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2021 MIPS Measure #238: Use of High-Risk Medications in the Elderly

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Measure TypeHigh Priority Measure?Collection Type(s)
ProcessyeseCQM, MIPS CQM

 

Measure 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.

NOTE:
Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable

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

DENOMINATOR :

Patients 65 years and older who had a visit during the measurement period

AND

Patient encounter during performance period (CPT or HCPCS): 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

NUMERATOR:

Patients with an order for at least one high-risk medication 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 numerator 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

 

Description

Prescription

Anticholinergics, first-generation antihistamines

 

Brompheniramine

Carbinoxamine

Chlorpheniramine

Clemastine

Cyproheptadine

Dexbrompheniramine

Dexchlorpheniramine

Dimenhydrinate

Diphenhydramine (oral)

Doxylamine

Hydroxyzine

Meclizine

Orphenadrine

Promethazine

Pyrilamine

Triprolidine

 

Anticholinergics, anti-Parkinson agents

 

Benztropine (oral)

Trihexyphenidyl

 

Antispasmodics

 

Atropine (exclude ophthalmic)

Belladonna alkaloids

Chlordiazepoxide-clidinium

Dicyclomide

Hyoscyamine

Methscopolamine

Propantheline

Scopolamine

 

Antithrombotics

Dipyridamole, oral short- acting (does not apply to the combination with aspirin)

Cardiovascular, alpha agonists, central

 

Methyldopa

Guanfacine

 

Cardiovascular, other

 

Disopyramide

Nifedipine, immediate release

 

Central nervous system, antidepressants

 

Amitriptyline Hydrochloride

Clomipramine

Amoxapine

Desipramine

Imipramine

Trimipramine

Nortriptyline

Paroxetine

Protriptyline

 

Central nervous system, barbiturates

 

Amobarbital

Butabarbital

Butalbital

Pentobarbital

Phenobarbital

Secobarbital

 

Central nervous system, vasodilators

 

Ergot mesylates

Isoxsuprine

 

Central nervous system, other

Meprobamate

Endocrine system, estrogens with or without progestins; include only oral and topical patch products

 

Conjugated estrogen

Estropipate

Estradiol

Esterified estrogen

 

Endocrine system, sulfonylureas, long- duration

 

Chlorpropamide

Glimepiride

Glyburide

 

Endocrine system, other

 

Desiccated thyroid

Megestrol

 

Pain medications, skeletal muscle relaxants

 

Carisoprodol

Chlorzoxazone

Cyclobenzaprine

Metaxalone Methocarbamol

Orphenadrine

 

Pain medications, other

 

Indomethacin Meperidine

Ketorolac, includes parentera

 

 *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.

Table 2 – High-Risk Medications With Days Supply Criteria

Description

Prescription

Days Supply Criteria

Anti-Infectives, other

 

Nitrofurantoin

Nitrofurantoin macrocrystals

Nitrofurantoin macrocrystals- monohydrate

 

>90 days

Nonbenzodiazepine hypnotics

 

Eszopiclone

Zaleplon

Zolpidem

 

>90 days

 NUMERATOR NOTE: Some high-risk medications are not included in this specific measure but should be avoided above a specified average daily dose. These medications are listed in Table 3. To calculate an average daily dose multiply the quantity of pills ordered by the dose of each pill and divide by the days supply. For example, a prescription for a 30-days supply of digoxin containing 15 pills, 0.250 mg each pill, has an average daily dose of 0.125 mg.

Table 3 – DAE-C: High-Risk Medications With Average Daily Dose Criteria

Description

Prescription

Average Daily Dose Criteria

Alpha agonists, central

Reserpine

>0.1 mg/day

Cardiovascular, other

Digoxin

>0.125 mg/day

Tertiary TCAs (as single agent or as part of combination products)

Doxepin

>6 mg/day

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 the 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 denominator 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 Table1
• Prescriptions for medications classified as high risk at any dose with greater than a 90 day cumulative medication duration listed in Table2

Numerator Options:
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 not ordered (G9368)

 

 

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