Query of Prescription Drug Monitoring Program (PDMP) | MIPS PI Measures for 2020 Reporting

Definition of Terms

Prescription:
The authorization by a MIPS eligible clinician to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization.

Permissible Prescriptions:
  All drugs meeting the current definition of a prescription as the authorization by a clinician to dispense a drug that would not be dispensed without such authorization and may include electronic prescriptions of controlled substances where creation of an electronic prescription for the medication is feasible using CEHRT and where allowable by state and local law.

Opioids:
Schedule II controlled substances under 21 CFR 1308.12, as they are recognized as having a high potential for abuse with potential for severe psychological or physicaldependence.

PDMP:
an electronic database that tracks prescriptions of controlled substances at the State level.

Reporting Requirements

YES/NO
The MIPS eligible clinician must attest YES to conducting a query of a PDMP f or at least one Schedule II opioid electronically prescribed using CEHRT to earn the bonus points.

Scoring Information

Required for Promoting Interoperability Performance Category Score: No
Measure Score: N/A
Eligible for Bonus Score: Yes,5 points

Note:  In order to earn a score greater than zero for the Promoting Interoperability performance category, MIPS eligible clinicians must:

• Submit a “yes” to the Prevention of Information Blocking Attestations; and
• Submit a “yes” to the ONC Direct Review Attestation, if applicable; and
• Submit a “yes” that they have completed the Security Risk Analysis measure during the calendar year in which the MIPS performance period occurs; and
• Report the required measures from each of the four objectives.

Additional Information

• MIPS eligible clinicians must use 2015 Edition CEHRT. The 2015 Edition functionality must be in place by the first day of the performance period and the product must be certified to the 2015 Edition criteria by the last day of the performance period. The MIPS eligible clinicians must be using the 2015 Edition functionality for the full performance period. In many situations, the product may be deployed, but pending certification.
• MIPS eligible clinicians are required to report certain measures from each of the four objectives, with performance-based scoring occurring at the individual measure-level. Each measure is scored based on the MIPS eligible clinician’s performance for that measure, based on the submission of a numerator/denominator,  or a    “yes or no” statement.
• MIPS eligible clinicians must query the PDMP and report a “yes” in order to earn a 5 point bonus.
• Actions must occur within the performance period.
• More information about Promoting Interoperability performance category scoring is available on the QPP website.
• Query of the PDMP for prescription drug history must be conducted prior to the electronic transmission of the Schedule II opioid prescription.
• MIPS eligible clinicians have flexibility to query the PDMP using data from CEHRT in any manner allowed under their State law.
• Includes all permissible prescriptions and dispensing of Schedule II opioids regardless of the amount prescribed during an encounter.
• When MIPS eligible clinicians choose to report as a group, data should be aggregated for all MIPS eligible clinicians under one Taxpayer Identification Number (TIN). This includes those MIPS eligible clinicians who may qualify for reweighting through an approved Promoting Interoperability hardship exception, hospital or ASC-based status, or in a specialty which is not required to report data to the Promoting Interoperability performance category.

Regulatory References

For further discussion, please see the 2018 Physician Fee Schedule final rule – Quality Payment Program final rule:  83 FR 59788. 

In order to meet this measure, MIPS eligible clinicians must use the capabilities and standards of CEHRT at 45 CFR 170.315 (a)(10) and (b)(3).

Certification Standards and Criteria

Below are the corresponding certification criteria and standards for electronic health record technology that support this measure.

Certification Criteria:
nformation about certification for 2015 Edition CEHRT can be found at the links below:
§170.315(a)(10) Drug-Formulary and Preferred Drug List checks
§170.315(b)(3) Electronic Prescribing

Standards Criteria:
Standards for 2015 Edition CEHRT can be found at the ONC’s 2015 Standards Hub:
https://www.healthit.gov/topic/certification/2015-standards-hub