CMS 156 Use of High-Risk Medications in the Elderly

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Overview

The Program Performance Dashboard reports each of this measure's numerators individually, using the same Initial Patient Population, Denominator, and Denominator Exclusion criteria for each. It reports the percentage of patients who were 65 years old or older at the beginning of the measurement period who meet the following numerator criteria:

Numerator #1 reports on patients with one prescription for a drug that poses a high risk to the elderly. Reported as 2020 CMS 156 Rate 1 Use of High-Risk Medications in the Elderly: 1 or More High-Risk Medications.
Numerator #2 reports on patients with two different prescriptions for the same high-risk drugs. Reported as 2020 CMS 156 Rate 2 Use of High-Risk Medications in the Elderly: 2 or More High-Risk Medications.

Compliance with this measure is indicated by a lower percentage. A 100% performance rate does not indicate compliance for reporting purposes. However, any performance rate less than 100% does indicate compliance.

At a Glance

eMeasure ID	CMS156v8
NQF	N/A
Used For?	Medicaid PI/Stage 3, MIPS (Quality)
Domain	Patient Safety
MIPS Quality ID	238
MIPS Measure Type	Process
MIPS High Priority?	Yes

Measure Specification and Value Sets

You should be familiar with this measure’s specification, Value Sets, and direct reference codes (if applicable). Refer to Downloading Measure Specifications and Value Sets for more information. Measure help now includes hyperlinks to the Value Sets used by this measure. You must be registered for a UMLS license and signed in to your account to see this content.

Identifying Event Times

See Identifying Event Times for important information about the logic this dashboard uses.

Amending Signed Notes

As a best practice, Notes should not be signed until they are finalized. Amending a signed Note (by making changes to it in Prime Suite and then re-saving it) will change a patient’s qualification for this measure. Re-signing the amended Note may allow the patient to qualify again, but only if it is re-signed during the time period required by the measure.

Measure Calculations

Initial Patient Population	Patients 65 years and older who had a visit during the measurement period
Denominator	Initial Patient Population
Numerator 1	Patients with an order for at least one high-risk medication during the measurement period
Numerator 2	Patients with at least two orders for the same high-risk medication during the measurement period

Measure Details

Initial Population/Denominator

Patients are counted in the denominator if both of the following are met:

They were 65 years old or older at the beginning of the measurement period. Age is based on the date of birth (DOB) entered on the patient's Information page.

They had at least one non-voided face-to-face visit during the measurement period. This must be documented in the Plan or E&M section of a Note using a code from one of the following Value Sets:

Denominator Exclusions

Patients will be excluded from the denominator if they received hospice care. This must be documented with a vocabulary term in the Results or in a Flowsheet. This documentation must show one of the following:

They were discharged from the hospital into hospice care during the measurement period. This must be documented with a vocabulary term using a parent code from the Encounter Inpatient Value Set and a child code using either of the following SNOMEDCT version 2019-05-10 direct reference codes:
- 428371000124100 indicating a patient was Discharged to a health care facility for hospice care.
- 428361000124107 indicating a patient was Discharged to home for hospice care.
They received hospice care. This must be documented with a vocabulary term in a Flowsheet using a code from the Hospice care ambulatory Value Set. The date the provider enters this documentation must occur during the measurement period.
They had an order for hospice care. This must be documented in the Plan or Results section of a Note using a code from the Hospice care ambulatory Value Set. This order must have been created during the measurement period.

Cumulative Days and High-Risk Drugs

Numerator 2 includes criteria for qualifying patients who were taking drugs that can be considered high risk when taken for more than 90 days cumulatively.

Patients do not have to take these drugs for 90 days consecutively: if they take the drug for 30 days during the measurement period, then don't take it for several months, and then take it for another 60 days during the measurement period, they will have taken the drug for at least 90 days during the measurement period.

Numerator 1 (a. One Med)

Patients are counted in Numerator #1 if they meet either of the following:

They had at least one prescription for a high-risk drug written during the measurement period. This must be documented using a code from the High Risk Medications for the Elderly Value Set.
They had at least one prescription for a drug that can be considered high risk prescribed for at least 90 days during the measurement period. These drugs must be documented using a code from the High-Risk Medications With Days Supply Criteria Value Set.

The prescriptions for Numerator #1 must be documented in the Plan section of a Note or on the Medication List. The prescriptions must be either e-prescribed or printed to qualify. If a prescription is saved without being e-prescribed or printed, it will not qualify.

Numerator 2 (b. >= 2 Meds)

Patients are counted in Numerator #2 if they meet one of the following:

They had at least two different prescriptions from the same grouping of high-risk drugs written on different days during the measurement period. See Value Sets for High-Risk Drugs for a list of the Value Sets used by these drug groupings.
They had at least two different prescriptions from the same grouping of drugs that can be considered high risk when taken for 90 days or more (cumulatively) during the measurement period. These prescriptions must have been written at least one day apart during the measurement period. Patients must have taken the prescriptions for 90 days or more (cumulatively) during the measurement period to qualify. Note that the two prescriptions can be active at the same time. If the two prescriptions overlap, the overlapping days only count once towards the 90 days the patient must meet to qualify. See Value Sets for Drugs Considered High Risk when Taken for 90 Days or More for a list of the Value Sets used by these drug groupings.

Patients must have two prescriptions that were documented using a code from the same Value Set. Prescriptions that qualify for Numerator #2 must be documented in the Plan section of a Note or on the Medication List. The prescriptions must be either e-prescribed or printed to qualify. If a prescription is saved without being e-prescribed or printed, it will not qualify.

Value Sets for High-Risk Drugs

Value Sets for Drugs Considered High Risk when Taken for 90 Days or More

An additional check will be performed when the patient was prescribed a drug from a group that’s listed on the Value Sets for Drugs Considered High Risk when Taken for 90 Days or More list. Patients with two prescriptions from the same Value Set will qualify if the patient was prescribed the drugs for 90 days or more (cumulatively) during the measurement period. The drugs must be written at least one day apart.

Numerator Exclusions

Not Applicable

Denominator Exception

Not Applicable

Prime Suite Help Topics

In addition to the steps listed in the Measure Details section of this document, the following Prime Suite Help topics are related to capturing the data required to meet this measure: