eCQM: Use of High-Risk Medications in the Elderly (CMS 156v5)


Use of High-Risk Medications in the Elderly


CMS 156v5

Measure Type:


MIPS High Priority Measure:


Quality ID:


Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance Benchmark for MIPS:

0% (Zero Percent*)This eCQM is an inverse measure, which means a lower performance rate indicates better performance. In Practice Fusion’s eCQM Dashboard, the EHR displays an inverse performance rate for this measure to make it easier to quickly see how you are performing. This means that the measure percentage will increase as the measure numerator decreases. Specifically, a higher measure percentage and lower measure numerator are an indicator of better measure performance.  


Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported:

  1. Percentage of patients who were ordered at least one high-risk medication.
  2. Percentage of patients who were ordered at least two different high-risk medications.

  • Numerator 1: Patients with an order for at least one high-risk medication during the measurement period.
    Numerator 2: Patients with an order for at least two different high-risk medications during the measurement period.

  • Denominator: Patients 66 years and older who had an eligible visit (defined as a signed chart note with one of the following encounter types: Office Visit, Nursing Home Visit, Nurse Visit, or Home Visit) during the measurement period.

    • Denominator Exclusions: None

    • Denominator Exceptions: None

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 156v5 Use of High-Risk Medications in the Elderly are:

  • Initial patient population
  • Denominator
  • Numerator

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. Review the current medication list for all patients age 66 years and older at each encounter.

  2. If the patient is taking one of the high-risk medications as defined by the measure, determine if this medication is still appropriate for the patient. Examples of high-risk medications as defined by this measure include certain dosages and strengths of:

    1. Acetaminophen

    2. BUtabarbital sodium

    3. Diphenhydramine Hydrochloride

    4. Estrogens

  3. Prior to prescribing (which includes printed, recorded, and electronic prescriptions (eRx))  any of the high-risk medications defined by the measure to patients age 66 years and older, determine whether this is the most appropriate care for the patient.

To access a complete list of medications that are categorized as “high-risk” for the purposes of this measure, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

Additional Measure Information

  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:

    • Additional clarification added regarding the intent of the measure requirements, as detailed below:

    • The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them.

  • High-risk medications are those than can result in adverse events for seniors or medications that are clinically inappropriate for seniors. The measure numerator is calculated based on medications that are prescribed to patients who fall in the age range specified in the measure criteria. Patients will only be counted in the measure numerator if they have a printed, recorded, or electronic prescription (eRx) for the medication within the Practice Fusion EHR. A patient who has a medication without a recorded prescription will not be counted.

More Information


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