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TFQ Clinical Workgroup Meeting July 15, 2009

TFQ Clinical Workgroup Meeting July 15, 2009. Webinar 3:30PM or Immediately following TFQ Stakeholder Council if ends later than 3:30PM. Medicaid Transformation / TFQ. Together for Quality. A Toolkit for Transformation. AGENDA. Welcome and Roll Call Meeting Notes Agenda Overview

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TFQ Clinical Workgroup Meeting July 15, 2009

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  1. TFQ Clinical Workgroup MeetingJuly 15, 2009 Webinar 3:30PM or Immediately following TFQ Stakeholder Council if ends later than 3:30PM

  2. Medicaid Transformation / TFQ Together for Quality A Toolkit for Transformation

  3. AGENDA • Welcome and Roll Call • Meeting Notes • Agenda Overview • ARRA and CHiPRA

  4. Agenda (Cont) • Domain Experts – Invited to August Meeting • CV Disease Measures-Discuss revisions to May version

  5. ARRA-American Recovery and Reinvestment Act of 2009 http://www.hhs.gov/recovery/

  6. CV Measures Discussed April and May Meetings

  7. Coronary Heart Disease • Beta Blocker prescription • Aspirin (any dose) → Anti-platelet therapy • Influenza vaccine in the past 12 months (CPT 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90663) • EITHER Measurement of cholesterol in past 12 months (CPT 82465) • OR Measurement of lipid profile in past 12 months (CPT 80061)

  8. Coronary Heart Disease The unbundled lipid profile consists of: • Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478), or 3011F (calculated HDL).

  9. CV Disease Draft Logic-Revisions

  10. CV Disease Logic-Revised • Denominator (Population): All patients diagnosed with CAD older than or equal to 18 years and less than 65 years old at the beginning of the measurement period. The denominator will include recipients identified as a result of the following diagnoses on any claims during the measurement period; 414.00-414.07, 414.8, 414.9, 410.00-410.92, 412, V45.81, V45.82, 411.0-411.89, 413.0-413.9 and/or procedure codes, 33140, 92980-92982, 92984, 92995, 92996, 33510-33514, 33516-33519, 33521-33523, 33533-33536 AND

  11. CV Disease Logic-Revised • AND have at least two office visits during the measurement period (99201-99295, 99212-99215, 99241-99245, 99341-99345, 99347-99350, 99354-99355, 99385-99387, 99395-99397, 99401-99404, 99411, 99412, 99420, 99429 )  NOTE: This is not part of current logic but is part of national (DOQ-IT) or at least not version 2.0.

  12. Numerators Measure 1- Lipid Profile • Patients who received at least one lipid profile, CPT 80061 or ALL component tests, CPT 82465 AND 83718, and 83721, and 84478 during the measurement period (dates of service XX/XX/XXXX – XX/XX/XXXX with paid dates through XX/XX/XXXX).

  13. Measure 2-Antiplatelet Therapy • Patients who were prescribed aspirin or clopidogrel therapy during  the measurement period (Table X) (dates of service XX/XX/XXXX – XX/XX/XXXX with paid dates through XX/XX/XXXX). NOTE: We will need drug codes identified by PHARMACY and updating recommendations on these to make sure they remain current.

  14. CV Disease Logic-Revised Measure 2 – Antiplatelet Therapy • Exclusions: Patients with following ICD-9 codes; 459.0, 571.0-573.9, 456.0, 456.20, 531.00-531.91, 532.00-532.91, 533.00-533.91, 534.00-534.91, 280.0, 280.9, 287.3, 287.4, 287.5 OR Adverse Effect 1 Code AND Adverse Effect 2 Code present; 995.0, or 995.1,or 995.2 AND E935.3 or E934.8.

  15. CV Disease Logic - Revised Measure 3 – Beta Blocker Therapy with Prior MI • Patients who were prescribed beta-blocker therapy (Table X) during the measurement period, (dates of service XX/XX/XXXX – XX/XX/XXXX with paid dates through XX/XX/XXXX). NOTE: This will require PHARM to identify drug codes.

  16. CV Disease Logic - Revised Measure 3 - Beta Blocker Therapy with Prior MI • Exclusions: Patients with the following ICD-9 Codes; 493.XX, 458.xx, 427.81, 427.89, 337.0, 491.20, 491.21, 492.0, 492.8, 496, 518.2, 506.4 OR any 2nd or 3rd degree AV block codes in the absence of a permanent pacemaker (V45.01). If the pacemaker is present then the patient will NOT be excluded.

  17. CV Disease Logic - Revised Measure 4 - Annual Flu Immunization • Patients who received an influenza vaccination, V04.81 or 90655-90660, or G0008  from September through February of the year prior to the measurement period (dates of service XX/XX/XXXX – XX/XX/XXXX with paid dates through XX/XX/XXXX).  NOTE: We also discussed the merits of 90661, 90662, and 90663.

  18. CV Disease Logic - Revised Measure 4 – Annual Influenza Immunization • Exclusions: Patients with any of the following ICD-9 codes; 693.1, V15.03, 995.68 OR at least ONE Adverse Effect 1 Code (995.0, 9951, 995.2) AND the Adverse Effect 2 Code (E949.6) is present.

  19. Discussion

  20. Next Meeting Dates • August 19, 5:00PM • Additional Meeting for 2009 (October 21?)

  21. Contact Information • Mary G. McIntyre, MD, MPH Office of Clinical Standards and Quality Alabama Medicaid Agency Email: mary.mcintyre@medicaid.alabama.gov Phone: 334-353-8473 • Medicaid Website- Clinical Workgroup http://www.medicaid.alabama.gov/Transformation/clinical_workgroup.aspx

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