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Changes to the QPM score program for measurement year 2014

October 1, 2014

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.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.


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