Use of Opioids from Multiple Providers in Persons Without Cancer

CBE ID

2950

Endorsement Status

Endorsement Removed

E&M Committee Rationale/Justification

Steward no longer seeking to maintain endorsement

1.0 New or Maintenance

Maintenance

1.1 Measure Structure

Single Measure

Previous Endorsement Cycle

Full Year 2015

Is Under Review

1.6 Measure Description

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids from four (4) or more prescribers AND four (4) or more pharmacies.

Measure Specs

General Information

1.7 Measure Type

Process

1.3 Electronic Clinical Quality Measure (eCQM)

1.8 Level of Analysis

Health Plan

Other

1.9 Care Setting

Other

1.20 Types of Data Sources

Claims Data

Numerator

1.14 Numerator

Any member in the denominator who received opioid prescription claims from 4 or more prescribers AND 4 or more pharmacies.

Denominator

1.15 Denominator

Any member with two or more prescription claims for opioids filled on at least two separate days, for which the sum of the days supply is greater than or equal to 15.

Exclusions

Any member with a diagnosis for Cancer or a Prescription Drug Hierarchical Condition Category (RxHCC) 8, 9, 10, or 11 for Payment Year 2015; or RxHCC 15, 16, 17, 18, or 19 for Payment Year 2016; (see list in S.11 and S.2b); or a hospice indicator from the enrollment database.

Measure Record

Most Recent Endorsement Activity

Endorsed Patient Safety Project 2015-2017, Phase 3

Initial Endorsement

2017-01