Musculoskeletal: Musculoskeletal

The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the four rates separately and as a total rate.

• Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)
• Annual monitoring for members on digoxin
• Annual monitoring for members on diuretics

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with medical record documentation that a physician advised them against bed rest lasting four days or longer.

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with medical record documentation that a physician advised them to maintain or resume normal activities.

Percentage of patients at least 18 years of age and younger than 80 with a diagnosis of back pain for whom the physician ordered imaging studies during the six weeks after pain onset, in the absence of “red flags” (overuse measure, lower performance is better).

Percentage of patients at least 18 years of age and younger than 80 with back pain who have received an epidural steroid injection in the absence of radicular pain AND those patients with radicular pain who received an epidural steroid injection without image guidance (i.e. overuse measure, lower performance is better).

Percentage of patients at least 18 years of age and younger than 80 with a diagnosis of back pain who have medical record documentation of all of the following on the date of the initial visit to the physician:
1. Pain assessment
2. Functional status
3. Patient history, including notation of presence or absence of “red flags”
4. Assessment of prior treatment and response, and
5. Employment status

The percentage of patients at least 18 years of age and younger than 80 with a diagnosis of back pain for whom documentation of a mental health assessment is present in the medical record prior to intervention or when pain lasts more than 6 weeks.

Percentage of patients at least 18 years of age and younger than 80 with back pain with documentation that the physician conducted reassessment of both of the following within four to six weeks of their initial back pain visit or of a surgical procedure date:
1) Pain AND
2) Functional status

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with documentation of a physical examination on the date of the initial visit with the physician.

Percentage of patients at least 18 years of age and younger than 80 with back pain lasting more than 12 weeks, with documentation of physician advice for supervised exercise.