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June 2014

PGIP primary care physicians who perform well on HEDIS® quality measures can earn new fee uplift

Not in PGIP? Here’s your chance

We’ll be accepting applications from physician organizations that would like to join our Physician Group Incentive Program from July 1 through Aug. 29, 2014.

This innovative program, developed with input from physicians across Michigan, is helping improve the quality, value and efficiency of health care in the state. PGIP facilitates change through a wide variety of initiatives, and rewards physician organizations for improving health care delivery.

If you represent a physician organization and would like to complete an application, email the Value Partnerships staff at providerpartnerships@bcbsm.com. The Blues must receive completed application packets by Aug. 29, 2014.

Keep in mind that physicians must join PGIP as part of a physician organization. Details on the requirements for participating and instructions on how to join are in the health care provider area of our website.

If you’re an individual practitioner with questions about participating in PGIP, contact your provider consultant. Not sure who that is? Check our website.

All primary care physicians in the Physician Group Incentive Program will have the chance to earn a new 5 percent fee uplift, effective July 1, 2014.

The fee uplift is available to physicians who perform well on evidence-based care measures in the Healthcare Effectiveness Data and Information Set or HEDIS®. It will apply to select evaluation and management and preventive service codes in the office or outpatient setting for PPO and Traditional commercial claims.

"The goal of the new fee uplift is to support and reward those practitioners for providing high quality, evidence-based health care services that help our members achieve and maintain optimal health," said Tom Leyden, director of Value Partnerships.

The fee uplift will be added to any other uplift they’re currently receiving. For example, if a physician is receiving a 10 percent fee uplift recognizing their Patient-Centered Medical Home designation, he or she would receive a 15 percent total fee uplift.

The HEDIS performance measures for the new fee uplift include eleven adult measures and four pediatric measures. Internal medicine physicians will be scored based on the adult measures, pediatricians will be scored on the pediatric measures and family practice physicians will be scored either on the adult only or the adult and pediatric measures, depending on the makeup of their patient population.

Following are the adult and pediatric measures included in the new fee uplift:

Adult

  • Avoidance of antibiotic treatment in adults with acute bronchitis
  • Use of spirometry in the assessment and diagnosis of chronic obstructive pulmonary disease
  • Persistence of beta blocker treatment after a heart attack
  • LDL-C screening in patients with coronary artery disease
  • HbA1c testing in patients with diabetes
  • LDL-C screening in patients with diabetes
  • Nephropathy screening in patients with diabetes
  • Use of imaging studies in low back pain
  • Treatment of major depression with antidepressant medication
  • Annual monitoring for patients on persistent medications
  • Use of appropriate medication for adults with asthma

Pediatric

  • Appropriate treatment for children with an upper respiratory infection
  • Use of appropriate medications for children with asthma
  • Appropriate testing for children with pharyngitis
  • Follow-up care for children prescribed medication for attention deficit hyperactivity disorder

Initially, the fee uplift will be implemented for a one-year period from July 1, 2014, through June 30, 2015. It will be calculated using BCBSM claims data with dates of service from Jan. 1, 2013, to Dec. 31, 2013.

The practices will be ranked according to the appropriate measures; those practices at or above the 80th percentile of PGIP primary care practices will receive the 5 percent fee uplift. The HEDIS fee uplift analysis and selection process will occur annually.

If you’re a PGIP primary care physician and want more information about your performance on the HEDIS measures and opportunities for improvement, contact your physician organization. For more details on the measures included in the new fee uplift, contact your PO or send us an email at providerpartnerships@bcbsm.com

If you’re not currently a member of PGIP and would like to join, contact your provider consultant. Check out our PGIP flier by clicking here.

To learn more about PGIP, go to the Physician Group Incentive Program section of valuepartnerships.com.

HEDIS is a registered trademark of the National Committee for Quality Assurance.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
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