Thank you for being a Health Partners Plans (HPP) participating provider and for your continued efforts to manage our members’ health. HPP would like to share some helpful information about the Osteoporosis Management in Women Who Had a Fracture (OMW) measure, which is part of CMS’ Stars program.

Osteoporosis is a bone disease characterized by low bone mass, which leads to bone fragility and increased susceptibility to fractures of the hip, spine and wrist. With appropriate screening and treatment, the risk of future osteoporosis-related fractures can be reduced.

The OMW measure is defined as:

The percentage of women 67-85 years of age as of December 31 of the Measurement Year who suffered a fracture and who had either of the following in the six months after the fracture:

• A bone mineral density (BMD) test.
• A prescription for a drug to treat osteoporosis.

Please note that fractures of finger, toe, face and skull are not included in this measure.

HPP would like to share a few best practices and tips with you.

• A BMD test must take place within six months of the fracture. Contact patients for an office visit as soon as possible after an event occurs.
• If one of your patients is interested in an in-home visit for a DEXA scan, you can refer patients to HPP’s Quality Improvement Outreach Team at 215-967-4530.
• If the fracture resulted in an inpatient stay, long-acting osteoporosis therapy administered during the stay OR a BMD test administered during the stay will close the care opportunity.
• Osteoporosis medication must be filled using a patient’s Part D prescription drug benefit.
• To help prevent women from being included in this measure incorrectly, please check that fracture codes are not used before a fracture has been verified through imaging.
• Submit a corrected claim to fix fracture codes submitted in error to remove the patient from this measure.
• Documentation that the medications aren’t tolerated is not an exclusion for this measure.
• A referral for a BMD will not close this care opportunity.

There are also several exclusions that will remove the patient from the measure denominator, including:

• Patients in hospice or using hospice services anytime during the measurement year.
• Patients who died any time during the measurement year.
• Patients who received palliative care during the measurement period. Please use ICD-10 code Z51.5
• Patients identified with Frailty, Frailty and Advanced Illness, Living in Long Term Care.
• Patients who had a BMD test during the 24 months prior to the fracture.
• Patients who had osteoporosis therapy during the 12 months prior to the fracture.
• Patients who were dispensed a medication or had an active prescription for medication to treat osteoporosis during the 12 months prior to the fracture.

Osteoporosis medications include:

If you have questions regarding the measure, appropriate coding and documentation, or would like additional education, please reach out to your Provider Relations Representative or contact our Provider Services Helpline at 1-888-991-9023 (Monday – Friday, 9 a.m. – 5:30 p.m.).

Thank you for being part of the HPP participating provider network and your anticipated partnership to provide great service to our members.