Mount Carmel Health Partners HEDIS Tip Sheets - Page 23

HEDIS Tip Sheet Osteoporosis Management in Women Who Have Had a Fracture Definition: Percentage of women 67 – 85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test [DEXA scan] or prescription for a drug to treat or prevent osteoporosis within the six months after the fracture. The fracture must have occurred between July 1 prior to the measurement year and June 30 of the measurement year. Service Needed: Testing or treatment for osteoporosis after the fracture: • A BMD test [DEXA scan] on the date of fracture or within the 180-day (6-month) period after. • A BMD test [DEXA scan] during the inpatient stay for the fracture (applies only to fractures requiring hospitalization). • A dispensed prescription to treat osteoporosis on the date of fracture or within the 180-day (6-month) period after. Exclusions: • Fractures of the fingers, face, skull, or toes are not included in this measure. • A diagnosis/claim for osteoporosis or filled prescription for osteoporosis in the twelve months prior to the fracture within the eligible time period OR a BMD test [DEXA scan] within 24 months prior to the fracture. • Hospice care in the measurement year. Chart Review Tips: • Look for any exclusions. If exclusions are identified, please note it for future reference. • BMD tests [DEXA scan] can be found in the "Radiology" section of the chart. • Osteoporosis medications can be found in the "Medications" section of the chart or noted in recent office visit /progress note. Member Outreach Tips: • If the patient has had a fracture and has no exclusions, ask if she has had a BMD test or is taking medications for the fracture. If she is not, encourage her to schedule an appointment with her doctor to discuss a BMD test [DEXA scan] or medications to strengthen her bones. Supplemental Data Tips A list of Osteoporosis medications are shown below. Description Biphosphonates Other agents Prescription • Alendronate (Fosamax) • Alendronate-cholecalciferol (Fosamax Plus D) • Calcium carbonate-risedronate (Actonel with calcium) • Calcitonin (Fortical, Miacalcin) • Denosumab (Prolia, Xgeva) • Ibandronate (Boniva) • Risedronate (Actonel) • Zoledronic acid (Reclast, Zometa) • Raloxifene (Evista) • Teriparatide (Forteo) 23