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## Complete Summary

#### TITLE

Obesity prevention and treatment: percent of enrollees who had a
surgical treatment for obesity with a diagnosis of obesity, morbid
obesity, and overweight (MEDDIC-MS).

#### SOURCE(S)

Wisconsin Department of Health and Family Services, Division of Health
Care Financing, Bureau of Managed Health Care Programs. MEDDIC-MS 2007
technical specifications. Medicaid encounter data driven improvement
core measure set. Madison (WI): State of Wisconsin; 2007 May. 48 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Use of Services

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percent of enrollees who had surgical
treatment for obesity with a primary or secondary diagnosis of obesity,
morbid obesity, or overweight.

#### RATIONALE

Obesity is linked to increased risk for diabetes, hypertension, heart
disease, disability and adverse outcomes of pregnancy, including
prematurity and increased maternal and infant mortality.

Costs associates with dealing with the effects of obesity are increasing
as its prevalence increases. Demand for the most costly intervention,
bariatric surgery such as gastric bypass, has tripled in recent years.
Demand for the procedure to surgically remove excess tissue after weight
loss, called pannicutectomy, has also increased.

Recent research indicates the post-operative complication rate for
bariatric surgery is significantly higher than previously thought, and
the costs associated with post-operative complications in the first year
after surgery are substantial. For example, 4 out of 10 bariatric
surgery patients have complications within six months of discharge. Risk
for adverse health outcomes are therefore also higher than previously
believed. Being a Medicaid recipient has also been shown to increase the
risk of post-operative mortality.

Patients insured through Medicaid had nearly 5 times the risk of dying
than privately insured patients, and those requiring re-operation were
at 22 times higher risk of dying.

Policy options to deal with the problem by shifting resources away from
invasive interventions and to prevention and non-surgical interventions
are necessary to improve patient safety, improve quality of care,
quality of life and avoid preventable excess costs associated with
obesity.

#### PRIMARY CLINICAL COMPONENT

Obesity; morbid obesity; overweight; surgical treatment

#### DENOMINATOR DESCRIPTION

Medicaid/BadgerCare enrollees in each age cohort (age 11 to 17 years and
over age 18 years) continuously enrolled with the same health
maintenance organization (HMO) for at least 304 days immediately prior
to the measure end date with no more than one gap in enrollment of not
more than 45 days. The enrollee must have a total of not less than 259
enrolled days in the look-back period (see the \"Description of Case
Finding\" field in the Complete Summary).

Include all enrollees in the encounter with primary or secondary
diagnosis codes for obesity, morbid obesity, or overweight.

#### NUMERATOR DESCRIPTION

Enrollees in the denominator with an encounter with primary or secondary
diagnosis codes for obesity, or overweight and procedure codes for
selected bariatric surgery

**Note**: Refer to the original measure documentation for specific
administrative codes used to define surgical encounters and a diagnosis
of obesity, morbid obesity, and overweight.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE VALUE OF MONITORING USE OF SERVICE

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Monitoring and planning\
Variation in use of service

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Division of Health Care Financing, Bureau of Managed Health Care
Programs. MEDDIC-MS data book. Clinical quality: value-based purchasing
in Wisconsin Family Medicaid and BadgerCare. Vol. 1, 2006 overall
performance data. Madison (WI): Wisconsin Department of Health and
Family Services; 2007 Sep. 29 p.

Division of Health Care Financing, Bureau of Managed Health Care
Programs. MEDDIC-MS. Clinical quality: value-based purchasing in
Wisconsin Family Medicaid and BadgerCare. Vol. 2, 2006 HMO-specific
performance data. Madison (WI): Wisconsin Department of Health and
Family Services; 2007 Sep. 36 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Decision-making by managers about resource allocation\
External oversight/Medicaid\
External oversight/Medicare\
External oversight/State government program\
Monitoring and planning\
Pay-for-performance

### Application of Measure in its Current Use

#### CARE SETTING

Managed Care Plans

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Ages greater than or equal to 6 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Three age cohorts are reported for this measure, including low-income
children (ages 6 to 10 years, 11 to 17 years, and 18+).

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

The National average for prevalence of overweight or obesity among
children age 6 to 19 years of age in 2000 was recently estimated at
approximately 11 percent. The same report cited an estimated prevalence
of 23 percent among adults over age 19 years nationwide. These
percentages are based only on age-adjusted estimates and subjective
survey data. Data from the Centers for Disease Control and Prevention
(CDC) NHANES survey estimated obesity among children age 12 to 19 years
of age to be 16 percent.

CDC data estimates the prevalence of obesity among Wisconsin adults at
21.9 percent.

Prevalence of diagnosed overweight, obesity or morbid obesity in all age
cohorts was 6.2 percent, with adults being diagnosed more than twice as
frequently as children.

In 2006, the average period prevalence for encounters with a diagnosis
of obesity among children age 6 to 10 years old was 2 percent. Among
children age 11 to 17 years, the average period prevalence was 3.5
percent (n=2,167) and 8.5 percent (n=8,133) among adults 18 and over.

**Note** that CDC data are estimates based on consumer self-report and
survey data, not objective clinical data. The Wisconsin Medicaid
MEDDIC-MS Obesity Prevention and Treatment data is based on actual
encounter data.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Division of Health Care Financing, Bureau of Managed Health Care
Programs. MEDDIC-MS data book. Clinical quality: value-based purchasing
in Wisconsin Family Medicaid and BadgerCare. Vol. 1, 2006 overall
performance data. Madison (WI): Wisconsin Department of Health and
Family Services; 2007 Sep. 29 p.

Division of Health Care Financing, Bureau of Managed Health Care
Programs. MEDDIC-MS. Clinical quality: value-based purchasing in
Wisconsin Family Medicaid and BadgerCare. Vol. 2, 2006 HMO-specific
performance data. Madison (WI): Wisconsin Department of Health and
Family Services; 2007 Sep. 36 p.

Katz DL, O\'Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S,
Dietz W. Public health strategies for preventing and controlling
overweight and obesity in school and worksite settings: a report on
recommendations of the Task Force on Community Preventive Services. MMWR
Recomm Rep2005 Oct 7;54(RR-10):1-12. \[109 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16261131)

National Center for Health Statistics (NCHS). Prevalence of overweight
and obesity among adults: United States, 1999-2002. \[internet\].
Hyattsville (MD): National Center for Health Statistics, Centers for
Disease Control and Prevention; 2007 Jan 11\[accessed 2008 Jan 14\]. \[3
p\].

Prevalence of overweight among children and adolescents: United States,
1999-2002.Hyattsville (MD): National Center for Health Statistics
(NCHS); 2007

#### ASSOCIATION WITH VULNERABLE POPULATIONS

See the \"Rationale\" and \"Incidence/Prevalence\" fields.

#### BURDEN OF ILLNESS

See the \"Rationale\" field.

#### UTILIZATION

Surgical interventions, referred to as bariatric surgery, were not used
in the child population in Wisconsin, but did occur in 1.2 percent of
adults (n=99). The net percentage of cases involving bariatric surgery
was 1.0 percent of all cases (child and adult) with a diagnosis of
overweight, obesity or morbid obesity. The estimated national average
was 0.6 percent among those adults eligible for surgery.

Nationwide, bariatric surgical procedures increased from 13,365 in 1998
to 72,177 in 2002. Based on preliminary state-level data (1998-2003),
the number of bariatric surgical procedures is projected to be 102,794
in 2003. The increase in the use of bariatric surgery has been even more
explosive in Wisconsin. The number of gastric bypass surgeries performed
in Wisconsin more than doubled in one year, from 182 in 2001 to 426 in
2002. Thus, in 2002, there was roughly one bariatric surgery for every
200 morbidly obese Wisconsin adults.

#### EVIDENCE FOR UTILIZATION

Encinosa WE, Bernard DM, Steiner CA, Chen CC. Use and costs of bariatric
surgery and prescription weight-loss medications. Health Aff
(Millwood)2005 Jul-Aug;24(4):1039-46.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16012144)

Erickson JL, Remington PL, Peppard PE. Trends in bariatric surgery for
morbid obesity in Wisconsin. WMJ2004;103(2):32-7.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15139556)

Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical
procedures. JAMA2005 Oct 19;294(15):1909-17.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16234497)

#### COSTS

See the \"Rationale\" field.

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Not within an IOM Care Need

#### IOM DOMAIN

Not within an IOM Domain

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Medicaid/BadgerCare enrollees in each age cohort (ages 6 to 10 years, 11
to 17 years, and over 18 years) continuously enrolled with the same
health maintenance organization (HMO) for at least 304 days immediately
prior to the *measure end date*\* with no more than one gap in
enrollment of not more than 45 days. The enrollee must have a total of
not less than 259 enrolled days in the *look-back period*\*\*.

Include all enrollees in the encounter with primary or secondary
diagnosis codes for obesity, morbid obesity, or overweight.

\**Measure end date*: The last day by which measured services can be
rendered to be included in the measure numerator. This is the date from
which the look-back period begins.

\*\**Measure look-back period*: 365 days from the measure end date.
Services provided prior to enrollment in the HMO are counted in the
numerator if identified from fee-for-service (FFS) claims data. Services
provided by non-network providers are counted in the numerator when they
are captured in FFS claims or managed care organization (MCO) encounter
data.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Medicaid/BadgerCare enrollees in each age cohort (ages 6 to 10 years, 11
to 17 years, and over age 18 years) continuously enrolled with the same
health maintenance organization (HMO) for at least 304 days immediately
prior to the measure end date with no more than one gap in enrollment of
not more than 45 days. The enrollee must have a total of not less than
259 enrolled days in the look-back period.

Include all enrollees in the encounter with primary or secondary
diagnosis codes for obesity, morbid obesity, or overweight.

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are not equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter\
Patient Characteristic

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Enrollees in the denominator with an encounter with primary or secondary
diagnosis codes for obesity, or overweight and procedure codes for
selected bariatric surgery

**Note**: Refer to the original measure documentation for specific
administrative codes used to define surgical encounters and a diagnosis
of obesity, morbid obesity, and overweight.

**Exclusions**\
Refer to the original measure documentation for age-specific Current
Procedure Terminology (CPT) codes that are to be excluded.

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data

#### LEVEL OF DETERMINATION OF QUALITY

Does not apply to this measure

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Undetermined

#### ALLOWANCE FOR PATIENT FACTORS

Analysis by subgroup (stratification on patient factors, geographic
factors, etc.)

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

The following three age cohorts are reported:

-   Age 6 to 10 years

-   Age 11 to 17 years

-   Age 18 years and older

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

This measure was tested and validated by an independent third party and
subject to internal review prior to implementation.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

APS Healthcare. Measure testing/validation reports for MEDDIC-MS OPT
measure. Madison (WI): APS Healthcare (APS); 2006.

### Identifying Information

#### ORIGINAL TITLE

Obesity prevention and treatment (MEDDIC MS OPT): surgical treatment of
obesity.

#### MEASURE COLLECTION

[MEDDIC-MS (Medicaid Encounter Data Driven Improvement Core Measure
Set). Automated rapid-cycle performance measures for the Medicaid and
BadgerCare HMO
programs.](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=28&doc=10168)

#### MEASURE SET NAME

[MEDDIC-MS (Medicaid Encounter Data Driven Improvement Core Measure
Set). Measures applicable to AFDC/HS (Medicaid) and SCHIP
(BadgerCare).](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=28&doc=10204)

#### MEASURE SUBSET NAME

[Monitoring
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=28&doc=10514)

#### DEVELOPER

State of Wisconsin, Department of Health and Family Services

#### FUNDING SOURCE(S)

Routine general purpose revenue (GPR) funding for all development,
testing, deployment and routine operations and public reporting. No
budgetary increases or special funding was required.

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Internal and external stakeholder groups contributed to the design,
topic selection and data architecture of the measure system. These
included providers of a range of types (MD, DO, RN, DDS, etc.),
consumers, advocates, Health Maintenance Organization (HMO) quality
improvement staff, data analysts, systems consultants, representatives
of a range of state bureaus and sections.

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

None

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 May

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Wisconsin Department of Health and Family Services, Division of Health
Care Financing, Bureau of Managed Health Care Programs. MEDDIC-MS 2007
technical specifications. Medicaid encounter data driven improvement
core measure set. Madison (WI): State of Wisconsin; 2007 May. 48 p.

#### MEASURE AVAILABILITY

The individual measure, \"Obesity Prevention and Treatment (MEDDIC-MS
OPT): Surgical Treatment of Obesity,\" is published in \"Medicaid
Encounter Data Driven Improvement Core Measure Set (MEDDIC-MS 2007).\"

State of Wisconsin\
Department of Health and Family Services\
DHCF/BMHCP\
Gary R. Ilminen, RN, Nurse Consultant\
1 W. Wilson Street, PO Box 309\
Madison, WI 53701-0309

\(608\) 261-7839 Office\
(608) 261-7792 Fax\
<ilmingr@dhfs.state.wi.us>

#### COMPANION DOCUMENTS

The following are available:

-   Division of Health Care Financing, Bureau of Managed Health Care
    Programs. MEDDIC-MS data book. Clinical quality: value-based
    purchasing in Wisconsin Family Medicaid and BadgerCare. Vol. 1, 2006
    overall performance data. Madison (WI): Wisconsin Department of
    Health and Family Services; 2007 Sep. 29 p. This document is
    available in Portable Document Format (PDF) from the [Wisconsin
    Medicaid Managed Care Web
    site](http://dhfs.wisconsin.gov/medicaid7/reports_data/quality_reports/pdfs/2006vol1.pdf).

-   Division of Health Care Financing, Bureau of Managed Health Care
    Programs. MEDDIC-MS. Clinical quality: value-based purchasing in
    Wisconsin Family Medicaid and BadgerCare. Vol. 2, 2006 HMO-specific
    performance data. Madison (WI): Wisconsin Department of Health and
    Family Services; 2007 Sep. 36 p. This document is available in PDF
    from the [Wisconsin Medicaid Managed Care Web
    site](http://dhfs.wisconsin.gov/medicaid7/reports_data/quality_reports/pdfs/2006vol2.pdf).

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on December 3, 2007.
The information was verified by the measure developer on December 13,
2007.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

Free use, public domain information notice: MEDDIC-MS and the MEDDIC-MS
SSI performance measures are in the public domain and are not subject to
copyright restrictions. States or other entities wishing to adopt or
adapt them to their own Medicaid managed care or other programs may do
so. Determination of the suitability or applicability of the measures
for use in any program is the responsibility of the prospective user.
Attribution to the State of Wisconsin Department of Health and Family
Services is requested.

This performance measure does not constitute clinical practice
guidelines and does not establish a standard of medical care. The
measure is designed to assist the Wisconsin Department of Health and
Family Services in assessing and improving quality of care delivered to
managed care program enrollees. The performance measure is subject to
review and may be revised or rescinded at any time by the Wisconsin
Department of Health and Family Services.

### Disclaimer

#### NQMC DISCLAIMER

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008