Measure Title: Avoidance of Long-Acting (LA) or Extended-Release (ER) Opiate Prescriptions and Opiate Prescriptions for Greater Than 3 Days Duration for Acute Pain
Measure Description: Percentage of Adult Patients Who Were Prescribed an Opiate Who Were Not Prescribed a Long-Acting (LA) or Extended-Release (ER) Formulation and for Whom the Prescription Duration Was Not Greater than 3 days for Acute Pain
Denominator:Any patient ≥ 18 years of age evaluated by the Eligible Professional in Emergency Department, Urgent Care Clinic, or Outpatient Clinic settings (E/M Codes 99202-99205, 99212-99215, 99281-99285, 99291-99292 AND Place of Service Indicator: 02, 10, 11, 19, 20, 22 or 23 or equivalent in standardized code sets)
PLUS
• Opiate prescribed (VE284)
PLUS
20 Last Updated: 12.2.2024
• ICD-10 diagnosis codes for pain, strains, sprains, lacerations, open wounds and fractures (see
Appendix B for codes)
PLUS
• Disposition of Discharged
Numerator: Patients who were not prescribed a long-acting (LA) or extended-release (ER) opiate, and not prescribed an opiate and any opiate prescription for greater than 3 days duration
Denominator Exclusions: None
Denominator Exceptions: LA/ER formulation opiate prescribed for terminal (late-stage) cancer, comfort care measures, palliative care, or coordinated plan of care for Medication Assisted Treatment (MAT)
NQF ID Number: N/A
NQS Domain: Effective Clinical Care
High Priority Measure: Yes
Measure Type: Process
Includes Teleheatlh: Yes
Inverse Measure: No
Proportional Measure: Yes
Continuous Variable Measure: No
Ratio Measure: No
Number of performance rates to be calculated and submitted: 1
Risk-Adjusted Status: No
Care Setting: Ambulatory; Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Ambulatory Care: Urgent Care; Emergency Department and Services; Hospital; Hospital Outpatient; Outpatient Services
Submission Pathway: Traditional MIPS