CMS-10219 CMS-10219.8_Use of Services B_pp 271-302

Use of Services: Discharges and Average Length of Stay—Maternity Care 271

Discharges and Average Length of Stay—Maternity Care (MAT)

Summary of Changes to HEDIS 2007

• No changes to this measure.

Description

This measure determines utilization of maternity-related care for enrolled females who had live births during the measurement year, reported for total deliveries, vaginal deliveries and Cesarean section (C-section) deliveries.

Calculations

Product lines	Commercial: Construct Tables MAT-2 and MAT-2E using Table MAT-2 as a template. Report discharges, discharges/1,000 members per year, days, days/1,000 members per year and average length of stay (ALOS) for female members in the product line group that each table addresses. Medicaid: Construct Tables MAT-1A through MAT-1D using Table MAT-1 as a template. Report discharges, discharges/1,000 member months, days, days/1,000 member months and ALOS for female members in the Medicaid eligibility category that each table addresses.
Member months	Report all female member months for the measurement year for members with a medical benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Discharges	Refer to Specific Instructions for Use of Services Tables and the codes listed in Tables MAT-A and MAT-B to report discharges for maternity care.
Days	Refer to Specific Instructions for Use of Services Tables and the codes listed in Tables MAT-A and MAT-B to report days for maternity care. Birthing center deliveries are counted as one day of stay.
ALOS	Refer to Specific Instructions for Use of Services Tables and the codes listed in Tables MAT-A and MAT-B to report ALOS for maternity care. In calculating the length of stay, both pre-delivery and post-delivery days are included.
Total deliveries	Identify all live births delivered in an inpatient setting and at birthing centers. The sum of C-sections and vaginal deliveries should equal the total deliveries. At-home deliveries are not counted in this measure. Count multiple births (e.g., twins, triplets) as one delivery. Refer to Tables PPC-A and PPC-B.
C-section deliveries	Identify all C-section delivery live births delivered in an inpatient setting and at birthing centers. From the total deliveries identified above, use the codes in Table MAT-A to identify C-sections. Count multiple births as one delivery.

Table MAT-A: Codes to Identify C-Sections

CPT	ICD-9-CM Procedure	DRG
59510, 59514, 59515, 59618, 59620, 59622	74.0-74.2, 74.4, 74.99	370-371
OR
An equivalent method used by the MCO to identify C-sections. The MCO must document the method, including codes used, for identifying C-sections.

Vaginal deliveries

Identify all vaginal delivery live births delivered in an inpatient setting and at birthing centers. Count multiple births as one delivery. At-home deliveries do not count in this measure. To identify vaginal deliveries, use DRGs or CPT codes with an appropriate ICD-9-CM Diagnosis code. The MCO may also use an equivalent method such as calculating the residual deliveries left after C-sections are removed from total deliveries. Residual category = (total deliveries – C-sections).

Table MAT-B: Codes to Identify Vaginal Deliveries

CPT	ICD-9-CM Diagnosis	ICD-9-CM Procedure	DRG
59400, 59409, 59410, 59610, 59612, 59614	650	72.0-73.99*	372-375
OR
An equivalent method used by the MCO to identify vaginal deliveries. The MCO must document the method, including codes used, for identifying vaginal deliveries.

*These codes may also appear for women who had a C-section delivery. If the woman has a code for both vaginal and C-section delivery (Table MAT-A), the plan should only count the c-section.

Table MAT-1: Discharges and Average Length of Stay—Maternity Care: Medicaid

Age	Female Member Months
10-14	______________
15-19	______________
20-34	______________
35-49	______________
50+	______________
Unknown	______________
Total:	______________

Age	Discharges	Discharges/1,000 Female Member Months	Days		Days/1,000 Female Member Months	Average Length of Stay
Total Deliveries
10-14	_____________	_____________	_____________		_____________	____________
15-19	_____________	_____________	_____________		_____________	____________
20-34	_____________	_____________	_____________		_____________	____________
35-49	_____________	_____________	_____________		_____________	____________
50+	_____________	_____________	_____________		_____________	____________
Unknown	_____________		_____________			____________
Total:	_____________	_____________	_____________		_____________	____________
Vaginal Deliveries: Live Births
10-14	_____________	_____________	_____________	_____________		____________
15-19	_____________	_____________	_____________	_____________		____________
20-34	_____________	_____________	_____________	_____________		____________
35-49	_____________	_____________	_____________	_____________		____________
50+	_____________	_____________	_____________	_____________		____________
Unknown	_____________		_____________			____________
Total:	_____________	_____________	_____________	_____________		____________
C-Section Deliveries: Live Births
10-14	_____________	_____________	_____________	_____________		____________
15-19	_____________	_____________	_____________	_____________		____________
20-34	_____________	_____________	_____________	_____________		____________
35-49	_____________	_____________	_____________	_____________		____________
50+	_____________	_____________	_____________	_____________		____________
Unknown	_____________		_____________			____________
Total:	_____________	____________	_____________	_____________		____________

Table MAT-2: Discharges and Average Length of Stay—Maternity Care: Commercial

Age	Female Member Months
10-14	______________
15-19	______________
20-34	______________
35-49	______________
50+	______________
Unknown	______________
Total:	______________

Age	Discharges	Discharges/1,000 Female Member Years	Days		Days/1,000 Female Member Years	Average Length of Stay
Total Deliveries
10-14	_____________	_____________	_____________		_____________	____________
15-19	_____________	_____________	_____________		_____________	____________
20-34	_____________	_____________	_____________		_____________	____________
35-49	_____________	_____________	_____________		_____________	____________
50+	_____________	_____________	_____________		_____________	____________
Unknown	_____________		_____________			____________
Total:	_____________	_____________	_____________		_____________	____________
Vaginal Deliveries: Live Births
10-14	_____________	_____________	_____________	_____________		____________
15-19	_____________	_____________	_____________	_____________		____________
20-34	_____________	_____________	_____________	_____________		____________
35-49	_____________	_____________	_____________	_____________		____________
50+	_____________	_____________	_____________	_____________		____________
Unknown	_____________		_____________			____________
Total:	_____________	_____________	_____________	_____________		____________
C-Section Deliveries: Live Births
10-14	_____________	_____________	_____________	_____________		____________
15-19	_____________	_____________	_____________	_____________		____________
20-34	_____________	_____________	_____________	_____________		____________
35-49	_____________	_____________	_____________	_____________		____________
50+	_____________	_____________	_____________	_____________		____________
Unknown	_____________		_____________			____________
Total:	_____________	____________	_____________	_____________		____________

Births and Average Length of Stay, Newborns (NEW)

Summary of Changes to HEDIS 2007

• No changes to this measure.

Description

This measure summarizes utilization information about newborns discharged during the measurement year and reports information for total newborns, well newborns and complex newborns.

Newborns are identified and reported separately from maternity members. Newborn care is care provided from birth to discharge to home. If a newborn is transferred from one hospital to another and has never gone home, the care is still newborn care. Newborn care that is rendered after the baby has been discharged should be reported in Table IPU-A (Inpatient Utilization—General Hospital/Acute Care).

Include newborns delivered in an inpatient setting and at birthing centers. For newborns delivered in birthing centers, count one day of stay.

Some MCOs do not keep separate records on well newborns who leave the hospital at the same time as their mothers. The MCO must develop a methodology to estimate the number of well newborns for whom the MCO does not produce separate discharge records; for example, the mother’s length of stay can be used as a proxy for the well newborn’s length of stay. The MCO must provide documentation for the approach used.

Calculations

Product lines	Medicaid: Construct Tables NEW-1A through NEW-1D using Table NEW-1 as a template. Report the total number of newborns; newborns/1,000 female member months; discharges; newborn discharges/1,000 member months; days; days/1,000 member months; and ALOS. Stratify by maternal age into total newborns (any maternal age); 10–49 years; Other (0–9, 50+ and unknown age). Commercial: Construct Tables NEW-2 and NEW-2E using Table NEW-2 as a template. Report the total number of newborns; newborns/1,000 female member years; discharges; newborn discharges/1,000 member years; days, days/1,000 member years; and ALOS. Stratify by maternal age into total newborns (any maternal age); 10–49 years; Other (0–9, 50+ and unknown age).
Member months	Report all member months for the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Discharges	Refer to Specific Instructions for Use of Services Tables and the codes listed below to report discharges for newborn care.
Days	Refer to Specific Instructions for Use of Services Tables and the codes listed to report days for newborn care. Count all days associated with the listed discharges.
ALOS	Refer to Specific Instructions for Use of Services Tables and the codes listed below to report the ALOS for newborn care.

Total newborns

Include all covered babies, whether or not their mothers were members of the MCO. The MCO should exclude all stillbirths.

Table NEW-A: Codes to Identify Total Newborns

ICD-9-CM Diagnosis	DRG
V30-V39	385-391

Complex newborns

Newborns are defined as complex if: Their LOS is five days or more, or Their LOS is less than five days and the newborn expired, or They are transferred to another facility and the MCO is unable to track total LOS between the two facilities.

Note: Expired newborns are those with a patient status code (Form Locator 22) equal to 20–29.

Well newborns	Newborns who are not defined as complex and have an LOS of less than five days.
Note: Under no circumstances should a newborn be counted more than once.

Table NEW-1: Births and Average Length of Stay, Newborns: Medicaid

Member Months
Total member months (male and female, 0-85+) __________________	Total female member months (10-49) __________________

	Newborn Discharges	Newborn Discharges/ 1,000 Female Member Months (10-49)	Newborn Discharges/ 1,000 Member Months (Males and Females)	Newborn Days	Newborn Days/1,000 Member Months (Males and Females)	Average Length of Stay
Total Newborns
Total newborns	_________		__________	________	___________	_________
10-49 years	_________	___________		________		_________
Other*	_________			________		_________
Total Well Newborns
Total well newborns	_________		__________	________	___________	_________
10-49 years	_________	___________		________		_________
Other*	_________			________		_________
Total Complex Newborns
Total complex newborns	_________		___________	________	___________	_________
10-49 years	_________	___________		________		_________
Other*	_________			________		_________

* “Other” includes female members ages 0–9 years, 50+ years and unknown age. Include all covered babies born to mothers who are not members of the MCO.

Table NEW-2: Births and Average Length of Stay, Newborns: Commercial

Member Months
Total member months (male and female, 0-85+) __________________	Total female member months (10-49) __________________

	Newborn Discharges	Newborn Discharges/ 1,000 Female Member Years (10-49)	Newborn Discharges/ 1,000 Member Years (Males and Females)	Newborn Days	Newborn Days/1,000 Member Years (Males and Females)	Average Length of Stay
Total Newborns
Total newborns	__________		___________	________	___________	_________
10-49 years	__________	___________		________		_________
Other*	__________			________		_________
Total Well Newborns
Total well newborns	__________		___________	________	___________	_________
10-49 years	__________	___________		________		_________
Other*	__________			________		_________
Total Complex Newborns
Total complex newborns	__________		__________	________	__________	_________
10-49 years	__________	___________		________		_________
Other*	__________			________		_________

* “Other” includes female members ages 0–9 years, 50+ years and unknown age. Include all covered babies born to mothers who are not members of the MCO.

Mental Health Utilization—Inpatient Discharges and
Average Length of Stay (MIP)

Summary of Changes to HEDIS 2007

• No changes to this measure.

Description

This measure summarizes utilization of inpatient mental health services, stratified by age and sex.

Calculations

Product lines	Medicaid: Construct Tables MIP-1A–MIP-1D using Table MIP-1 as a template. Report discharges; discharges/1,000 member months; days; and ALOS for members in the Medicaid eligibility category that each table addresses. Commercial and Medicare: Construct Tables MIP-2, MIP-2E and MIP-3 using Table MIP-2/3 as a template. Report discharges; discharges/1,000 member years; days; and ALOS for members in the product line that the table addresses.
Benefit	Mental health (inpatient).
Member months	Report member months for the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Inpatient discharges	Include inpatient care with mental health as the principal diagnosis, at either a hospital or a treatment facility. Refer to Specific Instructions for Use of Services Tables and the codes listed in Table MIP-A to report discharges for inpatient mental health care. Do not count inpatient services discharges with ICD-9-CM principal diagnosis codes of 317–319.
Days	Count all days associated with the reported discharges. Include days associated with residential care and rehabilitation. Exclude days associated with intermediate care or partial hospitalization. Refer to Specific Instructions for Use of Services Tables to report days for inpatient mental health care.
ALOS	Refer to Specific Instructions for Use of Services Tables to report ALOS for inpatient mental health care.

Table MIP-A: Codes to Identify Inpatient Services

ICD-9-CM Principal Diagnosis	DRG
290, 293-302, 306-316	424-432 except discharges with ICD-9-CM principal diagnosis of 317-319

Note: DSM-IV codes mirror ICD-9-CM codes. An MCO that has access to DSM-IV codes only should use and document them. Follow the specifications outlined above for ICD-9-CM codes.

Table MIP-1: Mental Health Utilization—Inpatient Discharges and Average Length of Stay,
by Age and Sex: Medicaid

Member Months
Age	Male	Female	Total
0-12	_________	_________	_________
13-17	_________	_________	_________
18-64	_________	_________	_________
65+	_________	_________	_________
Unknown	_________	_________	_________
Total:	_________	_________	_________

Age	Sex	Discharges	Discharges/1,000 Member Months	Days	Average Length of Stay
0-12	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
13-17	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
18-64	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
65+	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Unknown	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Total	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________

Table MIP-2/3: Mental Health Utilization—Inpatient Discharges and Average Length of Stay, by Age and Sex: Commercial and Medicare (Report Separately)

Member Months
Age	Male	Female	Total
0-12	_________	_________	_________
13-17	_________	_________	_________
18-64	_________	_________	_________
65+	_________	_________	_________
Unknown	_________	_________	_________
Total:	_________	_________	_________

Age	Sex	Discharges	Discharges/1,000 Member Years	Days	Average Length of Stay
0-12	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
13-17	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
18-64	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
65+	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Unknown	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Total	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________

Mental Health Utilization—Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services (MPT)

Summary of Changes to HEDIS 2007

• Added HCPCS codes to Table MPT-A.

Description

This measure gives an overview of the extent to which different levels of mental health services are utilized. It summarizes the number and percentage of members receiving the following during the measurement year.

• Any mental health services (includes inpatient, intermediate or ambulatory)

• Inpatient mental health services

• Intermediate mental health services

• Ambulatory mental health services

Report in each category the number of members who received the respective service. For enrollees with a mental health benefit, report the percentage who received the respective service by age and sex.

Calculations

Product lines	Commercial, Medicaid, Medicare. Construct Tables MPT-1A through MPT-1D, MPT-2, MPT-2E and MPT-3 using Table MPT as a template. Report the number and rate per 1,000 member years of MCO members in the product lines/eligibility group that each table addresses who receive any mental health services, inpatient, intermediate or ambulatory mental health services. Count members who received inpatient, intermediate and ambulatory mental health services in each column. Count members only once in each column, regardless of number of visits. Count members in the “Any Mental Health Services” column only if they had at least one inpatient, intermediate or ambulatory visit during the measurement year. For members who have had more than one encounter, count in each column the first visit in the measurement year and report the member in the respective age category as of the date of discharge.
Benefit	Mental health.
Member months	Report all member months during the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Inpatient	Include inpatient care with mental health diagnoses at either a hospital or a treatment facility. Refer to the Mental Health Utilization—Inpatient Discharges and Average Length of Stay measure to identify inpatient mental health services.

Intermediate care

Use CPT code ranges in conjunction with ICD-9-CM codes to separate mental health and chemical dependency, and report only mental health services. ICD-9-CM codes should be consistent with those used to capture inpatient discharges. Use the principal diagnosis code reported on the claim, regardless of overlapping MH/CD problems in an individual case. Count services provided by non-physician practitioners the same as those provided by physicians. Include all other ambulatory care MH/CD service day treatment and partial hospitalization programs, because these programs represent a significant amount of services rendered. These services could be represented by Level II HCPCS codes. They are reported under intermediate care, separate from ambulatory services. Exclude any utilization the MCO knows is designated as inpatient from the Type of Bill code that refers to location of service. Count the CPT and HCPCS codes listed in Table MPT-A only if they appear in conjunction with a listed ICD-9-CM Diagnosis code.

Table MPT-A: Codes to Identify Intermediate Care and Ambulatory Services

CPT	HCPCS
90801, 90802, 90804-90819, 90821-90824, 90826-90829, 90845, 90847, 90849, 90853, 90857, 90862, 90870-90871, 90875, 90876, 99201-99205*, 99211-99215*, 99217-99219*, 99220*, 99241-99245*, 99281-99285*, 99341-99345*, 99347-99350*, 99381-99387*, 99391-99397*, 99401-99404*, 99420*	G0155, G0176, G0177, H0002, H0004, H0031, H0034-H0037, H0039, H0040, H2000, H2001, H2010-H2020, M0064, S9480, S9484, S9485

WITH

ICD-9-CM Diagnosis

290, 293-302, 306-316

* All services with CPT E&M codes must be with a mental health practitioner. MCOs should refer to Appendix 3 for the definition of mental health practitioners.

Separate the procedure codes identified in conjunction with the ICD-9-CM codes into intermediate care using the appropriate codes listed in Table MPT-B.

Ambulatory

Count ambulatory services delivered in any setting (e.g., hospital outpatient clinic, physician’s office) in Tables MPT-B and MPT-1/2/3. The MCO may use Revenue and Type of Bill codes to separate ambulatory from inpatient services if data from the UB-92 are used. Report as ambulatory services observation stays and emergency department visits with a principal diagnosis of mental health that do not result in an inpatient stay. To identify ambulatory services, repeat the identification of members using the procedure and ICD-9 codes under intermediate care, and separate ambulatory services using the appropriate codes listed in Table MPT-B.

Table MPT-B: Codes to Identify Intermediate Care and Ambulatory Services

Intermediate UB-92 Revenue	OR	Ambulatory UB-92 Revenue	OR	Ambulatory POS
0905, 0907, 0912, 0913		045x, 0510, 0513, 0515-0517, 0519-0523, 0526, 0529, 0762, 0900-0903, 0909-0911, 0914-0916, 0918, 0919, 0961		11, 12, 22, 23, 49, 50, 53, 57, 71 or 72
WITH		WITH
UB-92 Type of Bill		UB-92 Type of Bill
13x or 43x		13x or 43x

Note: Because some MCOs may offer different benefits for inpatient and outpatient mental health services, denominators in the columns of this table may vary. The denominator in the column “any mental health services” should include all enrollees who have any mental health benefit.

Table MPT-1/2/3: Mental Health Utilization—Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services: Commercial, Medicaid, Medicare (Report Separately)

Member Months (Any)					Member Months (Inpatient)
Age		Male	Female	Total	Male	Female	Total
0-12		_________	_________	_________	_________	_________	________
13-17		_________	_________	_________	_________	_________	________
18-64		_________	_________	_________	_________	_________	________
65+		_________	_________	_________	_________	_________	________
Unknown		_________	_________	_________	_________	_________	________
Total:		_________	_________	_________	_________	_________	________
Member Months (Intermediate)					Member Months (Ambulatory)
Age	Male		Female	Total	Male	Female	Total
0-12	_________		_________	_________	_________	_________	________
13-17	_________		_________	_________	_________	_________	________
18-64	_________		_________	_________	_________	_________	________
65+	_________		_________	_________	_________	_________	________
Unknown	_________		_________	_________	_________	_________	________
Total:	_________		_________	_________	_________	_________	________

Table MPT-1/2/3: Mental Health Utilization—Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services: Commercial, Medicaid,
Medicare (Report Separately) (continued)

Age	Sex	Any Mental Health Services		Inpatient Mental Health Services		Intermediate Mental Health Services		Ambulatory Mental Health Services
		Number	Percent	Number	Percent	Number	Percent	Number	Percent
0-12	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______
13-17	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______
18-64	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______
65+	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______
Unknown	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______
Total	Male	______	______	______	______	______	______	______	______
	Female	______	______	______	______	______	______	______	______
	Total:	______	______	______	______	______	______	______	______

Chemical Dependency Utilization—Inpatient Discharges
and Average Length of Stay (CIP)

Summary of Changes to HEDIS 2007

• No changes to this measure.

Description

This measure summarizes utilization of inpatient chemical dependency services, stratified by age and sex.

Calculations

Product lines	Medicaid: Construct Tables CIP-1A through CIP-1D using Table CIP-1 as a template. Report discharges; discharges/1,000 member months; days; and ALOS for members in the Medicaid eligibility category that each table addresses. Commercial and Medicare: Construct Tables CIP-2, CIP-2E and CIP-3 using Table CIP-2/3 as a template. Report discharges; discharges/1,000 member years, days; and ALOS for members in the product line that each table addresses.
Benefit	Chemical dependency (inpatient).
Member months	Report all member months for the measurement year with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Inpatient discharges	Include inpatient care with chemical dependency as the principal diagnosis, including detoxification, at either a hospital or a treatment facility. Refer to Specific Instructions for Use of Services Tables and the codes listed in Table CIP-A to report discharges for inpatient chemical dependency care.
Days	Count all days associated with the reported discharges. Include days associated with residential care and rehabilitation. Exclude days associated with intermediate care or partial hospitalization. Refer to Specific Instructions for Use of Services Tables to report days for inpatient chemical dependency care.
ALOS	Refer to the instructions for Use of Services Tables for calculating ALOS.

Table CIP-A: Codes to Identify Inpatient Services

ICD-9-CM Principal Diagnosis	DRG
291-292, 303-305, 960-979 with a secondary diagnosis of chemical dependency*	433, 521-523

* Claims or encounters with principal diagnoses of 960-979 without a secondary diagnosis substantiating chemical dependency should be reported in Table IPU-A (General Hospital/Acute Care).

Note: DSM-IV codes mirror ICD-9-CM codes. An MCO that has access to DSM-IV codes only should use and document them. Follow the specifications outlined above for ICD-9-CM codes.

Table CIP-1: Chemical Dependency Utilization—Inpatient Discharges and Average Length
of Stay, by Age and Sex: Medicaid

Member Months
Age	Male	Female	Total
0-12	_________	_________	_________
13-17	_________	_________	_________
18-64	_________	_________	_________
65+	_________	_________	_________
Unknown	_________	_________	_________
Total:	_________	_________	_________

Age	Sex	Discharges	Discharges/1,000 Member Months	Days	Average Length of Stay
0-12	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
13-17	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
18-64	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
65+	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Unknown	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Total	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________

Table CIP-2/3: Chemical Dependency Utilization—Inpatient Discharges and Average Length of Stay, by Age and Sex: Commercial and Medicare (Report Separately)

Member Months
Age	Male	Female	Total
0-12	_________	_________	_________
13-17	_________	_________	_________
18-64	_________	_________	_________
65+	_________	_________	_________
Unknown	_________	_________	_________
Total:	_________	_________	_________

Age	Sex	Discharges	Discharges/1,000 Member Years	Days	Average Length of Stay
0-12	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
13-17	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
18-64	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
65+	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Unknown	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________
Total	Male	_____________	_____________	_____________	_____________
	Female	_____________	_____________	_____________	_____________
	Total:	_____________	_____________	_____________	_____________

Identification of Alcohol and Other Drug Services (IAD)

Summary of Changes to HEDIS 2007

• Added HCPCS codes to Table IAD-B.

Description

This measure gives an overview of the extent to which different levels of chemical dependency services are utilized. It summarizes the number and percentage of members with an alcohol and other drug (AOD) claim who received the following during the measurement year.

• Any chemical dependency services (includes inpatient, intermediate, ambulatory)

• Inpatient chemical dependency services

• Intermediate chemical dependency services

• Ambulatory chemical dependency services

An AOD claim contains a diagnosis of AOD abuse or dependence and a specific AOD-related service.

Calculations

Product lines	Commercial, Medicaid, Medicare. Construct Tables IAD-1A through IAD-D, IAD-2, IAD-2E and IAD-3 using Table IAD-1/2/3. Report the number and rate/1,000 member years of members in the respective age and sex group who receive any chemical dependency services, including inpatient, intermediate or ambulatory services. Count members who received inpatient, intermediate and ambulatory chemical dependency services in each column. Count members in each column only once, regardless of number of visits. Count members in the Any Chemical Dependency Services column only if they had at least one inpatient, intermediate or ambulatory visit during the measurement year. For members who had more than one encounter, count in each column the first visit in the measurement year and report the member in the respective age category as of the date of discharge.
Benefit	Chemical dependency.
Member months	Report all member months during the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Inpatient services	Include inpatient care with chemical dependency as the principal or secondary diagnosis, including detoxification, at either a hospital or a treatment facility. Refer to the codes listed in Table IAD-A to identify inpatient chemical dependency care.

Table IAD-A: Codes to Identify Inpatient Services

	ICD-9-CM Diagnosis		DRG
	291-292, 303-304, 305.0, 305.2-305.9, 535.3, 571.1, 94.62, 94.63, 94.65, 94.66, 94.68, 94.69		433, 521-523
Intermediate care
Step 1		Use CPT code ranges in conjunction with ICD-9-CM codes to separate mental health and chemical dependency and report only chemical dependency services. ICD-9-CM codes should be consistent with codes used to capture inpatient discharges. Count services provided by nonphysician practitioners the same as those provided by physicians. Include intermediate care with chemical dependency as the principal or secondary diagnosis.
Step 2		Include all ambulatory care MH/CD service day treatment and partial hospitalization programs because they represent significant services rendered. These services could be represented by Level II HCPCS codes. They are reported under intermediate care, separate from ambulatory services. Include intensive outpatient (IOP) services in the intermediate category. Exclude any utilization the MCO knows is designated “inpatient” by the location of service portion of the Type of Bill code. Count the CPT and HCPCS codes listed in Table IAD-B only if they appear in conjunction with a listed ICD-9-CM Diagnosis code. The ICD-9-CM Procedure codes are counted alone and do not need to be in conjunction with other codes..

Table IAD-B: Codes to Identify Intermediate Care and Ambulatory Services

CPT	HCPCS
90801-90802, 90804-90819, 90821-90824, 90826-90829, 90845, 90847, 90849, 90853, 90857, 90862, 90870-90871, 90875-90876, 99201-99205, 99211-99215, 99217-99220, 99241-99245, 99281-99285, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99420	G0155, G0176, G0177, H0001, H0002, H0004, H0005, H0007, H0012-H0016, H0020, H0031, H0034-H0037, H0039, H0040, H2000, H2001, H2010-H2020, H2035, H2036, M0064, S9475, S9480, S9484, S9485, T1006, T1012

WITH

ICD-9-CM Diagnosis

291-292, 303-304, 305.0, 305.2-305.9, 535.3, 571.1

OR

ICD-9-CM Procedure

94.62, 94.63, 94.65, 94.66, 94.68, 94.69

Separate the procedure codes identified in step 2 in conjunction with the ICD-9-CM Diagnosis codes into intermediate care using the appropriate codes listed in Table IAD-B.

Ambulatory services

Count ambulatory services delivered in any setting (e.g., hospital outpatient clinic, physician’s office) in Table IAD. Use the Revenue and Type of Bill codes to separate ambulatory from inpatient services if data from the UB-92 are used. Report as ambulatory services observation stays and emergency department visits with a principal or secondary diagnosis of chemical dependency that do not result in an inpatient stay. To identify ambulatory services, repeat the first two steps above under intermediate care and separate ambulatory using the appropriate codes listed in Table IAD-C.

Table IAD-C: Codes to Identify Intermediate Care and Ambulatory Services

Intermediate UB-92 Revenue	OR	Ambulatory UB-92 Revenue	OR	Ambulatory POS
0905-0907, 0912, 0913		045x, 0510, 0513, 0515-0517, 0519-0523, 0526, 0529, 0762, 0900-0903, 0909-0911, 0914-0916, 0918, 0919, 0944, 0945, 0961		11, 12, 22, 23, 49, 50, 53, 57, 71 or 72
WITH		WITH
UB-92 Type of Bill		UB-92 Type of Bill
13x or 43x		13x or 43x

Note: Because some MCOs may offer different benefits for inpatient and outpatient chemical dependency services, denominators in the columns of this table may vary. The denominator in the column Any Chemical Dependency Services should include all members who have a chemical dependency benefit.

Table IAD-1/2/3: Identification of Alcohol and Other Drug Services: Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services: Commercial, Medicaid, Medicare (Report Separately)

Member Months (Any)					Member Months (Inpatient)
Age		Male	Female	Total	Male	Female	Total
0-12		_________	_________	_________	_________	_________	________
13-17		_________	_________	_________	_________	_________	________
18-24		_________	_________	_________	_________	_________	________
25-34		_________	_________	_________	_________	_________	________
35-64		_________	_________	_________	_________	_________	________
65+		_________	_________	_________	_________	_________	________
Unknown		_________	_________	_________	_________	_________	________
Total:		_________	_________	_________	_________	_________	________
Member Months (Intermediate)					Member Months (Ambulatory)
Age	Male		Female	Total	Male	Female	Total
0-12	_________		_________	_________	_________	_________	________
13-17	_________		_________	_________	_________	_________	________
18-24		_________	_________	_________	_________	_________	________
25-34		_________	_________	_________	_________	_________	________
35-64		_________	_________	_________	_________	_________	________
18-64	_________		_________	_________	_________	_________	________
65+	_________		_________	_________	_________	_________	________
Unknown	_________		_________	_________	_________	_________	________
Total:	_________		_________	_________	_________	_________	________

Table IAD-1/2/3: Identification of Alcohol and Other Drug Services: Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services: Commercial, Medicaid, Medicare (Report Separately) (continued)

Age	Sex	Any Chemical Dependency Services		Inpatient Chemical Dependency Services		Intermediate Chemical Dependency Services		Ambulatory Chemical Dependency Services
		Number	Percent	Number	Percent	Number	Percent	Number	Percent
0-12	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
13-17	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	______	______	______	______	______	______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
18-24	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
25-34	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
35-64	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
65+	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	______	______	______	______	______	______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
Un- known	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______
Total	Male	_______	_______	_______	_______	_______	_______	_______	_______
	Female	_______	_______	_______	_______	_______	_______	_______	_______
	Total:	_______	_______	_______	_______	_______	_______	_______	_______

Outpatient Drug Utilization (ORX)

Summary of Changes to HEDIS 2007

• No changes to this measure.

Description

This measure summarizes data on outpatient utilization of drug prescriptions (total cost of prescriptions; average cost of prescriptions per member per month [PMPM]; total number of prescriptions; average number of prescriptions per member per year [PMPY]) during the measurement year, stratified by age.

Calculations

Product lines	Commercial, Medicaid, Medicare.
Age	Age as of the date the prescription is dispensed.
Benefit	Pharmacy.
Member months	Construct Tables ORX-1A through ORX-1D, ORX-2, ORX-2E and ORX-3 using Table ORX-1/2/3 as a template. Report all member months for the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.
Prescription	One 30-day (or less) supply of pharmaceuticals.* Supplies (e.g., syringes) do not count toward this measure.
* To calculate dispensing events for prescriptions longer than 30 days, the MCO should divide the days supply by 30 and round up to convert. For example, a 100-day prescription is equal to 4 dispensing events (100/30 = 3.33, rounded up to 4).
Formulas	Total cost of prescriptions = Discounted ingredient cost + dispensing or professional fees + administrative fees – formulary/ other rebates. Alternatively, total cost of prescriptions = MCO cost + member cost. Average total cost of prescriptions per member per month = [Discounted ingredient costs (before member copayments or deductibles) + dispensing or professional fees + administrative fees – formulary/other rebates]/member months for members with a pharmacy benefit. Alternatively, average total cost of prescriptions = [MCO costs + member costs]/ member months for members with a pharmacy benefit. For example, the average wholesale price for prescription “X” is $50. The MCO negotiates a 20 percent discount with the pharmacy. There is a $5 dispensing fee and member copay is $4. Assuming no administrative fees or other rebates/ formularies, the discounted ingredient cost is $40 ($50 average wholesale price less the 20 percent discount). The total cost of prescriptions is $45 ($40 discounted ingredient cost + $5 dispensing fee). While the cost to the member is $4 and the MCO cost is $41 (for a total of $45), the breakdown of total prescription cost between the MCO and the member is not reported. Annual total number of prescriptions per member per year = [Total number of prescriptions/member months for members with a pharmacy benefit]  12 months.

Note

• Employers and states are interested in knowing the total cost of prescriptions rather than cost of prescriptions to only the MCO. A breakdown of the cost of prescriptions to the member and to the MCO is not reported in this measure.

• Results of this measure might be affected by differences in pharmacy benefits across MCOs.

• An MCO that dispenses rebates on a lump-sum basis should average the rebates over the total number of prescriptions.

Table ORX-1/2/3: Outpatient Drug Utilization: Commercial, Medicaid, Medicare
(Report Separately)

Age	Member Months
0-9	______________
10-19	______________
20-44	______________
45-64	______________
65-74	______________
75-84	______________
85+	______________
Unknown	______________
Total:	______________

Age	Total Cost of Prescriptions	Average Cost of Prescriptions PMPM	Total Number of Prescriptions	Average Number of Prescriptions PMPY
0-9	______________	______________	______________	______________
10-19	______________	______________	______________	______________
20-44	______________	______________	______________	______________
45-64	______________	______________	______________	______________
65-74	______________	______________	______________	______________
75-84	______________	______________	______________	______________
85+	______________	______________	______________	______________
Unknown	______________		______________
Total:	______________	______________	______________	______________

Antibiotic Utilization (ABX)

Summary of Changes to HEDIS 2007

• Added data element “total number of prescriptions by drug class” to Table ABX-B and Table ABX-C.

• Clarified the calculation for the average number of antibiotics PMPY, reported by drug class, for selected “antibiotics of concern” and for “all other antibiotics.”

• Added Aztreonam, Carbenicillin, Cefixime, Cephradine, Piperacillin-Tazobactam and Ticarillin-Clavulanate to Table ABX-A.

• Added Aztreonam and Cefixime to Table ABX-B.

• Added Cefadroxil Hydrate, Carbenicillin, Cephradine, Piperacillin-Tazobactam and Ticarcillin-Clavulanate to Table ABX-C.

• Deleted Cloxacillin, Dirithromycin, Enoxacin, Flomefloxacin, Fusidic Acid, Methicillin, Mezlocillin, Netilmicin, Pefloxacin, Teicoplanin and Sulfamethizole from Tables ABX-A, ABX-B and ABX-C.

Description

This measure summarizes data on outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender and reported for each product, including the following.

• Total number of antibiotic prescriptions

• Average number of antibiotic prescriptions per member per year (PMPY)

• Total days supplied for all antibiotic prescriptions

• Average days supplied per antibiotic prescription

• Total number of prescriptions for antibiotics of concern

• Average number of prescriptions PMPY for antibiotics of concern

• Percentage of antibiotics of concern for all antibiotic prescriptions

• Average number of antibiotics PMPY reported by drug class:

• For selected “antibiotics of concern”

• For all other antibiotics

Measure Attributes

Product lines	Commercial, Medicaid, Medicare. Construct Tables ABX-1A through ABX-1D, ABX-2, ABX-2E and ABX-3 using Table ABX as a template. Report the information in Tables ABX (a-c)-1/2/3 by age and sex.
Age	Age as of the date the prescription is dispensed.
Benefit	Pharmacy.
Member months	Report all member months for the measurement year for members with the benefit. For more details, refer to Specific Instructions for Use of Services Tables.

Prescription antibiotics

Dispensing an antibiotic for any duration. Report the number of days supplied for all prescribed antibiotics in Table ABX-A. Different medications dispensed on the same day count as multiple dispensing events.

Calculation

Total number of antibiotic prescriptions	Total number of all antibiotic prescriptions for the measurement year of any duration of the medication.
Average number of antibiotic prescriptions PMPY	Annual total number of antibiotic prescriptions PMPY = [Total number of antibiotic prescriptions in the year/member months for members with a pharmacy benefit]  12 months.
Total days supplied for all antibiotic prescriptions	Count the number of days supplied for all antibiotic prescriptions during the measurement year. The MCO should identify the number of days supplied for each antibiotic prescription and sum the days for all antibiotic prescriptions during the measurement year.
Average number of days supplied per antibiotic prescription	Average number of days supplied per prescription = [Total days supplied for all antibiotics prescription in the year/Total number of antibiotic prescriptions in the year].

Table ABX-A: Antibiotic Medications

Prescriptions
Amikacin Amoxicillin Amoxicillin/Clavulanate Ampicillin Ampicillin-Sulbactam Azithromycin Aztreonam Benzathine penicillin Bicillin Carbenicillin Cefaclor Cefadroxil Cefadroxil hydrate Cefazolin Cefdinir Cefepime Cefixime Cefoperzone Cefotaxime Cefotetan Cefoxitin	Cefpodoxime proxetil Cefprozil Ceftazidime Ceftibuten Ceftitoren Ceftizoxime Ceftriaxone Cefuroxime Cephalexin Cephradine Chloramphenical Ciprofloxacin Clarithromycin Clindamycin Daptomycin Dicloxacillin Doxycycline Ery E-Succ/ Sulfisoxazole Erythromycin Fosfomycin	Gatifloxacin Gemifloxacin Gentamicin Kanamycin Levofloxacin Lincomycin Linezolid Lomefloxacin Loracarbef Metronidazole Minocycline Moxifloxacin Nafcillin Neomycin Nitrofurantoin Norfloxacin Ofloxacin Oxacillin Penicillin G Penicillin VK	Piperacillin Piperacillin-Tazobactam Procaine penicillin Rifampin Quinupristin/Dalfopristin Sparfloxacin Streptomycin Sulfisoxazole Sulfadizine Sulfamethoxazole Sulfasalzine Telithromycin Tetracycline Ticarcillin Ticarcillin-clavulanate Trimethoprim Trimethoprim-Sulfamethoxazole Vancomycin

Note: NCQA will provide a list of NDC codes for antibiotic medications on its Web site at www.ncqa.org by November 15, 2006.

Calculations for Antibiotics of Concern

Total number of prescriptions for antibiotics of concern	Total number of all prescriptions for antibiotics of concern during the measurement year. Table ABX-B contains all antibiotics of concern.
Average number of prescriptions PMPY for antibiotics of concern	Annual total number of prescriptions for antibiotics of concern per member per year = [Annual number of prescriptions for antibiotics of concern/member months for members with a pharmacy benefit]  12 months. Refer to Table ABX-B for a list of antibiotics of concern.
Percentage of antibiotics of concern of all antibiotic prescriptions	Percentage of prescriptions for antibiotics of concern of all antibiotic prescriptions = [Total number of prescriptions for antibiotics of concern in the year/Total number of antibiotic prescriptions in the year]. Refer to Table ABX-B for a list of antibiotics of concern.

Table ABX-B: List of Antibiotics of Concern by Therapeutic Class and Drugs

Therapeutic Class	Drugs
Quinolone	Ciprofloxacin Gatifloxacin Gemifloxacin	Levofloxacin Lomefloxacin Moxifloxacin	Norfloxacin Ofloxacin Sparfloxacin
Azithromycin and clarithromycin	Azithromycin	Clarithromycin
Cephalasporin (second, third and fourth generation)	Cefaclor Cefotetan Cefepime Cefdinir Cefixime Cefoperzone	Cefprozil Cefuroxime Cefotaxime Ceftibuten Cefpodoxime proxetil Ceftazidime	Cefoxitin Loracarbef Ceftizoxime Ceftitoren Ceftriaxione
Amoxicillin/Clavulanate	Amoxicillin/Clavulanate
Ketolide	Telithromycin
Clindamycin	Clindamycin
Miscellaneous antibiotics of concern	Aztreonam Chloramphenical	Linezolid Quinupristin/Dalfopristin	Vancomycin

Calculations for Reporting by Drug Class

Antibiotic utilization PMPY by drug class	For each product line, report the annual total number of antibiotic prescriptions by: total, average and PMPY by drug class in Tables ABX-1/2/3(b) and (c) for: Antibiotics of concern All other antibiotics.
Antibiotics of concern	Report the utilization of antibiotics of concern by the following six antibiotic drug classes and a miscellaneous category in Table ABX-1/2/3(b): Antibiotics of Concern Utilization PMPY by Drug Class. Quinolone Cephalosporin (includes second-, third- and fourth-generation cephalosporins) Azithromycin and clarithromycin Amoxicillin/clavulanate
	Ketolide Clindamycin Miscellaneous antibiotics of concern (includes linezolid, quinupristin/ dalfopristin, vancomycin, teicoplanin) Refer to Table ABX-B for a list of antibiotics of concern and therapeutic classes.
All other antibiotics	Report the utilization of all other antibiotics total, average and PMPY by the following seven antibiotic drug classes and a miscellaneous category in Table ABX-1/2/3(c): All Other Antibiotics Utilization PMPY by Drug Class. Absorbable sulfonamide Aminoglycoside Cephalosporin (includes first generation only): Lincosamide (other than clindamycin) Macrolide (other than azithromycin and clarithromycin) Penicillin (other than amoxicillin/clavulanate) Tetracycline Miscellaneous antibiotics, including chemotherapeutic agents, antibacterial, urinary tract agents Refer to Table ABX-4 for a list of all other antibiotics concern and therapeutic classes.

Table ABX-C: List of All Other Antibiotics by Therapeutic Class and Drugs

Therapeutic Class	Drugs
Absorbable sulfonamide	Sulfisoxazole Sulfadizine	Sulfamethoxazole Sulfasalzine	Trimethoprim-Sulfamethoxazole
Aminoglycoside	Amikacin Gentamicin Kanamycin	Neomycin Streptomycin
Cephalosporin (includes first generation only)	Cefadroxil Cefadroxil hydrate Cefazolin	Cephalexin Cephradine Carbenicillin	Piperacillin-tazobactam
Lincosamide (other than clindamycin)	Lincomycin
Macrolide (other than azithromycin and clarithromycin)	Ery E-Succ/Sulfisoxazole	Erythromycin
Penicillin (other than amoxicillin/clavulanate)	Ampicillin Ampicillin-Sulbactam Amoxicillin Benzathine penicillin Bicillin Dicloxacillin	Nafcillin Oxacillin Penicillin VK Penicillin G Piperacillin	Piperacillin-Tazobactam Procaine penicillin Ticarcillin Ticarcillin-Clavulanate
Tetracycline	Doxycycline	Minocycline	Tetracycline
Miscellaneous antibiotics (includes chemo-therapeutic agents, antibacterial, urinary tract agents)	Daptomycin Fosfomycin	Metronidazole Nitrofurantoin	Rifampin Trimethoprim

Table ABX-1/2/3: Plan Member Months

Member Months
Age	Male	Female	Total
0-9	_________	_________	_________
10-17	_________	_________	_________
18-34	_________	_________	_________
35-49	_________	_________	_________
50-64	_________	_________	_________
65-74	_________	_________	_________
75-84	_________	_________	_________
85+	_________	_________	_________
Unknown	_________	_________	_________
Total:	_________	_________	_________

Reporting Table ABX 1/2/3(a): Antibiotic Utilization (Commercial, Medicaid, Medicare)

Age	Sex	Total Antibiotic Scrips	Average Antibiotic Scrips PMPY	Total Days Supplied for All Antibiotic Scrips	Average Days Supplied per Anti-biotic Scrip	Total Scrips for Antibiotics of Concern	Average Scrips PMPY for Antibiotics of Concern	% of Antibiotics of Concern of All Antibiotic Scrips
0-9	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
10-17	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
18-34	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%

Reporting Table ABX 1/2/3(a): Antibiotic Utilization (Commercial, Medicaid, Medicare) (continued)

Age	Sex	Total Anti-biotic Scrips	Average Antibiotic Scrips PMPY	Total Days Supplied for All Antibiotic Scrips	Average Days Supplied per Anti-biotic Scrip	Total Scrips for Antibiotics of Concern	Average Scrips PMPY for Antibiotics of Concern	% of Antibiotics of Concern of All Antibiotic Scrips
35-49	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
50-64	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
65-74	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
75-84	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
85+	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
Unknown	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%
	Total:	__________	___________	___________	___________	___________	___________	_________%
Total	Male	__________	___________	___________	___________	___________	___________	_________%
	Female	__________	___________	___________	___________	___________	___________	_________%

Table ABX 1/2/3(b): Antibiotics of Concern Utilization PMPY by Drug Class

Age

Sex

Total # Quino-lone Scrips

Avg # Quino-lone Scrips PMPY

Total # Ceph-alo-sporin Scrips

Avg # Ceph-alo-sporins Scrips PMPY

Total # Azithro-mycin & Clar-ithro-mycin Scrips

Avg # Azithro-mycin & Clar-ithro-mycin Scrips PMPY

Total # Amox-icillin/ Clavu-lanate Scrips

Avg # Amox-icillin/ Clavu-lanate Scrips PMPY

Total # Keto-lide Scrips

Avg # Keto-lide Scrips PMPY

Total # Clinda-mycin Scrips

Avg # Clinda-mycin Scrips PMPY

Total # Misc Anti-biotics of Concern Scrips

Avg # Misc Anti-biotics of Concern Scrips PMPY

0-9

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

10-17

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

18-34

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

35-49

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

50-64

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

65-74

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

75-84

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Table ABX 1/2/3(b): Antibiotics of Concern Utilization PMPY by Drug Class (continued)

Age

Sex

Total # Quino-lone Scrips

Avg # Quino-lone Scrips PMPY

Total # Ceph-alo-sporin Scrips

Avg # Ceph-alo-sporins Scrips PMPY

Total # Azithro-mycin & Clar-ithro-mycin Scrips

Avg # Azithro-mycin & Clar-ithro-mycin Scrips PMPY

Total # Amox-icillin/ Clavu-lanate Scrips

Avg # Amox-icillin/ Clavu-lanate Scrips PMPY

Total # Keto-lide Scrips

Avg # Keto-lide Scrips PMPY

Total # Clinda-mycin Scrips

Avg # Clinda-mycin Scrips PMPY

Total # Misc Anti-biotics of Concern Scrips

Avg # Misc Anti-biotics of Concern Scrips PMPY

85+

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Unknown

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Total:

Male

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Female

_______

_______

_______

_______

_______

_______

_______

_______

_______

______

______

______

________

_______

Table ABX 1/2/3 (c): All Other Antibiotic Utilization PMPY by Drug Class

Age

Sex

Total # Absorb-able sulfona-mide Scrips

Avg # Absorb-able sulfona-mide Scrips PMPY

Total # Amino-glyco-side Scrips

Avg # Amino-glyco-side Scrips PMPY

Total # 1st Gen Ceph-alo-spor-ins Scrips

Avg # 1st Gen Ceph-alo-spor-ins Scrips PMPY

Total # Linco-samide Scrips

Avg # Linco-samide ScripsPMPY

Total # Macro-lides (not azith., clar.) Scrips

Avg # Macro-lides (not azith. , clar.) Scrips PMPY

Total # Peni-cillin Scrips

Avg # Peni-cillin Scrips PMPY

Total # Tetra-cycline Scrips

Avg # Tetra-cyc-line Scrips PMPY

Total # Misc. Anti-biotics Scrips

Avg # Misc. Anti-biotics Scrips PMPY

50-64

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Tot.

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

65-74

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Tot.

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

75-84

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Tot.

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

85+

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Tot.

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Un.

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Tot:

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

Total

M

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

F

______

_______

_____

______

______

_____

______

_____

______

______

_____

______

______

_____

______

______

HEDIS 2007, Volume 2