Physician Quality Measurement

Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to ongoing collaboration with health care providers across the state that helps us deliver information to our members to help them make informed decisions when seeking health care.

An integral part of this effort, the Physician Quality Measurement (PQM) program offers Blue members nationwide the online capability to view nationally endorsed physician quality measures via either our local website or the Blue Cross and Blue Shield Association's Blue National Doctor & Hospital Finder.

The PQM program:

  • Integrates local quality results into a consistent national display
  • Displays quality results at the individual physician or group practice level
  • Features a core set of National Quality Forum-endorsed, HEDIS® Physician Quality of Care measures

Measure1 Brief Description
Women's Health
Breast Cancer Screening Adult mammography for breast cancer screening
Cervical Cancer Screening Adult pap smears for cervical cancer screening
Chlamydia Screening Chlamydia screening in sexually active females
Cancer Screening
Breast Cancer Screening Adult mammography for breast cancer screening
Cervical Cancer Screening Adult pap smears for cervical cancer screening
Colorectal Cancer Screening One of four tests for adult colorectal cancer screening, e.g. fecal occult blood test
Diabetes
Retinal Eye Exam Performed Dilated eye exam (retinal) for diabetics or a prior negative retinal exam
HgA1C Testing HgA1C testing
LDL-C Screening Low-density lipoprotein cholesterol screening of diabetics
Medical Attention for Nephropathy Urine protein screening and medical treatment, if needed
Heart Disease
Persistence of Beta-Blocker Treatment After a Heart Attack Persistent beta-blocker treatment after acute myocardial infarction (AMI) discharge.
Cholesterol Screening for Patients With Cardiovascular Conditions Low-density lipoprotein cholesterol screening of AMI, CABG, PCI or IVD patients
Asthma
Use of Appropriate Medications for People With Asthma Use of appropriate medications for people with persistent asthma
Respiratory Infections
Appropriate Testing for Children With Pharyngitis Appropriate testing of children with pharyngitis (CWP)
Appropriate Treatment for Children With Upper Respiratory Infection Appropriate treatment for children with upper respiratory infection (URI)
Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Antibiotics were not prescribed for patients with viral bronchitis
Medication Monitoring
Annual Monitoring For Patients on Persistent Medications Therapeutic monitoring for adults on persistent medications
Back Pain
Use of Imaging Studies for Low Back Pain The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
Depression
Antidepressant Medication Management The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment.

PQM is the basis of practice improvement efforts and highlights the commitment of a physician or group practice to provide safe and evidence-based care. The PQM program helps to:

  • Engage and empower consumers to make informed health care decisions
  • Complement your practice improvement efforts
  • Highlight your commitment to providing safe, effective and patient-centered care in your community
  • Work toward improving care through measuring data, promoting ongoing practice improvements, and recognizing you as a champion of care delivery

Physician Performance Reports

Part of the PQM program consists of mailing Provider Performance Analytics (PPA) reports to contracted physicians to inform them about their performance measures. It also includes an online rating system, based on the same data presented in the PPA reports, which can be viewed by members nationwide.

PQM results are displayed on the Blue Cross and Blue Shield Association's Blue National Doctor & Hospital Finder, available at www.bcbsa.com via the "Find a Doctor or Hospital" search function.

Currently, PQM data is displayed for the following physician specialties:

  • Family Practice
  • General Practice
  • Internal Medicine
  • Pediatrics
  • OB/GYN
  • Cardiology

PQM helps Blue members understand how their doctor performs compared to local norms. These results are based on locally calculated measures and comparisons, which are consistently displayed using a "star" rating system:

    ★ ★ ★ Exceeds local benchmarks
    ★ ★ Meets local benchmarks
    Below local benchmarks

This is the overall compliance rate for all North Carolina physicians in a specialty type who meet minimum episode or opportunity thresholds. This comparison is based on claims sets for same-specialty peers participating in our networks.

Benefits of Displaying PQM Information

Research shows that health care consumers value quality measurement information about doctors and hospitals. The PQM program complements your practice improvement efforts, as well as highlights your commitment to providing safe, evidence-based and patient-centered care in your community.