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Asthma Medication Ratio

EHP, Priority Partners / VBP, and USFHP. Members age 5–64 years of age.

The percentage of members 5-64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 50% or greater during the measurement year.

Best Practice and Measure Tips

Schedule follow-up appointments:

  • Ensure the patient is not using more rescue medications than preventive medication to control their asthma (i.e., rescue meds have 50 percent less usage than preventive meds)
  • Report the appropriate diagnosis codes for the member’s condition. Include the appropriate codes for diagnosed conditions that may exclude the member from this measure.
  • Ensure at least half of the medications dispensed to treat their asthma are controller medications throughout the treatment/measurement period. 

Patient is considered to have persistent asthma if they have any of the following:

  • At least 1 ER visit with a principal diagnosis of asthma; 
  • At least 1 acute inpatient encounter with a principal diagnosis of asthma;
  • At least 1 inpatient discharge with a principal diagnosis of asthma on the discharge claim;
  • At least 4 outpatient visits, observation visits, telephone visits or e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least 2 asthma medication dispensing events for any controller or reliever medication;
  • At least 4 asthma medication dispensing events for any controller or reliever medications. 

Measure Exclusions

Required Exclusions:  Any of the below anytime during a member’s history through Dec. 31 of the measurement year:

  • Acute respiratory failure
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic respiratory conditions due to fumes/vapors
  • Cystic fibrosis
  • Emphysema
  • Obstructive chronic bronchitis
  • Other emphysema
  • Members who weren’t prescribed an asthma medication any time during the measurement year.

Measure Codes

Examples of persistent asthma codes include: J45.30-32, J45.40-42, J45.50-52.

Exclusion Codes:

  • COPD
    • ICD-10: J44.0, J44.1, J44.9
  • Cystic fibrosis
    • ICD-10: E84.0, E84.11, E84.19, E84.8, E84.9
  • Acute respiratory failure
    • ICD-10: J96.0-J96.02, J96.20-J96.22
  • Emphysema
    • ICD-10: J43.0-J43.2, J43.8, J43.9, J98.2-J98.3
  • Obstructive chronic bronchitis
    • ICD-10: 491.20 -491.22
  • Chronic respiratory conditions
    • ICD-10: J68.4

Measure Medications

  • Asthma Reliever Medications Short-acting, inhaled beta-2 agonists:
    • Albuterol
    • Levalbuterol Controller Medications Antiasthmatic combinations
  • Dyphylline-guaifenesin Antibody inhibitors
  • Omalizumab Anti-interleukin-4
  • Dupilumab Anti-interleukin-5
  • Benralizumab, Mepolizumab, Reslizumab Inhaled steroid combinations
  • Budesonide-formoterol
  • Fluticasone-salmeterol
  • Fluticasone-vilanterol
  • Formoterol-mometasone Inhaled corticosteroids
  • Beclomethasone
  • Budesonide
  • Ciclesonide
  • Flunisolide
  • Fluticasone
  • Mometasone Leukotriene modifiers
  • Montelukast
  • Zafirlukast
  • Zileuton Methylxanthines
  • Theophylline