SPC
To fall into the SPC denominator, a male patient must be within this age range.
Ages 21-75?
These patients fall into the SUPD measure.
Patients with diabetes ages 40–75, regardless of male or female.
What age range of women with a fracture put them in the OMW measure?
Ages 67 - 85.
What age group (male or female) qualify for the A1c measure?
What is 18-75?
How many fills of hypertension, diabetes, or cholesterol medication does a patient have to have filled through part d to fall in one of the MAH, MAD, or MAC measures?
What is 2?
Unlike males, the age requirement for females in the SPC measure is this.
Ages 40-75?
Which intensity of Statin does a patient have to be on to fulfill this measure?
Any intensity: low, medium, or high.
If the woman has a fracture, how many months from the fracture date do we have to fulfill the measure requirements?
What is 6 months?
What range does an A1c need to be under to fulfill the measure?
What is less than 9.
If a female isn't 75 until December 31st of the measurement year, will they still fall into the BCS measure?
Yes
Which intensity of Statin does a patient have to be on to fulfill this measure?
What is medium or high intensity?
Does myalgia count as an exclusion for this measure?
No
What needs to happen within 6 months from the fracture date for the measure to be fulfilled?
The patient needs to have a DEXA scan or be prescribed one of the approved medications AND have it filled through part D.
Which kinds of blood sugar testing are approved to fulfill the A1c measure?
What are: A1c blood drawn, A1c POC (Point of Care), or CGM (Continuous Glucose Monitor)
If a SUPD or SPC task in coop is dispositioned as "not applicable. Provider noted exclusion. Exclusion diagnosis is typed in" will that exclude the patient from the measure?
No. The navigator then has to ensure the exclusionary diagnosis code gets billed to the insurance. That means the navigator needs to have a conversation with: the provider, the office manager, the biller, or whomever in the office ensures chart notes are accurate before billing goes out to insurance.
To be included in the SPC measure, a patient must have had a diagnosis billed for one of the following during what measurement period?
Myocardial infraction (MI)
Coronary artery bypass graft (CABG)
Percutaneous coronary intervention (PCI)
Other revascularization
What is the year prior to the measurement year?
How many fills of a statin, through part D, in the measurement year will fulfill this measure?
What is one?
If the patient had a DEXA _______ months prior to the fracture date, they are excluded from the measure.
What is 24 months?
If using a CGM to fulfill the A1c measure, how many days of readings are required to obtain the GMI (Glucose Management Indicator)?
What is 14?
Does a Bone Scan fulfill the OMW measure?
No, has to be a DEXA.
To be included in the SPC measure, a patient must have had a diagnosis billed for Ischemic vascular disease (IVD) during what measurement period?
Both measurement year and year prior to the measurement year?
This measure must be fulfilled which way (choose one):
* Patient or provider reported data
* Office note stating the pt. was prescribed a med
* Part D claim of a med
What is a part D claim of a med?
If the patient had one of the approved OMW medications filled through part d ________ months before the fracture date, the patient is excluded from the measure.
What is 12?
True or False?
Member-reported GMI results can be documented in the member’s medical record and do not need to be collected by a PCP or specialist.
True
Name one of the Diagnoses that excludes a patient from the SUPD and SPC measure.
What is: Hospice, ESRD, Dialysis status, rhabdomyolysis, myositis, myopathy, pregnancy, fertility treatments, cirrhosis.