Product Lines:
Advantage MD.

Measurement Period: January 1 - December 31

Description:
The percentage of women 65–75 years of age who received osteoporosis screening.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 66–75 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: The measurement period and the year prior to the measurement period.
• Allowable Gap: No more than one gap of ≤45 days during each year of the continuous enrollment period. No gaps on the last day of the measurement period.

Denominator:
The initial population minus denominator exclusions.

Numerator:
One or more osteoporosis screening tests on or between the person’s 65th birthday and the last day of the measurement period

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

 

Best Practice and Measure Tips

• Ensure members without a diagnosis and who have not been treated for osteoporosis receive bone mineral testing.
• Educate member about bone health and adopting healthy practices:
  • Maintain a balance diet
  • Engage in weight-bearing exercises
  • Adequate Calcium and Vitamin D Intake
  • Preventing and avoiding falls
  • Review medications that may cause bone loss
  • Review diseases, conditions and medical procedures that may cause bone loss
  • Avoiding smoking and limiting alcohol.

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.[Members 66 years of age and older as of December 31 of the measurement year (all product lines) with frailty and advanced illness. 
• Persons 66 years of age or older by the last day of the measurement period, with both frailty and advanced illness.
• Medicare enrollees, 66 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 dispensed prescription to treat osteoporosis (Osteoporosis Medications List) any time on or between January 1 three years prior to the measurement period through the last day of the year prior to the measurement period.
• Persons who had a claim/encounter for osteoporosis therapy (Osteoporosis Medication Therapy; Long-Acting Osteoporosis Medications) any time in the person's history through the last day of the year prior to the measurement period.

Exclusion Codes

• Osteoporosis Medication Therapy Value Set
  • HCPCS: J0897, J1740, J3110, J3111, J3489, Q5136
• Long-Acting Osteoporosis Medications Value Set
  • HCPCS: J0897, J1740, J3489, Q5136

Exclusion Medications

Osteoporosis Medications

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

Measure Codes

Osteoporosis Screening Tests 

• CPT: 76977, 77078, 77080, 77081, 77085