Reduction in Suicidal Ideation or Behavior Symptoms

Measure Specification

Mental and substance use disorders are among the 25 leading causes of years lived with disability and contribute significantly to the global burden of disease. Specifically, 19% of U.S. adults (46.6 million individuals aged 18 and older) have a mental illness and 7.6% (18.7 million individuals aged 18 and older) have a substance use- disorder. Mental and substance use disorders often co-occur with about 8.

5 million adults aged 18 and older in the US having both conditions. Individuals with mental and/or substance use disorders are at high risk for suicide - a leading cause of death in the US and a preventable cause of lost lives. For the past 20 years death by suicide has increased significantly with more than 40,000 Americans dying by suicide each year and reaching over 47,000 in 2018.

Adding alarm to this issue is the even greater number of Americans who attempt suicide each year (i.e., 20 to 25 times more than the number of suicide) and the resulting health consequences including the group’s 2-4 times increased risk for dying by suicide. An even greater proportion of Americans (~100X) have serious thoughts of suicide. This measure encourages the provision of evidence-based care to individuals presenting to a number of health professionals across a variety of settings for the assessment and care of their mental or substance use disorders.

More specifically, the proposed measure aims to avert or reduce the risk of suicide and associated outcome (i.e., suicide attempts) in this population that is at high risk for suicide and suicide attempts. The measure emphasizes patient- centered quality care, which is important for combating these prevalent and preventable outcomes that affect thousands of Americans each year.

Suicidal ideation and behavior should be assessed using the Columbia-Suicide Severity Rating Scale 'Screen Version' or the 'Since Last Visit' version of the C-SSRS (CSSR, 2008). The C-SSRS is a patient self-reported tool that asks about wish for death, thoughts of suicide, suicidal thoughts with method without specific thoughts or intent, suicidal intent without and with specific plan, and suicide behavior.

The C-SSRS “score” for the current measure is the sum of all the Yes/No items (Yes = 1, No = 0) if using the ‘Screen Version’ or intensity of ideation if using the ‘Since Last Visit’ version. A non-zero on questions 1 or 2 of either C-SSRS version qualifies as at risk. C-SSRS ‘Screen Version’ available at: https://www.cms.gov/files/document/cssrs-screen-version-instrument.

pdf C-SSRS ‘Since Last Visit’ available at: https://cssrs.columbia.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.