CMS156v13: Use of High-Risk Medications in the Elderly

This is an inverse measure. A lower score indicates better performance Percentage of Patients 65 years of age and older who were ordered at least two high-risk medications. Three rates are reported:

1. Percentage of patents 65 years of age and older who were ordered at least two high-risk medications from the same drug class
2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medication from the same drug class, except for appropriate diagnoses
3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators)

Numerator

Percentage of Patients 65 years of age and older at the end of the measurement period who were ordered at least two high-risk medications. Three rates are reported:

1. Percentage of patents 65 years of age and older who were ordered at least two high-risk medications from the same drug class on different days
   1. at least two orders of high-risk medications from the same drug class
   2. at least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days
   3. at least two orders of high-risk medication from the same drug class each exceeding average daily dose criteria
2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medication from the same drug class on different days except for appropriate diagnosis.
   1. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics.
   2. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have 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.
3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators)

Denominator

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

Denominator Exclusions

• Exclude patients whose hospice or palliative care overlaps the measurement period:
  • Identified in the patient's Alerts and Directives, located in the demographic screen or the Summary Sheet, in the name, text or comments saved with that alert/directive. The Alert/Directive should include either of the following phrases:
    • palliative
    • hospice