ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS

Transcription

1 ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE What screening should be done? NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? HEDIS (Administrative) To identify members who received at least 180 treatment days on one of the following: - Angiotensin converting enzyme (ACE) / angiotensin receptor blockers (ARB) - Digoxin - Diuretics And of those, how many received at least one agent-appropriate therapeutic monitoring event during the measurement year. Members 18 years and older as of December 31st of the measurement year Members who have been prescribed an ACE/ARB, digoxin, or diuretics for 180 days should have at least one serum potassium and either a serum creatinine or a blood urea nitrogen (BUN) therapeutic monitoring test during the measurement year. Please see code table. ACE/ARB, DIGOXIN, DIURETICS A comprehensive list of each drug class is included below. A code for a lab panel test during the measurement year. A code for a serum potassium and a code for serum creatinine during the measurement year. A code for a serum potassium, a code for serum creatinine and a code for serum digoxin during the measurement year. The medical record should show which medication has been prescribed to the member, as well as the date of service and the results of a lab panel; serum potassium and

2 REFERENCES serum creatinine; or a serum creatinine, potassium and serum digoxin monitoring test for the prescribed drug during the measurement year. Each test should occur at least once during the measurement year. For more information, please refer to Passport Health Plan s Clinical Practice Guideline. The criteria above are based on standards established under NCQA s HEDIS 2017 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). *If you have questions about medications or our formulary, please visit our website or contact: o Paula Straub, Outreach Pharmacist Consultant (contracted) pstraub@phdelivery.com or phone o Cheryl Stevens, Outreach Pharmacisit Consultant (contracted)-covers regions 1,2,4,7 & 8. cstevens@phdelivery.com or phone Table CDC-L: ACE Inhibitors/ARBs Description Angiotensin converting enzyme inhibitors Angiotensin II inhibitors Antihypertensive combinations Benazepril Captopril Enalapril Fosinopril Prescription Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan Aliskiren-valsartan Amlodipine-valsartan Hydrochlorothiazide-lisinopril Amlodipine-benazepril Benazeprilhydrochlorothiazide Hydrochlorothiazide-moexipril Hydrochlorothiazide-losartan Amlodipinehydrochlorothiazidevalsartahydrochlorothiazidolmesartan Candesartan- Hydrochlorothiazide- Amlodipine- Captopril-hydrochlorothiazide Hydrochlorothiazide-quinapril hydrochlorothiazide- olmesartan Eprosartantelmisartan Enalapril-hydrochlorothiazide Hydrochlorothiazide- Amlodipine-olmesartan hydrochlorothiazide Hydrochlorothiazide-valsartan Amlodipine-telmisartan Fosinopril-hydrochlorothiazide Trandolapril-verapamil Azilsartan-chlorthalidone Hydrochlorothiazideirbesartan Table MPM-B: Drugs to Identify Members on Digoxin Description Prescription

3 Inotropic agents Digoxin Table MPM-C: Drugs to Identify Members on Diuretics Description Antihypertensive combinations Loop diuretics Potassium-sparing diuretics Thiazide diuretics Prescription Aliskiren-hydrochlorothiazide Fosinopril-hydrochlorothiazide Aliskiren-hydrochlorothiazideamlodipine Hydrochlorothiazide-lisinopril Hydrochlorothiazide-irbesartan Amiloride-hydrochlorothiazide Hydrochlorothiazide-losartan Amlodipine-hydrochlorothiazideolmesartan Hydrochlorothiazide-metoprolol Hydrochlorothiazide-methyldopa Amlodipine-hydrochlorothiazidevalsartan Hydrochlorothiazide-olmesartan Hydrochlorothiazide-moexipril Atenolol-chlorthalidone Hydrochlorothiazide-propranolol Azilsartan-chlorthalidone Hydrochlorothiazide-quinapril Benazepril-hydrochlorothiazide Hydrochlorothiazide-spironolactone Bendroflumethiazide-nadolol Hydrochlorothiazide-telmisartan Bisoprolol-hydrochlorothiazide Hydrochlorothiazide-triamterene Candesartan-hydrochlorothiazide Hydrochlorothiazide-valsartan Captopril-hydrochlorothiazide Chlorthalidone-clonidine Enalapril-hydrochlorothiazide Eprosartan-hydrochlorothiazide Bumetanide Furosemide Ethacrynic acid Torsemide Amiloride Spironolactone Eplerenone Chlorothiazide Chlorthalidone Triamterene Hydrochlorothiazide Indapamide Methyclothiazide Metolazone

4 ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS Meet Screening Criteria Lab Panel CPT CPT CPT CPT CPT Serum Potassium CPT CPT LOINC Potassium [Moles/volume] in Serum or Plasma --2nd specimen LOINC Potassium [Moles/volume] in Serum or Plasma --3rd specimen LOINC Potassium [Mass/volume] in Serum or Plasma LOINC Potassium [Moles/volume] in Serum or Plasma LOINC Potassium [Moles/volume] in Red Blood Cells LOINC Potassium [Moles/volume] in Serum or Plasma --post dialysis LOINC Potassium [Moles/volume] in Arterial blood LOINC Potassium [Moles/volume] in Venous blood LOINC Potassium [Moles/volume] in Capillary blood LOINC Potassium [Moles/volume] in Mixed venous blood LOINC Potassium [Moles/volume] in Serum or Plasma --pre dialysis LOINC Potassium [Moles/volume] in Blood LOINC Potassium [Mass/volume] in Blood Serum Creatinine CPT CPT LOINC Creatinine [Mass/volume] in Serum or Plasma --post dialysis LOINC Creatinine [Mass/volume] in Serum or Plasma --pre dialysis LOINC Creatinine renal clearance/1.73 sq M in 24 hour LOINC Creatinine renal clearance in 4 hour LOINC Creatinine renal clearance in 6 hour LOINC Creatinine renal clearance in 8 hour LOINC Creatinine renal clearance/1.73 sq M in 4 hour LOINC Creatinine renal clearance/1.73 sq M in 6 hour

5 LOINC Creatinine renal clearance/1.73 sq M in 8 hour LOINC Creatinine renal clearance/1.73 sq M in 12 hour LOINC Creatinine [Moles/volume] in Serum or Plasma LOINC Creatinine [Mass/volume] in Serum or Plasma --2 hour specimen LOINC Creatinine [Mass/volume] in Serum or Plasma --4 hour specimen LOINC Creatinine [Mass/volume] in Arterial blood LOINC Creatinine [Mass/volume] in Serum or Plasma LOINC Creatinine renal clearance in 12 hour LOINC Creatinine renal clearance in 24 hour LOINC Creatinine renal clearance in 2 hour LOINC Creatinine/Urea nitrogen [Mass Ratio] in Serum or Plasma LOINC Creatinine renal clearance in collected for unspecified duration LOINC Creatinine [Mass or Moles/volume] in Serum or Plasma LOINC Creatinine renal clearance predicted by Cockcroft-Gault formula LOINC Creatinine renal clearance/1.73 sq M.predicted by Cockcroft-Gault formula, BSA formula LOINC Creatinine renal clearance/1.73 sq M in collected for unspecified duration LOINC Creatinine renal clearance/1.73 sq M in 2 hour LOINC Creatinine [Mass/volume] in Blood LOINC Creatinine [Mass/volume] in Serum or Plasma --pre XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours pre XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --1 hour pre XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --45 minutes pre XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --30 minutes pre XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --45 minutes post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --4 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --8 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --9 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --10 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --12 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --16 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --18 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --2 days post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --4 days post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --7 days post XXX challenge

6 LOINC Creatinine [Moles/volume] in Serum or Plasma --pre XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma hours pre XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --1 hour pre XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --45 minutes pre XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --30 minutes pre XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --45 minutes post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --4 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --8 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --9 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --10 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --12 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --16 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --18 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --2 days post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --4 days post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --7 days post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --baseline LOINC Creatinine [Mass/volume] in Serum or Plasma --30 minutes post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --1 hour post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --2 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --3 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --5 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --6 hours post XXX challenge LOINC Creatinine [Mass/volume] in Serum or Plasma --1 day post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --baseline LOINC Creatinine [Moles/volume] in Serum or Plasma --30 minutes post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --1 hour post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --2 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --3 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --5 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --6 hours post XXX challenge LOINC Creatinine [Moles/volume] in Serum or Plasma --1 day post XXX challenge LOINC Creatinine [Mass/volume] (Maximum value during study) in Serum or Plasma LOINC Creatinine renal clearance/1.73 sq M predicted among females by Cockcroft- Gault formula, BSA formula

7 LOINC Creatinine renal clearance/1.73 sq M predicted among males by Cockcroft-Gault formula, BSA formula LOINC Creatinine [Moles/volume] in Serum or Plasma --pre dialysis LOINC Creatinine [Moles/volume] in Serum or Plasma --post dialysis LOINC Creatinine [Moles/volume] in Blood LOINC Creatinine reduction ratio in Serum or Plasma LOINC Creatinine [Moles/volume] in Serum or Plasma --post XXX challenge Digoxin Level CPT LOINC Digoxin [Mass/volume] in Serum or Plasma LOINC Digoxin>12 hours post dose [Mass/volume] in Serum or Plasma