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Physician Quality Measurement

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

As part of these efforts, 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. 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
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.
Asthma
Use of Appropriate Medications for People With Asthma Use of appropriate medications for people with persistent asthma
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 Quality Reports

Part of the PQM program consists of providing practice level quality reports on a monthly basis to contracted physician groups so they can track and manage their performance metrics. It also includes an online rating system that can be viewed by members nationwide. The online rating system is based on the same data presented in the Provider Quality Reports.

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 practice specialties:

  • Family Practice
  • General Practice
  • Internal Medicine
  • Pediatrics
  • OBGYN

Utilizing PQM, BCBSNC helps Blue members understand how their clinic or practice performs compared to local norms. These results are based on locally calculated measures and comparisons and are displayed consistently using a three tier rating system.

    Exceeds local benchmarks
    Meets local benchmarks
    Below local benchmarks

The ratings are the overall compliance rate for all North Carolina clinics or practices in the above specialty types who meet minimum episode or opportunity thresholds. This comparison is based on claims sets for same-specialty type practices participating in our networks. These ratings will be updated annually in the Spring and will be representative of the previous calendar year.

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.