Quality/Effective Care

Quality/Effective Care

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HRR | HSA | State | County | Footnotes

Data Source

Atlas Data – General Atlas Rates – Selected Primary Care Access and Quality Measures

Effective care consists of evidence-based interventions for which the benefits so far exceed the harms that all patients in need should receive the service. Life-saving drugs following heart attack are examples. Variations in the use of such treatments among eligible patients reflect a failure to deliver needed care, or underuse.

Quality/Effective Care 2015 – by HRR


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Quality/Effective Care 2015 – by HSA


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Quality/Effective Care 2015 – by State


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Quality/Effective Care 2015 – by County


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Footnotes
Diabetes
Measures of the quality of diabetic care for Medicare beneficiaries age 65-75 are not adjusted. Because every diabetic patient in this cohort should receive these tests, regardless of age, sex or race, statistical adjustments to correct for underlying population differences are not relevant.

Mammography
Mammography rates for female Medicare beneficiaries age 67-69 are not adjusted. Because the measure is already restricted by age and sex, and women of all races should receive the test, statistical adjustments to correct for underlying population differences are not relevant.

Denominator Definition
Diabetes
Non-HMO Medicare enrollees age 65 – 75 (on December 31) with Parts A & B eligibility, 20% sample with diagnosis of diabetes.

Diabetes diagnosis
Two face-to-face encounters with different dates of service in an ambulatory setting or nonacute inpatient setting or one face-to-face encounter in an acute inpatient or emergency room setting during measurement year or prior year.

Diabetes definition
ICD-9 codes: 250xx, 357.2x, 362.0x, 366.41, 648.0x
DRGs 294, 295; for Q4, MS-DRG codes 637, 638, 639.

Outpatient/non-acute inpatient CPT codes
92002-92014, 99201-99205, 99211-99215, 99217-99220, 99241-99245, 99341-99345, 99347-99350, 99384-99387, 99394-99397, 99401-99404, 99411-99412, 99420, 99429, 99455, 99456, 99499, 99301-99313, 99315, 99316, 99318, 99321-99328, 99331-99337.

Acute inpatient/emergency department CPT codes
99221-99223, 99231-99233, 99238, 99239, 99251-99255, 99261-99263, 99291, 99281-99285.

Outpatient/non-acute inpatient revenue center codes
051x, 052x, 057x-059x, 077x, 082x-085x, 088x, 0982, 0983, 0118, 0128, 0138, 0148, 0158, 019x, 055x, 066x.

Acute inpatient/emergency department revenue center codes
010x, 0110-0114, 0119, 0120-0124, 0129, 0130-0134, 0139, 0140-0144, 0149, 0150-0154, 0159, 016x, 020x-022x, 072x, 080x, 0987, 045x, 0981.

Mammography
Medicare women, non-HMO, age 67-69 (December 31 of last year of measurement period); Part B eligible.

Numerator Definition
Diabetes
Hemoglobin A1c testing
CPT codes 83036, 83037; CPT II codes 3046F, 3047F.

Blood lipids testing
CPT codes 80061, 83700, 83701, 83704, 83715, 83716, 83721; CPT II codes 3048F, 3049F, 3050F.

Eye examination
A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year*; or a negative retinal exam (no evidence of retinopathy: ICD-9 codes 250.50-250.53, 362.01-362.07) by an eye care professional in the year prior to the measurement year (specialty codes: 18=ophthalmology, 41=optometry).

*ICD-9 procedure codes 14.1-14.59, 14.9, 95.02-95.04, 95.11, 95.12, 95.16; CPT codes 67028, 67038-67040, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260, 99203-99205, 99213-99215, 99242-99245; CPT II codes 2022F, 2024F, 2026F, 3072F; HCPCS codes S0625, S3000.

Mammography
Any, but only one occurrence per patient during measurement year or prior year of CPT codes 76090-76092, 76083, 77055-77057; HCPCS G0202, G0204, G0206; ICD-9 codes 87.36, 87.37; V codes 76.11, 76.12; UB-92 revenue center codes 0401, 0403.