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 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

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 Exceptions None
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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