CMS 156 - Use of High-Risk Medications in the Elderly
Covered by this topic
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
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
Note
This is an inverse measure. The goal is to have a 0 in the numerator. When e-prescribing, avoid prescribing any of the medications listed below, to the specified population, whenever possible.
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.
- While documenting the encounter, use the Presenting Medications section and Medication Orders section to prescribe and reconcile medications, as usual.
- Prescribe medications, as needed.
- Continue documenting the encounter, as appropriate.
- 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)
WebChart Documentation
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