Print

List of Evidence Based Measures - 2009

BCBSTX uses Evidence Based Measures (EBM) to evaluate aspects of physician performance based on claims and enrollment data. These measures were developed based on nationally recognized evidence based guidelines. View additional information about the EBM guidelines , such as the clinical intent and sponsoring organizations. The measures listed below were used for scoring physician performance in the 2009 BlueCompare EBM evaluation.

#
Category
Description
Measured Working Specialties

1

Preventive Screening

Mammography Screening 

Family Practice, Geriatric Medicine, Internal Medicine, Obstetrics-Gynecology

2

Preventive Screening

Cervical Cancer Screening 

Family Practice, Internal Medicine, Obstetrics-Gynecology

3

Preventive Screening

Colorectal Cancer Screening 

Family Practice, Gastroenterology, Geriatric Medicine, Internal Medicine, Obstetrics-Gynecology

4

Diabetes

Diabetic Retinal Exam (Annual) 

Endocrinology, Family Practice, Geriatric Medicine, Internal Medicine, Nephrology

5

Diabetes

Glycosylated Hemoglobin (HbA1c) Test for Diabetics (Annual) 

Endocrinology, Family Practice, Geriatric Medicine, Internal Medicine, Nephrology

6

Diabetes

LDL Monitoring for Diabetes (Annual) 

Cardiovascular Disease – Non-interventional, Endocrinology, Family Practice, Geriatric Medicine, Internal Medicine, Nephrology

7

Cardiovascular Disease

Treatment of Cardiovascular Conditions: Monitoring Lipid Levels (Annual) 

Cardiovascular Disease – Non-interventional, Family Practice, Geriatric Medicine, Internal Medicine

8

Preventive Care

Annual Visual Field Tests for Patients with Primary Open Angle Glaucoma 

Ophthalmology

9

Antibiotic Use

Appropriate Treatment for Children with Upper Respiratory Infections (URI) 

Allergy-Immunology, Emergency Medicine, Family Practice, Pediatrics, Urgent Care

10

Medication Monitoring

Use of Long-term Control Drugs for Persistent Asthma 

Allergy-Immunology, Family Practice, Geriatric Medicine, Internal Medicine, Pediatric Pulmonology, Pediatrics, Pulmonology

11

Complication Avoidance

Risk-Adjusted Complication Likelihood for Surgeries: Appendectomy or Cholecystectomy 

General Surgery

12

Imaging

Appropriate Use of Imaging in Low Back Pain Assessment 

Emergency Medicine, Family Practice, Geriatric Medicine, Internal Medicine, Neurological Surgery, Neurology,  Orthopedic-Spine, Orthopedic Surgery, Physical Medicine & Rehab, Urgent Care

13

Imaging

X-ray prior to MRI/CAT Scan in the Evaluation of Lower Back Pain 

Emergency Medicine, Family Practice, Geriatric Medicine, Internal Medicine, Neurological Surgery, Neurology,  Orthopedic-Spine, Orthopedic Surgery, Physical Medicine & Rehab, Urgent Care

14

Cancer

Radiation Therapy Following Breast Conserving Surgery 

General Surgery, Oncology

15

Cancer

Follow-up After Initial Diagnosis and Treatment of Colorectal Cancer: CEA 

Colon-Rectal Surgery, Family Practice, Gastroenterology, General Surgery, Geriatric Medicine, Internal Medicine,  Oncology

16

Cancer

Follow-up After Initial Diagnosis and Treatment of Colorectal Cancer: Colonoscopy 

Colon-Rectal Surgery, Gastroenterology, General Surgery, Oncology


Informational Only:
The measures shown below were not used to evaluate any physician’s EBM performance in 2009. The information is provided to physicians as feedback on performance.

#
Category
Description
Measured Working Specialties

1

Preventive Screening

Chlamydia Screening for Women 

Family Practice,
Internal Medicine, Obstetrics-Gynecology

2

Diabetes

Monitoring for Diabetic Nephropathy 

Endocrinology, Family Practice, Geriatric Medicine, Internal Medicine

3

Appropriate Testing

Otitis Media with Effusion: Hearing Tests 

Family Practice, Otolaryngology, Pediatrics


 
iexchange