CMS506v7 Safe Use of Opioids Question about "Opioid Use Disorder"

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Jessica
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      Thank you for your feedback regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. CMS506v7 contains a known issue (EKI-31): https://oncprojectracking.healthit.gov/support/browse/EKI-31 regarding the denominator exclusion logic and the diagnosis and treatment of opioid use disorder (OUD).

      There is no solution for CMS506v7, however the measure was updated to address these concerns for CMS506v8 which can be found here: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS506-v8.2.000-QDM.html. Please see below for updated logic:

      Denominator exclusion logic:
                  or exists ( "Treatment For Opioid Use Disorders" OUDTreatment
                where Coalesce(start of Global."NormalizeInterval"(OUDTreatment.relevantDatetime, OUDTreatment.relevantPeriod), OUDTreatment.authorDatetime) during day of InpatientEncounter.relevantPeriod
            )

      Treatment for Opioid Use Disorders logic:
       ( ( ["Medication, Active": "Medications for Opioid Use Disorder (MOUD)"]
          union ["Medication, Order": "Medications for Opioid Use Disorder (MOUD)"] ) MedicationTreatment
              with ["Intervention, Performed": "Opioid Medication Assisted Treatment (MAT)"] MAT
                  such that Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of Global."NormalizeInterval" ( MAT.relevantDatetime, MAT.relevantPeriod )
                      and Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of "Measurement Period"
          )
          union ( ( ["Medication, Active": "Medications for Opioid Use Disorder (MOUD)"]
                  union ["Medication, Order": "Medications for Opioid Use Disorder (MOUD)"] ) MedicationTreatment
                      with ["Diagnosis": "Opioid Use Disorder"] OUD
                          such that Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of OUD.prevalencePeriod
                      and OUD.prevalencePeriod overlaps day of "Measurement Period"
                  )
      Show
      Thank you for your feedback regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. CMS506v7 contains a known issue ( EKI-31 ): https://oncprojectracking.healthit.gov/support/browse/EKI-31 regarding the denominator exclusion logic and the diagnosis and treatment of opioid use disorder (OUD). There is no solution for CMS506v7, however the measure was updated to address these concerns for CMS506v8 which can be found here: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS506-v8.2.000-QDM.html . Please see below for updated logic: Denominator exclusion logic:             or exists ( "Treatment For Opioid Use Disorders" OUDTreatment           where Coalesce(start of Global."NormalizeInterval"(OUDTreatment.relevantDatetime, OUDTreatment.relevantPeriod), OUDTreatment.authorDatetime) during day of InpatientEncounter.relevantPeriod       ) Treatment for Opioid Use Disorders logic:  ( ( ["Medication, Active": "Medications for Opioid Use Disorder (MOUD)"]     union ["Medication, Order": "Medications for Opioid Use Disorder (MOUD)"] ) MedicationTreatment         with ["Intervention, Performed": "Opioid Medication Assisted Treatment (MAT)"] MAT             such that Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of Global."NormalizeInterval" ( MAT.relevantDatetime, MAT.relevantPeriod )                 and Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of "Measurement Period"     )     union ( ( ["Medication, Active": "Medications for Opioid Use Disorder (MOUD)"]             union ["Medication, Order": "Medications for Opioid Use Disorder (MOUD)"] ) MedicationTreatment                 with ["Diagnosis": "Opioid Use Disorder"] OUD                     such that Coalesce(start of Global."NormalizeInterval"(MedicationTreatment.relevantDatetime, MedicationTreatment.relevantPeriod), MedicationTreatment.authorDatetime) during day of OUD.prevalencePeriod                 and OUD.prevalencePeriod overlaps day of "Measurement Period"             )
    • CMS0506v7
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      Patients are being excluded due to diagnosis of "OPIOID USE DISORDER" OR exists "Treatment for Opioid Use Disorders" (Medication active or Medication, Order) WITH "Intervention, performed": "OPIOID MED ASSISTED TREATMENT" The OR part is the issue. Patients may have an "OPIOID USE DISORDER" diagnosis, and that indicates that they are on chronic pain medications. They may not be on any treatment for this diagnosed disorder, rather they are continually being prescribed multiple opioids and/or benzos. The intent of the measure is to prevent an opioid disorder from occurring. How it is worded, will not accurately INCLUDE patient populations.
      Show
      Patients are being excluded due to diagnosis of "OPIOID USE DISORDER" OR exists "Treatment for Opioid Use Disorders" (Medication active or Medication, Order) WITH "Intervention, performed": "OPIOID MED ASSISTED TREATMENT" The OR part is the issue. Patients may have an "OPIOID USE DISORDER" diagnosis, and that indicates that they are on chronic pain medications. They may not be on any treatment for this diagnosed disorder, rather they are continually being prescribed multiple opioids and/or benzos. The intent of the measure is to prevent an opioid disorder from occurring. How it is worded, will not accurately INCLUDE patient populations.

      Patients are being excluded due to diagnosis of "OPIOID USE DISORDER" OR exists "Treatment for Opioid Use Disorders" (Medication active or Medication, Order) WITH "Intervention, performed": "OPIOID MED ASSISTED TREATMENT"

      A patient has a diagnosis of (SNOWMEDCT 19819002) Continuous opioid dependence disorder (OID 2.16.840.1.113762.1.4.1111.171). 

      This 75yr patient admitted with SBO and is discharged on:

      Norco 7.5-325mg, 1 tablet oral Q8 hrs PRN

      Norco 10-325mg, 1 tablet Q4 hrs PRN

      Tramadol 100mg Q8hrs PRN

      Trazodone HCl 150mg Nightly 

      No Medication, Active or Medication, Order for "Treatments for Opioid Use Disorders" were present, WITH no Intervention, Performed for "Opioid Medication Assisted Treatment." 

      Why would the OUD diagnosis be included IF there is no treatment ordered? 

       

      Reporter text conserved from the Solution field:

      The measure should state: 
      diagnosis of  "OPIOID USE DISORDER" 
               WITH (... not OR...)  
      "Treatment for Opioid Use Disorders" (Medication active or Medication, Order) 
      OR 
      "Intervention, performed": "OPIOID MED ASSISTED TREATMENT" 

      This would be more logical.

        1. SUO Onc Jira Question Oct 3 2025 ie OUD diagnosis OR treatment when it should be WITH.docx
          130 kB

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Jessica A. Gage
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              Updated:
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