Measure 238
Use of High-Risk Medications in Older Adults
DESCRIPTION:
Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.
| MEASURE ID: | 238 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | No |
| High priority: | Yes |
| Topped out: | Yes |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR or EHR |
| Maximum points: | 7 |
MEASURE PURPOSE:
This 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. Certain medications are associated with increased risk of harm from drug side-effects and drug toxicity in patients 65 and older. The measure encourages clinicians to avoid ordering two or more high-risk medications from the same drug class to this population.
Measure 238 FAQs
Q. Is this measure reportable via claims?
A. No.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes. This measure is telehealth eligible. Patient encounters conducted via telehealth using encounter codes found in the denominator criteria are allowed. If the patient meets all denominator criteria for a telehealth encounter, it is appropriate to include them in the denominator eligible patient population.
Q. The measure says to report once per performance period. Is the performance period a year?
A. Yes. The performance period for this measure is 12 months. This measure is to be submitted a minimum of once per performance period for denominator eligible cases.
Q. This is listed as an inverse measure. What does that mean?
A. An inverse measure means a lower calculated performance rate indicates better clinical care. The “Performance Not Met” numerator option represents the better clinical outcome. Submitting that option will produce a performance rate trending closer to 0% as quality increases. A rate of 100% means all denominator eligible patients did not receive appropriate care.
Q. How many submission criteria and performance rates does this measure have?
A. This measure contains two strata defined by two submission criteria and produces two performance rates. For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 1 is used for performance.
Q. If a patient had a high-risk medication previously prescribed by another provider, does that count toward the numerator?
A. No. If the patient had a high-risk medication previously prescribed by another provider, it would not count toward the numerator unless the submitting provider also ordered a high-risk medication for them from the same drug class.
Q. If the measure is submitted more than once for the same patient, which result is used?
A. The most advantageous quality data code (QDC) will be used if the measure is submitted more than once for the same patient during the performance period.
Q. A row in the medication table has only one medication listed. Does that still qualify as a drug class?
A. Yes. A row with one medication is considered a group (or drug class) of one. Therefore, two orders of that same medication are numerator compliant.
Q. How is “Average Daily Dose” calculated for Table 3 medications?
A. Multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a 30-day supply of digoxin containing 15 pills at 0.25 mg each has an average daily dose of 0.125 mg. For elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.
Q. How is “Cumulative Medication Duration” calculated for Table 2 medications?
A. Determine the number of Medication Days for each prescription (doses divided by dose frequency per day), then add the Medication Days for each prescription without counting any gaps between prescriptions. For example: an original prescription for 30 days with 2 refills of 30 days each, then after a 3-month gap, a 60-day prescription with 1 refill of 60 days = (30×3) + (60×2) = 210 days cumulative medication duration.
Calculation
Important — Inverse Measure: “Performance Not Met” is the representation of better clinical quality. Submitting that numerator option produces a performance rate trending toward 0%, which indicates higher quality care.
Criteria 1
The numerator: Patients ordered at least two high-risk medications from the same drug class during the measurement year (Tables 1, 2, and 3).
The denominator: All patients 65 years of age and older who had a visit during the measurement period.
Criteria 2
The numerator: Patients with at least two orders of high-risk medications from the same drug class (antipsychotics and benzodiazepines — Table 4), except for appropriate diagnoses.
The denominator: All patients 65 years of age and older who had a visit during the measurement period.
Note: For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 1 is used for performance. Criteria 2 captures antipsychotics and benzodiazepines only, with allowances for specific appropriate diagnoses.
Measure calculation example
Dr. Smith has 180 patients aged 65 and older seen during the performance period. This is the denominator.
Of those, 9 patients were ordered at least two high-risk medications from the same drug class. This is the numerator.
The performance rate = 9 ÷ 180 = 5.0%. This score translates to 1.0 to 1.9 points when reporting by registry.
Important note
Inverse Measure: “Performance Not Met” is the representation of better clinical quality. Submitting that numerator option produces a performance rate trending toward 0%, which indicates higher quality care.
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.
Benchmarks for registry submissions
The table below shows CMS benchmarks for registry submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | |
|---|---|---|---|---|---|---|---|
Performance rate |
9.62 - 0.03 |
0.02 - 0.01 |
-- |
-- |
-- |
-- |
0 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
6.0 - 6.9 |
7 |
Benchmarks for EHR submissions
The table below shows CMS benchmarks for EHR submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | |
|---|---|---|---|---|---|---|---|
Performance rate |
30.71 - 15.86 |
15.85 - 10.17 |
10.16 - 5.24 |
5.23 - 2.03 |
2.02 - 0.67 |
0.66 - 0.15 |
0.14 - 0 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
6.0 - 6.9 |
7 |
