Measure Name:
Evaluation of High Risk Pain Medications for MME
QCDR Measure ID:
SGC7
QCDR Measure Type:
New QCDR Measure
NQF ID Number (if applicable)
N/A
High Priority Type:
Opioid-related Measure
Measure Type:
Process
NQS Domain:
Effective Clinical Care
Inverse Measure?
No
Proportional Measure?
Yes
Continuous Variable Measure?
No
Ratio Measure?
No
Number of performance rates to be calculated and submitted in the XML
1
Risk-Adjusted?
Yes
If risk-adjusted, indicate which score is risk-adjusted
Age, chronic conditions such as OA and hospice admission
Measure Description:
Percentage of patients aged 18 years and older prescribed and actively taking one or more high risk pain medications and evaluated for clinical appropriateness of morphine milligram equivalents (MME)
What one meaningful measure area applies to this measure?
Prevention and Treatment of Opioid and Substance Use Disorders
Rational:
Monitoring the MME of patients prescribed and taking one or more opioid prescriptions will help to evaluate the effectiveness and appropriateness of written opioid prescriptions in the clinical setting. MME levels will help to determine if certain types of opioids and/or dose of opioid prescribed to patients will influence future prescribing habits of providers.
Denominator:
Patients 18 age and older on date of encounter
AND
Patient encounter during the performance period
AND
All eligible instances when MIPS measure #130 (NQF 0419): Documentation of Current Medications is reported the same encounter (2018 specifications)
OR
Patients 18 age and older on date of encounter
AND
Patient encounter during the performance period:
ANESTHESIA
BEHAVIORAL HEALTH
DENTAL CARE
AND
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications
Denominator Exclusions:
Hospice services received by patient any time during the measurement period:
Patients who are receiving comfort care only at the time of encounter:
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given
Numerator:
Numerator Criteria (Performance Met and Performance Not Met): Percentage of patients prescribed and actively taking one or more high risk pain medications.
Numerator Instructions: The eligible clinician must document in the medical record they obtained, updated, or reviewed a medication list on the date of the encounter. Eligible clinicians reporting this measure may document medication information received from the patient, authorized representative(s), caregiver(s) or other available healthcare resources. The MME must be documented in the medical record.
Definitions:
• Accurate and complete medication list – List of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration.
• MIPS measure #130 (NQF #0419) or the equivalent performance met documentation must be on file for the encounter to be eligible.
• High risk pain medications – Patients prescribed certain high risk pain medications including:
 Opiates: buprenorphine (Butrans not Suboxone), codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol
 Benzodiazepines: alprazolam, diazepam, clonazepam, lorazepam
 Anti-spastics: baclofen, carisoprodol, cyclobenzaprine, metaxolone, methocarbamol, tizanidine
 NSAIDs: ibuprofen, indomethacin, ketorolac, meloxicam, naproxen
 Excluded: Transdermal lidocaine.
SOURCE: Centers for Disease Control and Prevention, Atlanta, GA, May 2014.
• Morphine milligram equivalents (MME) – Also called morphine equivalent daily dose, the conversion factors identified below were developed by the Centers for Disease Control and Prevention in May 2014. MME can be calculated using: MME = (Drug Strength x Drug Quantity x MME Conversion Factor)/Days Supply
 Measure instructions reference CDC conversion factor equivalents and guidelines for calculation.
Numerator Options:
Performance Met: Patient evaluated and current high risk pain medication, current pharmacologic treatment regimen less than or equal to 25 MME
OR
Performance Met: Patient evaluated and current high risk pain medication, current pharmacologic treatment regimen greater than or equal to 26 MME and less than 50 MME
OR
Performance Not Met: Patient evaluated and current high risk pain medication, current pharmacologic treatment regimen less than or equal to 50 MME and less than 90 MME
OR
Performance Not Met: Patient evaluated and current high risk pain medication, current pharmacologic treatment regimen greater than or equal to 90 MME
OR
Performance Not Met: Patient not evaluated for the MME of their current high risk pain medication pharmacologic treatment regimen, reason not given
Numerator Exclusions:
Patient not prescribed a high risk pain medication.
Denominator Exceptions:
None