CMS 156 - Clarification regarding medications administered during surgery, procedure, inpatient stay

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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      Thank you for your inquiry for CMS156v13 (2025 performance period). Similar to other eligible clinician (EC) eCQMs, this measure is intended to be outpatient. However, as per measure specification, a specific setting for where a medication is expected to be administered/consumed is not required for numerator evaluation. For example: "Medication, Order": "Potentially Harmful Antihistamines for Older Adults" is not setting specific. This piece of logic is only looking for an order of antihistamines medication. We will consider the feasibility of adding medication setting specificity/constraint in a future measure version.
      Show
      Thank you for your inquiry for CMS156v13 (2025 performance period). Similar to other eligible clinician (EC) eCQMs, this measure is intended to be outpatient. However, as per measure specification, a specific setting for where a medication is expected to be administered/consumed is not required for numerator evaluation. For example: "Medication, Order": "Potentially Harmful Antihistamines for Older Adults" is not setting specific. This piece of logic is only looking for an order of antihistamines medication. We will consider the feasibility of adding medication setting specificity/constraint in a future measure version.
    • CMS0156v13

      Seeking clarification on CMS 156 and whether this quality measure should include medications orders administered during surgery, procedure, trauma event, or inpatient stay. 

      We are seeing a high volume of patients meeting denominator criteria for qualifying medications that are ordered and administered during surgery, a procedure, trauma event, or inpatient stay.  This does not seem to align with the intent of the measure. 

      According to the 'Definition' section for the measure on the eCQI site:

      "A high-risk medication is identified by any one of the following:
      a. A prescription for medications classified as high risk at any dose and for any duration.
      b. A prescription for medications classified as high risk at any dose with greater than a 90 day supply.
      c. A prescription for medications classified as high risk exceeding average daily dose criteria.

      An order is identified by either a prescription order or a prescription refill."

       

      The definition and measure logic do not appear to incorporate the clinical setting or context in which the medication is ordered, such as during surgery, procedures, trauma events, or inpatient stays, which may not align with the intent of the measure to identify inappropriate prescribing in the outpatient setting.

       

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Shari Black
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