This article series is our monthly tool to help you maximize patient health outcomes in accordance with NCQA's¹ HEDIS^®2 measurements for high-quality care on important dimensions of services.

HEDIS^® definition

Use of spirometry testing in the assessment and diagnosis of COPD: The percentage of commercial and Medicare members ages 40 and older with a new diagnosis of chronic obstructive pulmonary disease (COPD) or newly active COPD,who received appropriate spirometry testing to confirm the diagnosis.

Note: A period of two years with no claims/encounters containing any diagnosis of COPD is needed for a member to be considered newly diagnosed. For these newly diagnosed members, HEDIS^® is searching for at least one claim/encounter for spirometry testing within the last two years to confirm the diagnosis.

Coding guidelines

Use the following codes for a diagnosis of COPD and spirometry testing:

Plan performance

In a three-year comparison of national plan performance on the rate of spirometry testing to confirm the diagnosis of COPD, AmeriHealth New Jersey plan performance has trended at or below the 50th percentile of national averages. The following chart shows the gap in performance between AmeriHealth New Jersey plans and the 90th percentile national benchmark.

Quick tips

• ✔ Accurately define new or newly diagnosed members with COPD, and make sure a Spirometry Test is in the medical record to confirm the diagnosis.
• ✔ Regular Spirometry evaluation can assist in proper diagnosis and routine treatment,which should reduce COPD exacerbations and inpatient hospitalizations.

? National Quality Forum (endorsed measure)

Learn more

Visit http://www.amerihealth.com/providers/resources/hedis.html to view previously published Highlighting HEDIS^® articles.

If you have feedback or topic ideas for the Hightlighting HEDIS^® series, email us.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.

¹ The National Committee for Quality Assurance (NCQA) is the most widely recognizedaccreditation program in the U.S.

² The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care.