[
This article series is our monthly tool to help you maximize patient healthoutcomes in accordance with NCQA?s1 HEDIS?2 measurements for high-qualitycare 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 olderwith a new diagnosis of chronic obstructive pulmonary disease (COPD) ornewly active COPD, who received appropriate spirometry testing to confirmthe diagnosis.
Note: A period of two years with no claims/encounters containing any diagnosisof COPD is needed for a member to be considered newly diagnosed. For thesemembers, HEDIS? is searching for at least one claim/encounter for spirometrytesting 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 ofspirometry testing to confirm the diagnosis of COPD, IBC plan performancehas trended at or below the 50th percentile of national averages. The followingchart shows the 10 percent gap in performance between IBC plans and the90th percentile national benchmark.
QIPS3 Alert!
The use of spirometry testing inthe assessment and diagnosisof COPD is included as aperformance measure in theQuality Incentive PaymentSystem (QIPS) program formeasurement year 2014 forparticipating providers.
Support from IBC
IBC Health Coaches can collaboratewith you to support and guide patientsthrough an acute or chronic episodeto help achieve the medical treatmentgoals you establish.
Please encourage your patients tocontact an IBC Health Coach. IBCHealth Coaches are available 24/7and can support your patients asthey make important decisions abouttheir health. Ask your patients to call1-800-ASK-BLUE and say ?HealthCoach? when prompted.
Learn more
Go to our Highlighting HEDIS? web page for more Highlighting HEDIS? topics.If you have feedback about theHighlighting HEDIS? series or youhave topic ideas, 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 recognized accreditation program inthe U.S.
2 The Healthcare Effectiveness Data and Information Set(HEDIS) is an NCQA tool used by more than 90 percentof U.S. health plans to measure performance on importantdimensions of care.
3 The Quality Incentive Payment System (QIPS) is areimbursement system developed by Keystone Health PlanEast for participating Pennsylvania primary care physiciansthat offers incentives for high-quality, accessible, and costeffectivecare.
]