CMS 156v6: Use of High-Risk Medications in the Elderly

Measure: Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are reported:

  1. Percentage of patients who were ordered at least one high-risk medication
  2. Percentage of patients who were ordered at least two of the same high-risk medications
Measure Type High Priority Measure Scoring
Process Yes A lower percentage indicates better quality
Denominator Patients 65 years and older who had a visit during the measurement period
Numerator

Numerator 1: Patients with an order for at least one high-risk medication during the measurement period

Numerator 2: Patients with at least two orders for the same high-risk medication during the measurement period

Denominator Exceptions None
Denominator Exclusions Exclude patients who were in hospice care during the measurement year

Patients who meet the following criteria will be included in the denominator:

  • Age must be ≥ 65 years at the beginning of the Measurement Period

    AND

  • Must have at least one encounter during the Measurement Period finalized by the EC/EP

CPT: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99221, 99222, 99223, 99231, 99232, 99233, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99305, 99306, 99307, 99308, 99309, 99310, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99024, 99391, 99392, 99393, 99394, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439

Patients who were in hospice care during the measurement year will be excluded from the measure.

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted in Numerator 1 if at least one high-risk medication has been ordered for them during the Measurement Period. A patient will be counted in Numerator 2 if at least two of the same high-risk medication have been ordered for them during the Measurement Period.

  • A high-risk medication is identified as: a prescription for medications classified as high-risk at any dose and for any duration; or as prescriptions for medications classified as high-risk at any dose with greater than a 90-day supply.
  • Examples of high-risk medications include muscle relaxants and certain antihistamines. A comprehensive list of eligible high-risk medications can be located here.

https://ecqi.healthit.gov/ecqm/ep/2018/cms156v6

 

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