238. Use of High-Risk Medications in Older Adults

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

This measure is to be submitted a minimum of once per performance period for denominator eligible cases as defined in the denominator criteria.

This measure is intended to reflect the quality of services provided for patients aged 65 years of age and older who were ordered at least two high-risk medications. There is no diagnosis associated with this measure. This measure may be submitted by MIPS-eligible clinicians who perform the quality actions as defined by the numerator based on the services provided and the measure-specific denominator coding. The measure reflects potentially inappropriate medication use in older adults, both for medications where any use is inappropriate and for medications where use under all but specific indications is potentially inappropriate.

There are two performance criteria for this measure:

  • Criterion 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class
  • Criterion 2.Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses

This is an inverse measure. A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.

For a list of high-risk medications covered in this measure, go to the CMS QPP Reference Library.

Code quality with a special plan:

  1. Document a Diagnosis and Plan as you normally would.
  2. Tap Special Plans and select MIPS.
  3. From Popular Plans, select MIPS Quality and tap Save.
  4. Locate the MIPS Quality plan and tap Resume.
  5. Tap the Meds tab.
  6. Select the appropriate options from the Quality 238 drop-downs.
  7. Tap Done.
  8. Document the rest of the visit and Finalize.

Eyefinity products and documentation refer to the MIPS quality numbers. Other measure numbering systems are listed here for your reference.

Quality 238
NQF —
CMS 156
  • Registry

This topic describes how points are calculated for this measure. To learn more about scoring, go to Scoring.

Benchmarks are displayed here as both a chart and a table. The chart gives you a visual representation and helps you quickly compare benchmarks across different reporting methods. The table lists the specific benchmark criteria for each available reporting method.

 

Submission Method 3rd Decile 4th Decile 5th Decile 6th Decile 7th Decile 8th Decile 9th Decile 10th Decile
Registry* — — — — — — — —

* Benchmarking data for this submission method was unavailable at the time of publication.

Patients 65 years or older on the date of the encounter;

AND who had a visit during the measurement period or the year prior to the measurement period:

92002, 92004, 92012, 92014, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015,98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99387, 99397, G0402, G0438, G0439

Denominator Exclusions

Patients who use hospice services any time during the measurement period:

G9741

OR

Patients receiving palliative care during the measurement period:

G0034

Patients ordered at least two high-risk medications from the same drug class during the measurement year.

Performance Met

At least two orders for high-riskmedications from the same drug class:

G8752

Performance Not Met

At least two orders for high-risk medications from the same drug class not ordered:

G9368

Patients 65 years or older on the date of the encounter;

AND who had a visit during the measurement period or the year prior to the measurement period:

92002, 92004, 92012, 92014, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015,98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99387, 99397, G0402, G0438, G0439

Denominator Exclusions

Patients who use hospice services any time during the measurement period:

G9741

OR

Patients receiving palliative care during the measurement period:

G0034

Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines), except for appropriate diagnoses.

Performance Met

At least two orders for high-risk medications from the same drug class without appropriate diagnoses

G1209

Performance Not Met

At least two orders for high-risk medications from the same drug class not ordered:

G1210

OR two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the Index Prescription Start Date (IPSD) for antipsychotics:

G0032

OR two or more benzodiazepine prescriptions ordered for patients who had 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:

G0033