AMA weighs in on new opioid prescribing eCQM

American Medical Association (AMA) executive vice president and CEO James L. Madara, M.D., recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) to address a new electronic quality measure (eCQM) that reads “potential opioid overuse, percentage of patients aged 18 years or older who receive opioid therapy for 90 days or longer and who are prescribed a 90 milligram or greater morphine milligram equivalent (MME) daily dose.”

In his February 9 correspondence to CMS Administrator Seema Verna, Dr. Madara said that, “The AMA does not agree with the fundamental premise of this measure that daily dose and duration of therapy involving prescription opioid analgesics can serve on its own as a measure of quality patient care. Instead, quality measurement needs to focus on how well patients’ pain is controlled, whether functional improvement goals are met, and what therapies are being used to manage pain. If pain can be well-controlled and function improved without the need of high doses of opioids over a long period of time, that is an indication of good patient care; but a reduction in opioid dose alone is not an appropriate goal.”

Dr. Madara also stressed that “AMA believes that significant revisions and testing are required prior to implementing this measure in any federal program. The measure as constructed implies that patients who do not receive => 90 MME/day over a 90-day period receive higher quality care.”

He added that, “Information on how the measure performed when tested must be released publicly in order for physicians and others to adequately evaluate this measure…Alternative measures or ones that provide complementary information on the quality of care should also be explored, such as the proportion of patients with acute or chronic pain whose pain was well controlled and/or functioning improved without needing > 90 MME opioids for > 90 days.”

And Dr. Madara emphasized that, “We are also concerned with the feasibility of directly calculating the measure from the electronic health record (EHR).”

Click for AMA letter to CMS on new opioid prescribing eCQM