The following is a summary of changes being made to the Quality Performance
Measure (QPM) score program, a component of the Quality Incentive Payment
System (QIPS) program, for measurement year 2014. Eligible primary care
physicians (PCPs) will be sent a letter to further explain these changes.
Feedback process
Traditionally, in the first quarter following the measurement year practices
would be given an opportunity to submit feedback on members who, based on our
records, did not receive the indicated services. However, this report did not
include a full 12 months of claims data.
Beginning with measurement year 2014, practices will receive reports, based
on a full 12 months of claims data and 2 months of run-out, that include the
following:
- a preliminary QPM percentage and tier;
- a summary, by measure, of the number of members eligible for services and
the number of members who received these services;
- a list of members who did not receive services.
Unlike previous years, the feedback process going forward will become
optional. If a practice wishes to provide additional documentation to validate
the rendering of services that could potentially change their performance
outcome, they must elect to do so by notifying Independence via email within a
specific time frame.
Opportunity report
Due to a system upgrade, the data necessary to produce the opportunity
report is unavailable. Therefore, for measurement year 2014, an opportunity
report will not be available.
Quality performance measures
As a result of a clinical review and provider feedback, the following
quality performance measures have been eliminated from measurement year
2014:
- Cholesterol management (LDL-C) for patients with cardiovascular
conditions
- Diabetic care
- - LDL-C screening
- - LDL-C results
In addition, the following quality performance measures have been updated
for measurement year 2014 based on changes to the Healthcare Effectiveness Data
and Information Set (HEDIS®):
Measure
Change
Adolescent immunization —
Tdap or Td
The measure has been revised to allow for separate tetanus and diphtheria
vaccinations.
Diabetic care —
Dilated retinal eye examination
The need for a normal eye examination in the year prior to the measurement year
has been changed as follows:
- Previous. Dilated retinal eye examination in the
measurement year (2014) by an ophthalmologist or optometrist, or a negative
retinal exam in the year prior to the measurement year (2013).
- Updated. Dilated retinal eye examination by an
ophthalmologist or optometrist in the measurement year (2014) or in the year
prior to the measurement year (2013).
Osteoporosis management in women who had a fracture
- The age range has changed to 67 through 85. Previously, there was no upper
age limit.
- Pathological fractures have been removed from qualifying fractures.
Updated QIPS Program Manual
These changes, in detail, will be incorporated into the QIPS Program
Manual — Measurement Year 2014, which is available on the
NaviNet® web portal in the Current Publications section of
Independence?s Plan Central.
If you have any questions about these program changes, contact your Network
Coordinator.
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