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

Overview

CMS156v8 (2020)
CMS156v9 (2021)
CMS156v10 (2022)

Identifiers

CMS eCQM ID	NQF eCQM ID	NQF	MIPS Quality ID
CMS156v10	–	0022	238

*MIE only supports data collection and reporting using eCQM specifications

Definitions

Description	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.	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 , deduplicating for patients in both numerators).
Initial Patient Population	Patients 65 years and older who had a visit during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care during the measurement period.
Numerator	Patients with at least two orders of high-risk medications from the same drug class.	Patients with at least two orders of high-risk medications from the same drug class.	Total rate (the sum of the two previous numerators, deduplicated).
Numerator Exclusions	–	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.	–
Denominator Exceptions	–

Additional Information

Measure Type	Process measure
Measure Scoring	Proportion measure
Granularity	Patient
Improvement Notation	Lower score indicates better quality
Domain	Patient Safety

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Track all patients that are 65+ and prescribed high-risk medications. Two rates are reported, so be aware that patients with at least one high-risk medication, as well as patients with at least two orders for the same high-risk medication, will be reported for the measurement period. 1. While documenting the encounter, use the Presenting Medications section and Medication Orders section to prescribe and reconcile medications, as usual. 2. Prescribe medications, as needed. 3. Continue documenting the encounter, as appropriate. 4. When complete, Close and Archive the encounter.

Evidence

Initial Patient Population

Name	Value Set
Encounter, Performed: Annual Wellness Visit	2.16.840.1.113883.3.526.3.1240
Encounter, Performed: Care Services in Long-Term Residential Facility	2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed: Discharge Services - Nursing Facility	2.16.840.1.113883.3.464.1003.101.12.1013
Encounter, Performed: Home Healthcare Services	2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Nursing Facility Visit	2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.	CPT Code 99211
Encounter, Performed: Office Visit	2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Online Assessments	2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Ophthalmologic Services	2.16.840.1.113883.3.464.1003.101.11.1206
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed: Telephone Visits	2.16.840.1.113883.3.464.1003.101.12.1080

Denominator Exclusions

Name	Value Set
Assessment, Performed: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)	LOINC Code 71007-9
Encounter, Performed: Encounter Inpatient	2.16.840.1.113883.3.666.5.307
Encounter, Performed: Palliative Care Encounter	2.16.840.1.113883.3.464.1003.101.12.1090
Intervention, Order: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Palliative Care Intervention	2.16.840.1.113883.3.464.1003.198.12.1135

Numerator

Name	Value Set
Medication, Order: Amitriptyline Hydrochloride	2.16.840.1.113883.3.464.1003.196.12.1373
Medication, Order: Amoxapine	2.16.840.1.113883.3.464.1003.196.12.1273
Medication, Order: Anti Infectives, other	2.16.840.1.113883.3.464.1003.196.12.1481
Medication, Order: Antipsychotic	2.16.840.1.113883.3.464.1003.196.12.1523
Medication, Order: Atropine	2.16.840.1.113883.3.464.1003.196.12.1274
Medication, Order: Benzodiazepine	2.16.840.1.113883.3.464.1003.196.12.1522
Medication, Order: Benztropine	2.16.840.1.113883.3.464.1003.196.12.1361
Medication, Order: Brompheniramine	2.16.840.1.113883.3.464.1003.196.12.1427
Medication, Order: Butabarbital	2.16.840.1.113883.3.464.1003.196.12.1402
Medication, Order: Butalbital	2.16.840.1.113883.3.464.1003.196.12.1514
Medication, Order: Carbinoxamine	2.16.840.1.113883.3.464.1003.196.12.1306
Medication, Order: Carisoprodol	2.16.840.1.113883.3.464.1003.196.12.1369
Medication, Order: Chlorpheniramine	2.16.840.1.113883.3.464.1003.196.12.1352
Medication, Order: Chlorpropamide	2.16.840.1.113883.3.464.1003.196.12.1303
Medication, Order: Chlorzoxazone	2.16.840.1.113883.3.464.1003.196.12.1362
Medication, Order: Clemastine	2.16.840.1.113883.3.464.1003.196.12.1308
Medication, Order: Clomipramine	2.16.840.1.113883.3.464.1003.196.12.1336
Medication, Order: Conjugated Estrogens	2.16.840.1.113883.3.464.1003.196.12.135
Medication, Order: Cyclobenzaprine Hydrochloride	2.16.840.1.113883.3.464.1003.196.12.1372
Medication, Order: Cyproheptadine	2.16.840.1.113883.3.464.1003.196.12.1277
Medication, Order: Desiccated Thyroid	2.16.840.1.113883.3.464.1003.196.12.1354
Medication, Order: Desipramine	2.16.840.1.113883.3.464.1003.196.12.1278
Medication, Order: Dexbrompheniramine	2.16.840.1.113883.3.464.1003.196.12.1375
Medication, Order: Dexchlorpheniramine	2.16.840.1.113883.3.464.1003.196.12.1300
Medication, Order: Dicyclomine	2.16.840.1.113883.3.464.1003.196.12.1279
Medication, Order: Dimenhydrinate	2.16.840.1.113883.3.464.1003.196.12.1500
Medication, Order: Diphenhydramine	2.16.840.1.113883.3.464.1003.196.12.1293
Medication, Order: Dipyridamole	2.16.840.1.113883.3.464.1003.196.12.1349
Medication, Order: Disopyramide	2.16.840.1.113883.3.464.1003.196.12.1311
Medication, Order: Doxylamine	2.16.840.1.113883.3.464.1003.196.12.1515
Medication, Order: Esterified Estrogens	2.16.840.1.113883.3.464.1003.196.12.1419
Medication, Order: Estradiol	2.16.840.1.113883.3.464.1003.196.12.1365
Medication, Order: Estropipate	2.16.840.1.113883.3.464.1003.196.12.1319
Medication, Order: Glyburide	2.16.840.1.113883.3.464.1003.196.12.1368
Medication, Order: Guanfacine	2.16.840.1.113883.3.464.1003.196.12.1341
Medication, Order: Hydroxyzine	2.16.840.1.113883.3.464.1003.196.12.1374
Medication, Order: Hyoscyamine	2.16.840.1.113883.3.464.1003.196.12.1501
Medication, Order: Imipramine	2.16.840.1.113883.3.464.1003.196.12.1359
Medication, Order: Indomethacin	2.16.840.1.113883.3.464.1003.196.12.1366
Medication, Order: Isoxsuprine	2.16.840.1.113883.3.464.1003.196.12.1422
Medication, Order: Ketorolac Tromethamine	2.16.840.1.113883.3.464.1003.196.12.1364
Medication, Order: List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly	2.16.840.1.113883.3.464.1003.196.12.1272
Medication, Order: Meclizine	2.16.840.1.113883.3.464.1003.196.12.1506
Medication, Order: Megestrol	2.16.840.1.113883.3.464.1003.196.12.1342
Medication, Order: Meperidine	2.16.840.1.113883.3.464.1003.196.12.1351
Medication, Order: Meprobamate	2.16.840.1.113883.3.464.1003.196.12.1284
Medication, Order: Metaxalone	2.16.840.1.113883.3.464.1003.196.12.1358
Medication, Order: Methocarbamol	2.16.840.1.113883.3.464.1003.196.12.1370
Medication, Order: Methscopolamine	2.16.840.1.113883.3.464.1003.196.12.1525
Medication, Order: Methyldopa	2.16.840.1.113883.3.464.1003.196.12.1331
Medication, Order: Nifedipine	2.16.840.1.113883.3.464.1003.196.12.1353
Medication, Order: Nonbenzodiazepine hypnotics	2.16.840.1.113883.3.464.1003.196.12.1480
Medication, Order: Nortriptyline	2.16.840.1.113883.3.464.1003.196.12.1507
Medication, Order: Orphenadrine	2.16.840.1.113883.3.464.1003.196.12.1302
Medication, Order: Paroxetine	2.16.840.1.113883.3.464.1003.196.12.1508
Medication, Order: Pentobarbital	2.16.840.1.113883.3.464.1003.196.12.1518
Medication, Order: Phenobarbital	2.16.840.1.113883.3.464.1003.196.12.1348
Medication, Order: Promethazine Hydrochloride	2.16.840.1.113883.3.464.1003.196.12.1367
Medication, Order: Propantheline	2.16.840.1.113883.3.464.1003.196.12.1519
Medication, Order: Protriptyline	2.16.840.1.113883.3.464.1003.196.12.1509
Medication, Order: Pyrilamine	2.16.840.1.113883.3.464.1003.196.12.1524
Medication, Order: Scopolamine	2.16.840.1.113883.3.464.1003.196.12.1520
Medication, Order: Secobarbital	2.16.840.1.113883.3.464.1003.196.12.1521
Medication, Order: Trihexyphenidyl	2.16.840.1.113883.3.464.1003.196.12.1334
Medication, Order: Trimipramine	2.16.840.1.113883.3.464.1003.196.12.1285
Medication, Order: Triprolidine	2.16.840.1.113883.3.464.1003.196.12.1408

Numerator Exclusions

Name	Value Set
Diagnosis: Alcohol Withdrawal	2.16.840.1.113883.3.464.1003.105.12.1209
Diagnosis: Benzodiazepine Withdrawal	2.16.840.1.113883.3.464.1003.105.12.1208
Diagnosis: Bipolar Disorder	2.16.840.1.113883.3.464.1003.105.12.1157
Diagnosis: Generalized Anxiety Disorder	2.16.840.1.113883.3.464.1003.105.12.1210
Diagnosis: Other Bipolar Disorder	2.16.840.1.113883.3.464.1003.105.12.1204
Diagnosis: REM Sleep Behavior Disorder	2.16.840.1.113883.3.464.1003.105.12.1207
Diagnosis: Schizophrenia	2.16.840.1.113883.3.464.1003.105.12.1205
Diagnosis: Seizure Disorder	2.16.840.1.113883.3.464.1003.105.12.1206

Source(s)

eCQI CMS156