Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP).

Measurement Period: January 1 - December 31

Description:
The percentage of women 67-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the 180 days (6 months) after the fracture. 

Fractures of finger, toe, face and skull are not included in this measure.

Measure Reporting:
CMS Start Rating Measure.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.
  

Initial Population:

• Measure Item Count: Person.
• Age: 67–85 years of age as of the last day of the measurement period.
• Gender/sex criteria: Administrative Gender of Female any time in the person’s history.
• Benefits: Medical and Pharmacy.
• Continuous Enrollment: 365 days prior to the episode date through 180 days after the episode date.
• Allowable Gap: No more than one gap of ≤45 days during the continuous enrollment period. No gaps on the episode date.
  

Definition: 
Active prescription: A prescription is considered active if the “days supply” indicated on the date when the person was dispensed the prescription is the number of days or more between that date and the relevant service date.

Direct transfer: When the discharge date from the first inpatient setting precedes the admission date to a second inpatient setting by 1 calendar day or less.

Episode date: The date of service for an eligible encounter during the intake period with a diagnosis of fracture. 
For an outpatient or ED visit, the episode date is the date of service.
For an inpatient stay, the episode date is the date of discharge. 
For direct transfers, the episode date is the discharge date from the last admission.

IESD - Index episode start date: The earliest episode date during the intake period that meets all initial population criteria.

Intake period: July 1 of the year prior to the measurement period to June 30 of the measurement period. The intake period is used to capture the first fracture.

Denominator:
Persons who have suffered a facture.
Persons who had either of the following during the intake period:

• An outpatient visit or ED visit for a fracture. 
• An acute or nonacute inpatient discharge with a fracture on the discharge claim.
  

Numerator:
Persons with appropriate testing or treatment for osteoporosis in the specified time frames.

• A BMD test, in any setting, on the IESD or in the 180-day period after the IESD. 
• If the IESD was an inpatient stay, a BMD test during the inpatient stay. 
• Osteoporosis therapy on the IESD or in the 180-day period after the IESD.
• If the IESD was an inpatient stay, long-acting osteoporosis therapy during the inpatient stay.
• A dispensed prescription to treat osteoporosis on the IESD or in the 180-day period after the IESD.
  

Summary of changes:
Added an administrative gender code to the initial population.

Best Practice and Measure Tips

• BMD test must take place within six months of the fracture.
• If the fracture resulted in an inpatient stay, a BMD test administered during the stay will close the care opportunity.
• Documentation that the medications aren’t tolerated is not an exclusion for this measure.
• If the fracture resulted in an inpatient stay, long-acting osteoporosis therapy administered during the stay will close the care opportunity.
• See members for an office visit as soon as possible after an event occurs.
• Osteoporosis medication must be filled using a member’s Part D prescription drug benefit.
• To help prevent women from being included in this measure incorrectly, please check that fracture codes are not used before a fracture has been verified through imaging.
• Submit a corrected claim to fix Fracture codes submitted in error to remove the member from measure. Note: This is the only way to remove member from measure.
• A referral for a BMD will not close this care opportunity.
• Women at risk for osteoporosis should receive a bone density screening every two years.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.
• Persons receiving Palliative Care or had an encounter for Palliative Care any time during the intake period through the last day of the measurement period.[Frailty: Members age 81 and older with frailty during the measurement year.
• Persons 67–80 years of age as of the last day of the measurement period, with both frailty and advanced illness.
• Persons 81 years of age and older as of the last day of the measurement period, with frailty.
• Medicare enrollees, 67 years of age and older by the last day of the measurement period, in an institutional SNP (I-SNP) or living long-term in an institution (LTI). 
• Persons who had a BMD test during the 24 months prior to the fracture
• Persons who had osteoporosis therapy during the 12 months prior to the fracture
• Persons who were dispensed a medication or had an active prescription for medication to treat osteoporosis during the 12 months prior to the fracture.
• An outpatient visit, ED visit, telephone visit, e-visit or virtual check-in, acute or nonacute inpatient episodes with a fracture during the 60-day period prior to the episode date.

Measure Codes

Bone Mineral Density Tests Value Set 

• CPT: 76977, 77078, 77080, 77081, 77085, 77086
• ICD-10-PCS: BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1
• LOINC: 100225-2, 101804-3, 101805-0, 104938-6, 24701-5, 24890-6, 24966-4, 38261-4, 38262-2, 38263-0, 38264-8, 38265-5, 38266-3, 38267-1, 46278-8, 46279-6, 46383-6, 80932-7, 80933-5, 80934-3, 80935-0, 80936-8, 80937-6, 80938-4, 80939-2, 80940-0, 80941-8, 80942-6, 80943-4, 80944-2, 80945-9, 80946-7, 80947-5, 80948-3, 80949-1, 80950-9, 80951-7, 80952-5, 80953-3, 80954-1, 80955-8, 80956-6, 83311-1, 85385-3, 85386-1, 85387-9, 85388-7, 85389-5, 85390-3, 85391-1, 85392-9, 85393-7, 85394-5[

Bone Mineral Density Test Result or Finding

• SNOMED CT US Edition: 385342005, 391059003, 391060008, 391061007, 391064004, 391065003, 391066002, 391069009, 391070005, 391071009, 391075000, 391076004, 391078003, 391079006, 391080009, 391081008, 391082001, 440083004, 440099005, 440100002, 449781000, 707218004, 1345131002[

Osteoporosis Medication Therapy Value Set 

• HCPCS: J0897, J1740, J3110, J3111, J3489, Q5136

Long-Acting Osteoporosis Medications Value Set 

• HCPCS: J0897, J1740, J3489, Q5136

Measure Medications

One of the following osteoporosis medications within 180 days of their discharge for a fracture:

Osteoporosis Medications

• Abaloparatide
• Alendronate
• Alendronate-cholecalciferol
• Denosumab
• Ibandronate
• Raloxifene
• Risedronate
• Romosozumab
• Teriparatide
• Zoledronic acid