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Description
Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications.
Instructions
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
Patients 65 years and older who had a visit during the measurement period. Age information can be entered in DrChrono in the patient chart under the Demographics tab with the Patient Date of Birth.
AND
A relevant CPT or HCPCS code for the encounter: 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSION: Patients who use hospice services any time during the measurement period: G9741
Numerator
Patients with at least two orders for the same high-risk medication on different days during the measurement period
Definitions:
The intent of the numerator is to assess if the patient has either been prescribed at least two of the same high-risk medication in Table 1, received two or more prescriptions on different days, where the sum of days supply exceeds 90 days, for medications in the same medication class in Table 2. The intent of the measure is to assess if the submitting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the Quality ID #238 (NQF 0022): Use of High-Risk Medications in Older Adults – National Quality Strategy Domain: Patient Safety – Meaningful Measure Area: Medication Management Version 5.0 CPT only copyright 2020 American Medical Association. All rights reserved. November 2020 Page 2 of 8 numerators unless the submitting provider also ordered a high-risk medication for them.
Cumulative Medication Duration – an individual’s total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions.
For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.
Table 1 – High-Risk Medications at any dose or duration
*The registry version of the measure specifications only indicates the classes of drugs that are considered high-risk and do not include the specific coding of RxNorm. However, this measure aligns with the eCQM measure (CMS 156) and providers may review the RxNorm codes in the applicable eCQM value sets for submission.
Numerator Instructions:
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominators eligible patients did not receive the appropriate care or were not in proper control.
A high-risk medication is identified by either of the following:
- A prescription for medications classified as high risk at any dose and for any duration listed in Table 1
- Prescriptions for medications classified as high risk at any dose with greater than a 90-day cumulative medication duration are listed in Table 2
Numerator Options: The following codes can be entered in the HCPCS code section for the visit.
Performance Met: At least two orders for the same high-risk medication (G9367)
OR
Performance Not Met: At least two orders for the same high-risk medications were not ordered (G9368)
