CMS 137 - Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Overview

CMS137v8 (2020)

CMS137v9 (2021)

CMS137v10 (2022)

Identifiers

CMS eCQM IDNQF eCQM IDNQFMIPS Quality ID
CMS137v10305

*MIE only supports data collection and reporting using eCQM specifications

Definitions

DescriptionPercentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following.
Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosisPercentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.
Initial Patient PopulationPatients age 13 years of age and older who were diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period
DenominatorEquals Initial Population
Denominator Exclusions
  • Exclude patients with a negative diagnosis history, defined as an encounter or medication treatment for a diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence.
  • Exclude patients who are in hospice care for any part of the measurement period.
NumeratorInitiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis.Engagement in ongoing treatment within 34 days of initiation includes:
  • Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by a dispensed medication.
  • Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by two further psychosocial visits.
  • Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by both a further medication dispense and a psychosocial visit.
  • Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by two psychosocial visits.
Numerator Exclusions
Denominator Exceptions

Additional Information

Measure TypeProcess measure
Measure ScoringProportion measure
Stratification
  • 13-17 years
  • 18 or greater years
GranularityPatient
Improvement NotationHigher score indicates better quality
DomainEffective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Evidence

Initial Patient Population

NameValue Set
Diagnosis: Alcohol and Drug Dependence2.16.840.1.113883.3.464.1003.106.12.1001
Encounter, Performed: Discharge Services - Hospital Inpatient2.16.840.1.113883.3.464.1003.101.12.1007
Encounter, Performed: Discharge Services - Hospital Inpatient Same Day Discharge2.16.840.1.113883.3.464.1003.101.12.1006
Encounter, Performed: Emergency Department Visit2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed: Hospital Inpatient Visit - Initial2.16.840.1.113883.3.464.1003.101.12.1004
Encounter, Performed: Hospital Observation Care - Initial2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed: Office Visit2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Online Assessments2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Telephone Visits2.16.840.1.113883.3.464.1003.101.12.1080

Denominator Exclusions

NameValue Set
Encounter, Performed: Encounter Inpatient2.16.840.1.113883.3.666.5.307
Intervention, Order: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15

Numerator

NameValue Set
Encounter, Performed: Detoxification Visit2.16.840.1.113883.3.464.1003.101.12.1059
Intervention, Performed: Alcohol and Drug Dependence Treatment2.16.840.1.113883.3.464.1003.106.12.1005
Intervention, Performed: Psych Visit - Psychotherapy2.16.840.1.113883.3.526.3.1496
Medication, Order: Opiate Antagonists2.16.840.1.113883.3.464.1003.198.12.1132

Source(s)

eCQI CMS137


WebChart Documentation

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