Measure: CMS156

Use of High-Risk Medications in Older Adults

Measure Versions

eMeasure Code	Measure Year	Full Version Number	Title
CMS156v12	2024	12.0.000	Use of High-Risk Medications in Older Adults
CMS156v11	2023	11	Use of High-Risk Medications in Older Adults
CMS156v10	2022	10.2.000	Use of High-Risk Medications in Older Adults
CMS156v9	2021	9.3.000	Use of High-Risk Medications in Older Adults
CMS156v8	2020	8.3.000	Use of High-Risk Medications in the Elderly
CMS156v7	2019	7.3.000	Use of High-Risk Medications in the Elderly
CMS156v6	2018	6.4.000	Use of High-Risk Medications in the Elderly
CMS156v5	2017	5.1.000	Use of High-Risk Medications in the Elderly

Description

Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.

Guidance

Patient Group Definitions

Group	Description	Instructions Links
Initial Population	Patients 67 years and older at the end of the measurement period who had a visit during the measurement period	Webchart Instructions
Denominator	Equals Initial Population	Webchart Instructions
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.	Webchart Instructions
Numerator	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days. Total rate (the sum of the two previous numerators, deduplicated).	Webchart Instructions
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 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.	Webchart Instructions
Denominator Exceptions	None

Details

Full eMeasure Code	eMeasure Identifier	Measure Year	Version	NQF #	GUID
CMS156v11	156	2023	11	0022	a3837ff8-1abc-4ba9-800e-fd4e7953adbd

Steward	Developer	Endorsed By
National Committee for Quality Assurance	National Committee for Quality Assurance	None

Scoring Method	Measure Type	Stratification	Risk Adjustment
Proportion	Process	None	None

Rate Aggregation

None

Improvement Notation

Lower score indicates better quality

Rationale

Clinical Recommendation Statement

Definition

Transmission Format

Applicable Value Sets

Category	Value Set	OID
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
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	Encounter Inpatient	2.16.840.1.113883.3.666.5.307
Encounter, Performed	Home Healthcare Services	2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed	Hospice Encounter	2.16.840.1.113883.3.464.1003.1003
Encounter, Performed	Nursing Facility Visit	2.16.840.1.113883.3.464.1003.101.12.1012
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 Outpatient Visit	2.16.840.1.113883.3.464.1003.101.11.1206
Encounter, Performed	Palliative Care Encounter	2.16.840.1.113883.3.464.1003.101.12.1090
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
Intervention, Order	Hospice Care Ambulatory	2.16.840.1.113883.3.526.3.1584
Intervention, Performed	Hospice Care Ambulatory	2.16.840.1.113883.3.526.3.1584
Intervention, Performed	Palliative Care Intervention	2.16.840.1.113883.3.464.1003.198.12.1135
Medication, Order	Anti Infectives, other	2.16.840.1.113883.3.464.1003.196.12.1481
Medication, Order	Anticholinergics, anti Parkinson agents	2.16.840.1.113883.3.464.1003.1049
Medication, Order	Anticholinergics, first generation antihistamines	2.16.840.1.113883.3.464.1003.1043
Medication, Order	Antipsychotic	2.16.840.1.113883.3.464.1003.196.12.1523
Medication, Order	Antispasmodics	2.16.840.1.113883.3.464.1003.1050
Medication, Order	Antithrombotic	2.16.840.1.113883.3.464.1003.1051
Medication, Order	Benzodiazepine	2.16.840.1.113883.3.464.1003.196.12.1522
Medication, Order	Cardiovascular, alpha agonists, central	2.16.840.1.113883.3.464.1003.1052
Medication, Order	Cardiovascular, other	2.16.840.1.113883.3.464.1003.1053
Medication, Order	Central nervous system, antidepressants	2.16.840.1.113883.3.464.1003.1054
Medication, Order	Central nervous system, barbiturates	2.16.840.1.113883.3.464.1003.1055
Medication, Order	Central nervous system, other	2.16.840.1.113883.3.464.1003.1057
Medication, Order	Central nervous system, vasodilators	2.16.840.1.113883.3.464.1003.1056
Medication, Order	Digoxin	2.16.840.1.113883.3.464.1003.1065
Medication, Order	Doxepin	2.16.840.1.113883.3.464.1003.1067
Medication, Order	Endocrine system, estrogens with or without progestins	2.16.840.1.113883.3.464.1003.1058
Medication, Order	Endocrine system, other	2.16.840.1.113883.3.464.1003.1060
Medication, Order	Endocrine system, sulfonylureas, long duration	2.16.840.1.113883.3.464.1003.1059
Medication, Order	Nonbenzodiazepine hypnotics	2.16.840.1.113883.3.464.1003.196.12.1480
Medication, Order	Pain medications, other	2.16.840.1.113883.3.464.1003.1063
Medication, Order	Pain medications, skeletal muscle relaxants	2.16.840.1.113883.3.464.1003.1062
Medication, Order	Reserpine	2.16.840.1.113883.3.464.1003.1044
Patient Characteristic Ethnicity	Ethnicity	2.16.840.1.114222.4.11.837
Patient Characteristic Payer	Payer	2.16.840.1.114222.4.11.3591
Patient Characteristic Race	Race	2.16.840.1.114222.4.11.836
Patient Characteristic Sex	ONC Administrative Sex	2.16.840.1.113762.1.4.1

References

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Source: https://ecqi.healthit.gov/ecqm/measures/cms156v1