BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.

Hints for HEDIS® (and more) is a reference tool developed to explore various quality topics, including:

• Definitions, specifications, and exclusions of the many quality measures;
• Billing codes used to report gap closure;
• Collection and reporting methodologies; and
• Tips and best practices to maximize gap closure.

Osteoporosis management in women who had a fracture (OMW)

Eligible population:

Women ages 67-85 who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis within six months of the fracture (does not include fractures to the finger, toe, face, or skull).

This measure applies to members enrolled in Medicare Advantage plans.

Measurement period:

Fractures between 1 de julio de 2020 – 30 de junio de 2021

NOTA: This measure’s date range begins the year prior. Fractures that occurred in 20 de julio20 need to be closed by 20 de enero21.

Measure process outline:

1. Patient identified as having a fracture.
2. PCP is notified of fracture.
3. PCP outreach to patient for follow-up:
   1. BMD test completed; or
   2. Prescribed osteoporosis medication*; or
   3. Contact Signify to schedule in-home heel scan

Process must be completed within six months of fracture to close the HEDIS gap in care.

Best practices

• The treatment period to close this gap is only six months from the date of fracture.
• A referral for a BMD will not close this gap.
• Women at risk for osteoporosis should be prescribed a bone density screening every two years. At-risk women include those who are:
  • At increased risk for falls or have a history of falls
  • Being monitored to assess their response to, or efficacy of, an FDA-approved osteoporosis drug therapy regime
  • Diagnosed with primary hyperparathyroidism
  • Estrogen deficient
  • On long-term steroid therapy

BCBSRI partners with Signify to close these gaps. To help the patient schedule an in-home heel scan at no cost, call 1-844-857-3955.

Codes to use

• CPT codes to identify BMD test – 76977, 77078, 77080, 77081, 77085, 77086
• HCPCS codes to identify osteoporosis medication – J0897, J1740, J3489, J3110, J3111

Nota: This measure can only be closed through claims/administrative data.

Exclusions

• Members enrolled in a hospice program, receiving palliative care, or living in a long-term care facility
• Members who had a BMD test during the 730 days (24 months) prior to the fracture date
• Fractures of the finger, toe, face, or skull
• A dispensed dementia medication (see list below):

Cholinesterase inhibitors:

Donepezil

Galantamine

Rivastigmine

Miscellaneous central nervous system agents:

Memantine

Dementia combinations:

Donepezil-memantine

• Members who received a dispensed prescription or had an active prescription to treat osteoporosis during the 365 days (12 months) prior to the fracture date (see list below):

Bisphosphonates:

Alendronate

Alendronate-cholecalciferol

Ibandronate

Risedronate

Zoledronic acid

Other agents:

Abaloparatide

Denosumab

Raloxifene

Romosozumab

Teriparatide

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap in care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.