Quality ID #46 (NQF 0097): Medication Reconciliation Post-Discharge

– National Quality Strategy Domain: Communication and Care Coordination

– Meaningful Measure Area: Medication Management

2019 COLLECTION TYPE:

MEDICARE PART B CLAIMS

MEASURE TYPE:

Process – High Priority

DESCRIPTION:

• Submission Criteria 2: 65 years and older

• Total Rate: All patients 18 years of age and older

INSTRUCTIONS:

This measure is to be submitted at an outpatient visit occurring within 30 days of each inpatient facility discharge

date during the performance period. This measure is appropriate for use in the ambulatory setting only. There is no

diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System

(MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided

and the measure-specific denominator coding. This measure is not to be submitted unless a patient has been

discharged from an inpatient facility within 30 days prior to the outpatient visit.

This measure will be calculated with 3 performance rates:

facility, or rehabilitation facility) for patients 65 years and older seen within 30 days following discharge in

the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-

going care for whom the discharge medication list was reconciled with the current medication list in the

outpatient medical record

3) Total Rate (Overall Performance Rate): Percentage of discharges from any inpatient facility (e.g., hospital,

skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days

following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical

pharmacist providing on-going care for whom the discharge medication list was reconciled with the current

medication list in the outpatient medical record

Measure Submission Type:

DENOMINATOR:

All discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18

years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner,

registered nurse, or clinical pharmacist providing on-going care.

DENOMINATOR NOTE: This denominator is based on discharges followed by an office visit, not patients.

Patients may appear in the denominator more than once if there was more than one discharge followed by

an office visit in the performance period.

Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients 18-64 years of age on date of encounter

SUBMISSION CRITERIA 2: Patients aged 65 years and older on date of encounter

AND

Patient discharged from an inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation

facility) within the last 30 days

NUMERATOR (SUBMISSION CRITERIA 1 & 2 & 3):

Medication reconciliation conducted by a prescribing practitioner, clinical pharmacists or registered nurse on or within

30 days of discharge

Definition:

Medication Reconciliation – A type of review in which the discharge medications are reconciled with the

most recent medication list in the outpatient medical record. Documentation in the outpatient medical record

must include evidence of medication reconciliation and the date on which it was performed. Any of the

medications were prescribed or ordered upon discharge; (6) Documentation that patient was seen for post-

discharge follow-up with evidence of medication reconciliation or review, (7) Documentation in the discharge

summary that the discharge medications were reconciled with the current medications; the discharge

summary must be in the outpatient chart.

NUMERATOR NOTE: Medication reconciliation should be completed and documented on or within 30 days

of discharge. If the patient has an eligible discharge but medication reconciliation is not performed and

documented within 30 days, submit 1111F with 8P.

Numerator Quality-Data Coding Options:

Patient receiving Hospice Services, Patient Not Eligible:

Not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 1111F to submit circumstances when the

action described in the numerator is not performed and the reason is not otherwise specified.

Performance Not Met: 1111F with 8P: Discharge medications not reconciled with the current

medication list in outpatient medical record, reason

not otherwise specified

RATIONALE:

Medications are often changed while a patient is hospitalized. Continuity between inpatient and on-going care is

essential.

CLINICAL RECOMMENDATION STATEMENTS:

Hospital Medicine (Kripalani, 2007; Grennwald, 2010), ACOVE (Assessing Care of Vulnerable Elders; Knight, 2001),

and the Task Force on Medicines Partnership (2005). Additionally, measurement of medication reconciliation post-

discharge has been cited by the National Quality Forum and the National Priorities Partnership as a measurement

priority area (NQF, 2010)

No trials of the effects of physician acknowledgment of medications post-discharge were found. However, patients

are likely to have their medications changed during a hospitalization. Estimates suggest that 46% of medication

errors occur on admission or discharge from a hospital (Pronovost, 2003). Therefore, medication reconciliation is a

critical piece of care coordination post-discharge for all individuals who use prescription medications. Prescription

medication use is common among adults of all ages, particularly older adults and adults with chronic conditions. On

average, 82% of adults in the U.S. are taking at least one medication (prescription or nonprescription,

inpatient setting, and 32% of medications were not being taken at all. One survey study faulted the quality of

discharge communication as contributing to early hospital readmission, although this study did not implicate

medication discontinuity as the cause. (ACOVE)

Implementing routine medication reconciliation after discharge from an inpatient facility is an important step to ensure

medication errors are addressed and patients understand their new medications. The process of resolving

First, a medication list must be collected. It is important to know what medications the patient has been taking or

receiving prior to the outpatient visit in order to provide quality care. This applies regardless of the setting from which

the patient came — home, long-term care, assisted living, etc. The medication list should include all medications

(prescriptions, over-the-counter, herbals, supplements, etc.) with dose, frequency, route, and reason for taking it. It is

also important to verify whether the patient is actually taking the medication as prescribed or instructed, as

3) Have any new prescriptions been added today?

These questions should be reviewed by the physician who completed the procedure, or the physician who evaluated

and treated the patient.

• If the answer to all three questions is “no,” the process is complete.

• If the answer to any question is “yes,” the patient needs to receive clear instructions about what to do — all

changes, holds, and discontinuations of medications should be specifically noted. Include any follow-up

required, such as calling or making appointments with other practitioners and a timeframe for doing so

Institute for Healthcare Improvement (IHI)

COPYRIGHT:

This Physician Performance Measure (Measure) and related data specifications were developed by the National

Performance Rate in the Sample Calculation listed at the end of this document. Letter a