Statin Therapy For Patients With Cardiovascular Disease (SPC) Measure In HEDIS 2017 | Jane Jackson, RN, CRC | RxEconsult
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HEDIS 2017 Measure For Statin Therapy For Patients With Cardiovascular Disease (SPC) Category: Healthcare Administration by - December 22, 2016 | Views: 6359 | Likes: 0 | Comment: 0  

HEDIS 2017 Measure for statin therapy

HEDIS 2017 Statin Therapy For Patients With Cardiovascular Disease (SPC)

Statin Therapy for Patients with Cardiovascular Disease (SPC) is a somewhat complicated HEDIS (Health Effectiveness Data and Information Set) measure.  I have reviewed it several times and would like to share what I learned.  This measure applies to Medicare, Medicaid, and commercial insurance plans. 

Definition Of Statin Therapy for Patients with Cardiovascular Disease (SPC)

The percentage of males 21–75 years of age and females 40–75 years of age who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria.

  • Members who were dispensed at least one high or moderate-intensity statin medication during the measurement year.
  • Members who remained on a high or moderate-intensity statin medication for at least 80% of the treatment period.

Members are identified in two ways:  

1.  Event:  Any of the following during the year prior to the measurement year meet criteria:

  • Discharged from an inpatient setting with a Myocardial Infarction (MI).  To identify discharges:
  • Identify all acute and nonacute inpatient stays
  • Identify the discharge date for the stay
  • Members who had a Coronary Artery Bypass Graft (CABG) in any setting.
  • Members who had Percutaneous Coronary Intervention (PCI) in any setting.
  • Members who had any other revascularization procedures in any setting.

2.  Diagnosis:  Identify members as having ischemic vascular disease (IVD) who met at least one of the following criteria during both the measurement year and the year prior to the measurement year.

  • At least one outpatient visit with an IVD diagnosis
  • At least one acute inpatient encounter with an IVD diagnosis

Required Exclusions:

Exclude members who meet any of the following criteria:

  • Pregnancy during the measurement year or year prior to the measurement year.
  • In vitro fertilization in the measurement year or the year prior to the measurement year.
  • Dispensed at least one prescription for estrogen agonist (clomiphene) during the measurement year or the year prior to the measurement year.   
  • ESRD during the measurement year or the year prior to the measurement year.
  • Cirrhosis during the measurement year or the year prior to the measurement year.
  • Myalgia, myositis, myopathy, or rhabdomyolysis during the measurement year.
  • Members on hospice are excluded from the eligible population.

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