When you go to see a doctor, the doctor should do certain things to help you stay healthy or manage a disease. Look at this list of Evidence Based Measures (EBM ) that we use to measure a doctor’s performance and see why they can be important to you.
Is it important for my children to get shots?
Chicken pox vaccine (at 12-18 months)
Measles, Mumps, and Rubella (MMR) vaccine (at 12-15 months and 4-6 years)
Do you have diabetes? What kind of tests do you need to get?
Regular blood sugar testing (HbA1c) for diabetics
Regular tests for diabetic kidney disease
Diabetics: regularly monitor and lower cholesterol and triglycerides
Have an annual diabetic eye exam
What tests should a woman ask her doctor about?
Annual mammogram
Cervical cancer screening
Are you age 50 or older and have you talked about colorectal cancer screening with your doctor?
Colorectal cancer screening
What you should know before you go to the doctor.
When should my doctor prescribe me antibiotics?
I have low back pain: what should my doctor do first?
How should my doctor examine my low back pain? Avoid ordering imaging tests
Have you been diagnosed with cancer?
Breast cancer treatment guideline: radiation and breast conserving surgery
Colorectal cancer treatment guideline: have regular check-ups with your doctor following diagnosis and treatment
Do you have heart disease?
Heart disease: monitor and lower cholesterol
Are you considering surgery? Know your risks.
Problems after appendix or gall bladder surgery
Do you have asthma?
Using drugs every day to control asthma and prevent asthma attacks
Do you have glaucoma?
Annual eye exams for glaucoma patients
For doctors, here is what the BlueCompare EBM symbols mean:
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Exceeds expected performance compared to other doctors. |
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Meets expected performance compared to other doctors. |
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This doctor requested that the BlueCompare EBM symbol not be shown. |
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There is not enough data to measure performance or this doctor or provider is new to the network. Re-evaluations are conducted periodically. |
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Performance measures are not available for this specialty. |
What are Evidence Based Measures?
When a patient goes to the doctor, doctors should do certain things to help the patient stay healthy or manage a disease. Scientific studies help discover the most effective ways for doctors to help patients. Experts look at the results of those studies and write summaries that help doctors treat patients effectively. These summaries are called evidence based guidelines. The experts also create ways to measure whether doctors follow the guidelines when patients come to see them. These measures are Evidence Based Measures.
We look at our enrollment information to find the people who may benefit if certain things are done. We use claims from doctors, labs, X-ray facilities, and hospitals to see if those things happened. You should know that we only use the claims and enrollment data for people who are members of Blue Cross and Blue Shield of Texas. That means we don’t count the things a doctor does for patients who are covered by other insurance plans. We also can’t count the times when doctors follow the guidelines in a way that we can’t see when we look at the claims information. Patients who don't do what the doctor recommended can make it look like the doctor didn't follow the guidelines.
For doctors in BlueCompare, EBM compares how they performed to treat similar patients. We compare doctors in a practice to their peers in the same specialty.
Here is a list of the specialties we review:
Allergy-Immunology |
Cardiovascular Disease – Non-interventional |
Colon & Rectal Surgery |
Emergency Medicine |
Endocrinology |
Family Practice |
Gastroenterology |
General Surgery |
Geriatric Medicine |
Internal Medicine |
Nephrology |
Neurological Surgery |
Neurology |
Obstetrics-Gynecology |
Oncology |
Ophthalmology |
Orthopedic - Spine |
Orthopedic Surgery |
Pediatric Pulmonology |
Pediatrics |
Physical Medicine & Rehabilitation |
Rheumatology |
Urgent Care |
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Clinic/Group Practices: The BlueCompare EBM symbol is based on the performance of all the doctors in the same specialty in the practice. Each doctor in that specialty will have the same BlueCompare EBM symbol.
NOTE: For evaluation purposes, a doctor is normally assigned to a single specialty. If the doctor receives a BlueCompare EBM symbol and appears under other specialties, that EBM symbol may appear for all specialties under which the doctor is listed.
We provide information on how doctors in a practice compare to other doctors on EBM indicators to assist you in choosing a doctor. Since we can not count all the things that a doctor does, you should not make your choice using only this information. BlueCompare is not meant to tell you which doctor you should select. This is a very personal choice, and you should not decide based only on BlueCompare information.