CMS156v9 – Use of High-Risk Medications in the Elderly

Patients 65 years and older who had a visit during the measurement period

– NUMERATOR 

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

– DENOMINATOR EXCLUSION

Exclude patients whose hospice care overlaps the measurement period.

For Denominator:

Include patients aged 65 and older at the start of the measurement period with a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

For Numerator:

Include patients fulfilling one of the following criteria:

• Two anti-infective ordered for 90 or more days during the measurement period. The two medications should be ordered 1 day or more apart. To order a medication, use the workflow Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Prescribe’.

• Two non-benzodiazepine hypnotics ordered for 90 or more days during the measurement period. The two medications should be ordered 1 day or more apart. To order a medication, use the workflow Patient > Provider Note > Prescription.
• Same high risk medications ordered on different days during the measurement period. The two medications should be ordered 1 day or more apart and should have the same code. To order a medication, use the workflow Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Prescribe’.

For Denominator Exclusions:

Patients who were in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an intervention. Select ‘Order’ or ‘Performed’ from the ‘Status’ dropdown, then click ‘Sign’ or ‘Save’. Use the below mentioned codes to order or perform an intervention:

• 385763009: Hospice Care (Regime/Therapy)
• 385765002: Hospice Care Management (Procedure)

• To document an encounter inpatient, navigate to Patient > Clinical > Evaluations