Colorectal Cancer Screening in Michigan: Medicare Data Mapping & Coverage Information

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1 Colorectal Cancer Screening in Michigan: Medicare Data Mapping & Coverage Information Angela Vanker, MPH Elizabeth Venettis, MPH Haggerty Road, Suite 100, Farmington Hills, MI

2 Who Is MPRO? MPRO is an independent nonprofit organization and a national leader in health care quality improvement and medical review. MPRO serves as the federally designated quality improvement organization (QIO) for Michigan under contract with the U.S. Centers for Medicare & Medicaid Services.

3 Our Mission Improving quality, safety and efficiency across the healthcare continuum

4 Medicare 10 th Scope of Work Scope of work = 3 year contract period August 1, 2011 July 31, 2014 National focus is defined by CMS Priorities set by the Department of Health & Human Services 4

5 Ambulatory Quality Improvement Four projects: PQRS EHR Reporting Statewide PQRS claims improvement Cardiac Learning & Action Network (LAN) Prevention Learning & Action Network (LAN) Invite all M-CEITA (Michigan REC) practices who have gone live with health information technology (HIT) to learn, share, and discuss best practices surrounding patient engagement & self-management as it relates to: Flu Immunizations Pneumococcal Immunizations Colorectal Cancer Screening Breast Cancer Screening Tobacco Cessation 5

6 Coverage Information 6

7 Medicare Part B Coverage for CRC FOBT: Once every 12 months if 50 or older. No cost. Flex Sig: Once every 48 months if 50 or older, or 120 months after previous screening colonoscopy for those not at high risk. No cost if physician accepts assignment.* Colonoscopy: Once every 120 months (every 24 months if high risk) or 48 months after previous flex sig. No minimum age. No cost if physician accepts assignment.* Barium Enema: Once every 48 months if 50 or older (every 24 months if high risk) when used instead of sig or colonoscopy. No cost. *Assignment: An agreement by physician or other supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. Source: Medicare.gov, Colon Cancer Screenings 7

8 Other Medicare Coverage of CRC Original Medicare : Part A (Hospital Insurance) and/or Part B (Medical Insurance) Same coverage as Part B with exception to Barium Enema: Part B deductible does not apply; pay 20% of the Medicareapproved amount for the physician services Medicare Advantage Plan: Part C which includes both Part A and Part B Similar to HMO or PPO Same coverage as Part B 8

9 Data Mapping 9

10 Data Background Colorectal Cancer (CRC) Screening Analytic Dataset This data is an through an ad hoc pass-thru data request process. The data is processed by the Office of Clinical Standards and Quality (OCSQ), which is an office within The Centers for Medicare and Medicaid Services (CMS) It is created specifically for analysis on colorectal cancer screening. CRC flags are created during processing. The file contains one record for each eligible beneficiary. The eligible beneficiary can be any age from 50 to 80 years of age. Each record contains a numerator flag indicating whether or not the beneficiary met the measure. These files are available on a quarterly basis. 10

11 Data Background (Continued) The variables available in the Colorectal Cancer Screening Analytic Dataset include: Beneficiary First Name Beneficiary Last Name Beneficiary Social Security Number Medicare Claim Number (HIC) Beneficiary Date of Birth Beneficiary Age Beneficiary Gender Beneficiary State Code Beneficiary State FIPS Code Beneficiary County Name Beneficiary County Code Beneficiary County FIPS Code Current Zip+4 According to the Standard Data Processing System (SDPS) Enrollment Database (EDB) Data Beneficiary Race Code Underserved Flag 11

12 Data Background (Continued) The flags available in the Colorectal Cancer Screening Analytic Dataset include: CRC_OVERALL_FLAG CRC Any Test Quality Indicator Flag (0-No CRC Screening, 1-Received CRC Screening) CRC_FOBT_FLAG CRC Fecal Occult Blood Test Quality Indicator Flag (0-No Fecal Occult Blood Test, 1-Received Fecal Occult Blood Test) CRC_BE_FLAG CRC Barium Enema Test Quality Indicator Flag (0-No Barium Enema, 1- Received Barium Enema) CRC_SIG_FLAG CRC Sigmoidoscopy Test Quality Indicator Flag (0-No Sigmoidoscopy, 1- Received Sigmoidoscopy) CRC_COLON_FLAG CRC Colonoscopy Test Quality Indicator Flag (0-No Colonoscopy, 1- Received Colonoscopy) 12

13 Our Focus CRC_OVERALL_FLAG Any Colorectal Cancer (CRC) Screening CRC_FOBT_FLAG Fecal Occult Blood Test (FOBT) 13

14 MCRCEDP Locations 14

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17 FOBT Results 17

18 CRC FOBT Percent Determination Numerator Received a Fecal Occult Blood Test Denominator Medicare beneficiary aged 50 to 80 years 18

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20 CRC FOBT Percent Rankings for the Counties of Interest (Sorted by FOBT Percent Rank) *Note: There are 83 Counties in the State of Michigan. County Name Total Count FOBT Count FOBT Percent FOBT Percent Rank FOBT Quartile Leelanau Mason Eaton Isabella Bay Saginaw Manistee Montcalm Huron Charlevoix Grand Traverse Cheboygan Tuscola Crawford Arenac St. Clair Kent 1, Otsego Newaygo Osceola Antrim Benzie Montmorency Wexford Oceana Sanilac Muskegon Gladwin Roscommon Emmet Lake Barry Alpena Clare Presque Isle Kalkaska Mecosta Missaukee

21 Any CRC Test Results 21

22 CRC Overall Percent Determination Numerator Received CRC screening Denominator Medicare beneficiary aged 50 to 80 years 22

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24 All CRC Percent Rankings for the Counties of Interest (Sorted by FOBT Percent Rank) *Note: There are 83 Counties in the State of Michigan. County Name Total Count FOBT Count FOBT Percent FOBT Percent Rank FOBT Quartile Leelanau Benzie Grand Traverse Mason Emmet Eaton Missaukee Saginaw Crawford Charlevoix Wexford Clare Barry Sanilac Antrim Muskegon Alpena Kent 1,940 1, Montmorency Tuscola Manistee Kalkaska Osceola St. Clair Roscommon Presque Isle Arenac Newaygo Mecosta Montcalm Huron Oceana Gladwin Cheboygan Otsego Bay Isabella Lake

25 Comparison of FOBT to Any CRC Test Results 25

26 FOBT and All CRC Percent Rankings for the Counties of Interest (Sorted by Rank Difference) *Note: There are 83 Counties in the State of Michigan. County Name FOBT Rank Any CRC Rank Rank Difference Missaukee Isabella Bay Emmet Cheboygan Clare Montcalm Huron Benzie Barry Otsego Alpena Arenac Kalkaska Manistee Wexford Lake Muskegon Sanilac Oceana Grand Traverse Newaygo Presque Isle St. Clair Gladwin Tuscola Antrim Mecosta Crawford Montmorency Roscommon Osceola Eaton Charlevoix Kent Mason Saginaw Leelanau

27 Medicare CRC Resources Medicare Learning Network (MLN) Preventive Services Educational Products Webpage Learning-Network-MLN/MLNProducts/index.html MLN Cancer Screenings Brochure ening.pdf MLN Quick Reference Information: Medicare Preventive Services eferencechart_1.pdf 27

28 Questions/Comments? Thank You Contact Information: Angela Vanker, MPH Project Manager, Ambulatory Quality Improvement Elizabeth Venettis, MPH Data Analyst, Applied Epidemiology and Evaluation 28

29 MPRO s Mission: Improving quality, safety and efficiency across the healthcare continuum. This material was prepared by MPRO, the Medicare Quality Improvement Organization for Michigan, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MI-C