CMS 156v10: Use of High-Risk Medications in Older Adults

Measure: Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported:

  • Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class

  • Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses

  • Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators)

Measure TypeHigh Priority MeasureScoring
ProcessYesA lower percentage indicates better quality
DenominatorPatients 65 years and older who had a visit during the measurement period
Numerator

Rate 1 : Patients with at least two orders of high-risk medications from the same drug class.

Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines).

Total rate (the sum of the two previous numerators, deduplicated)

Denominator ExceptionsNone
Denominator Exclusions

  • Patients in hospice care for any part of the measurement period

  • Patients receiving palliative care during the measurement period

Numerator Exclusions

Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the Index Prescription Start Date (IPSD) for antipsychotics

For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines

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

  • Age is ≥ 65 years at the beginning of the Measurement Period

    AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 92002, 92004, 92012, 92014, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99315, 99316, 99318, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0438, G0439, G0071, G2010, G2012, G2061, G2062, G2063

A patient will be excluded from this measure if they meet any of the following conditions:

  • Is in hospice care for any part of the Measurement Period
  • Is receiving palliative care during the Measurement Period

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 Pending or Complete.

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

Palliative care services can be documented using the FACIT-Pal Questionnaire flowsheet or in the Orders/Procedure tab.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets

  2. Click Add New Flowsheet

  3. Select the FACIT-Pal Questionnaire flowsheet and click Add

  4. Click Add Column

  5. Populate the patient's responses to the questions as appropriate

  6. Click OK to save

Go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9054, M1017

Order Status must be marked as Complete.

Rate 1: A patient will be counted in the numerator if the patient has:

  • Two or more orders for the same high-risk medication, made on different days, during the Measurement Period

  • Two or more orders for high-risk medication with prolonged duration 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.

A comprehensive list of eligible high-risk medications can be located here.

Rate 2: A patient will be counted in the numerator if the patient has:

  • Two or more orders for antipsychotics

  • Two or more orders for benzodiazepines

A comprehensive list of eligible antipsychotics and benzodiazepines can be located here.

The Total Rate is the sum of Rate 1 and Rate 2, deduplicated.

For Rate 2:

  • A patient with two or more antipsychotic prescriptions ordered will be excluded if they have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the Measurement Period and the first prescription start date for antipsychotics.

  • A patient with two or more benzodiazepine prescriptions ordered will be excluded if they have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the Measurement Period and the first prescription start date for benzodiazepines.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for the conditions that meet the Numerator Exclusions can be located here.

https://ecqi.healthit.gov/ecqm/ep/2022/cms156v10

 

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