Search Value Sets” tab and enter the value set ID to review codes included in the respective value set. If the patient encounter contains a value from the “Encounter, Inpatient” value set, then this will meet the measure criteria for an inpatient encounter, providing the patient’s age greater than or equal to 18 at the time of the “Inpatient Encounter”, and prescribed one, or more, new, or continuing, opioids, or benzodiazepines at discharge. For specific codes that are found in the measure specifications please reference the eCQI Resource Center https://ecqi.healthit.gov/ The measure does not intend to capture discharges other than inpatient discharges, therefore we encourage you to work with your EHR vendor to ensure observation and other outpatient encounters are not inappropriately captured by the measure. We will investigate ways to address this in a future version of the measure.
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      Thank you for your question regarding CMS506v6, Safe Use of Opioids - Concurrent Prescribing. This measure uses the values found in the “Encounter, Inpatient” (2.16.840.1.113883.3.666.5.307) value set. You can reference the applicable codes found within this value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/ . Click on the “Search Value Sets” tab and enter the value set ID to review codes included in the respective value set. If the patient encounter contains a value from the “Encounter, Inpatient” value set, then this will meet the measure criteria for an inpatient encounter, providing the patient’s age greater than or equal to 18 at the time of the “Inpatient Encounter”, and prescribed one, or more, new, or continuing, opioids, or benzodiazepines at discharge. For specific codes that are found in the measure specifications please reference the eCQI Resource Center https://ecqi.healthit.gov/ The measure does not intend to capture discharges other than inpatient discharges, therefore we encourage you to work with your EHR vendor to ensure observation and other outpatient encounters are not inappropriately captured by the measure. We will investigate ways to address this in a future version of the measure.
    • CMS0506v6
    • CMS0506v5
    • Not measure related

      We are seeking clarification on the below Q & A from issues posted to Jira recently. When "swing beds" are referenced, we were not sure we were referring to the same thing. We often see cases pulled into the measure that have an Inpatient order, then are subsequently changed to OBS,  or another scenario would be OBS, IP, then OBS again right after–however the mapping picks up that Inpatient class as soon as the order is entered. These patients are being marked as IP as soon as the IP order is placed, and the measure logic does not seem to allow for an alternate mapping setup. 

      Initial Question: We have discovered patients included in the IPP that are billed as Outpatient patient class, but also are coded with one of the SNOMED codes in the Inpatient Encounter value sets because they have erroneous admit to inpatient orders which is pulled in by the measure mapping to count it as an Inpatient stay. Since these are obvious errors that should not be included in the IPP what is recommended to exclude these outpatient encounters from the measure?

      Scenario: Physician enters Inpatient admit order due to error, or they change their mind and enter OBS order, but our EHR vendor does not allow orders to be cancelled for IP once placed. The patient class will change appropriately to correct patient class, but our mapping is picking up that IP order and stopping there. Therefore, we see OBS and ED patient class in our measure. 

      Jira Answer: Thank you for your question regarding CMS506v6 Safe Use of Opioids - Concurrent Prescribing. Patients who are admitted to an inpatient encounter and subsequently transferred to a ‘sub-acute’ level of service within the same facility (swing beds) should not be included in the measure. The measure requires an ‘Inpatient Encounter’ to meet the denominator population. If your EHR is documenting these patients as an ‘Inpatient Encounter’, they would meet the denominator criteria for this measure. eCQMs are not able to differentiate patients based upon level of service. You will need to work with your EHR vendor to remove these patients from the measure for purposes of reporting. We will explore ways to address this issue in a future version of the measure.

            JLeflore Mathematica EH eCQM Team
            winterh Holly Winters (Inactive)
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