QCDR measure AAD 18
Avoidance of Opioid Prescriptions for Closures and Reconstruction After Skin Cancer Resection
DESCRIPTION:
Percentage of procedures in patients, aged 18 and older with a diagnosis of skin cancer, who had intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection where opioid/narcotic therapy was prescribed as first line therapy (as defined by a prescription in anticipation of or at time of surgery) for post-operative pain management by the reconstructing surgeon (inverse measure).
| MEASURE ID: | AAD18 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | N/A |
| High priority: | Yes |
| Topped out: | Yes |
| Telehealth Eligible: | No |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
This measure is specifically focused on not prescribing opioids and narcotics as first line treatment for reconstruction after skin cancer resection. Studies have shown that narcotic agents do not control pain better than non-narcotic agents and that there is no difference in surgical outcomes when pain strategies are compared. Avoidance can help decrease risk of opioid diversion, addiction, unintentional injury, and death.
AAD18 FAQs
Q. Is this measure reportable via claims?
A. No. This measure can only be reported via a registry, such as DataDerm.
Q. What is the numerator?
A. The numerator are patients who were prescribed opioid/narcotic therapy as first line treatment (as defined by a prescription in anticipation of or at time of surgery) for postoperative pain management by the reconstructing surgeon (inverse measure).
Q. What is the denominator?
A. All procedures in patients aged 18 and older with a diagnosis of skin cancer where intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection were performed.
Q. Are there any exceptions for this measure?
A. Yes. Medical reason exception for patients who cannot take non-opioid pain medications or greater than 3 skin cancer sites treated or reconstructed in one day of service.
Q. Are there any exclusions for this measure?
A. Yes, they include:
Location exclusion due to high tension closure and anticipated exceptional postsurgical pain (lower extremity, scalp, ear, genitals, perineum, lip, and nail unit)
Surgical procedures associated with anticipated exceptional post-surgical pain
Flaps greater than 30 square cm*
Split thickness skin grafts greater than 10 square cm*
Paramedian forehead flap*
Composite graft*
* These exclusions only apply to reconstruction.
Q. Is this an inverse measure?
A. Yes, where a lower score indicates higher quality.
Q. As a dermatologist (non-Mohs surgeon) will I be eligible to report AAD18 for MIPS for skin cancer excisions I perform in the office?
A. Yes, dermatologists that are non-Mohs surgeons could report these measures, but it will depend on your patient population and the types of procedures you perform. Measure AAD18 is related to intermediate layer, complex linear, and reconstruction after skin cancer resection procedures, not the malignant excision (11600, etc.) type procedures. A list of the eligible procedures can be found in the specifications on the measure page.
List of narcotic/opioid medications that should not be prescribed
The following narcotic/opioid medications should not be prescribed: morphine, oxycodone, fentanyl, oxymorphone, hydromorphone, buprenorphine, meperidine, codeine, butorphanol, tramadol, levophanol, sufentanil, pentazocine, tapentadol, and hydrocodone.
Calculation
The numerator: Patients who were prescribed opioid/narcotic therapy as first line treatment (as defined by a prescription in anticipation of or at time of surgery) for postoperative pain management by the reconstructing surgeon (inverse measure)
The denominator: All procedures in patients aged 18 and older with a diagnosis of skin cancer where intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection were performed.
Measure calculation example
Dr. Diaz saw 17 adult patients who underwent reconstruction after skin cancer resection. This is the denominator.
Of those 17, a total of 6 patients were prescribed opioid/narcotic therapy as a first line treatment for post-operative pain management. This is the numerator.
Quality of patient care = 6/17. Dr. Diaz has a score of 35.3% for this measure. This translates to 0 points. But the practice could receive 3 points if a small practice.
Important note
This is an inverse measure where a lower score indicates higher quality. Physicians must score a perfect 0% to earn the maximum of 10 points available. Any score higher than 0% will earn 0 points. Clinicians score 3 points even if they report on only one patient. This is applicable only to small practices with 15 providers or fewer.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
| Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
|
0 |
||||||||
Points |
1 - 1.9 |
2 - 2.9 |
3 - 3.9 |
4 - 4.9 |
5 - 5.9 |
6 - 6.9 |
7 - 7.9 |
8 - 8.9 |
9 - 9.9 |
10 |
