Physician Quality Measurement (PQM)

The Physician Quality Measurement (PQM) program helps Blue members understand how their doctors compare to other doctors in their area, so they can make more informed decisions about their healthcare services.

Right now, PQM data is available for doctors practicing in Internal Medicine, Family Practice, General Practice and Pediatrics if these doctors have enough data to compare results. A physician’s PQM data may not be displayed if the physician does not have enough claims data to be statistically valid. Also, physicians can opt not to have their PQM data displayed.

PQM measures are selected from measures for national quality of care benchmarks. Physicians practicing in the selected specialties will receive a one, two or three star designation for each individual quality measure evaluated. The star rating indicates whether a physician’s performance, based on a review of claims data, is statistically above average (three stars), average (two stars) or below average (one star) as compared to his/her peers in the same specialty group.

BCBSLA PQM MEASURES
Category Measure Specialties

Cancer Screening

Breast Cancer Screening *

Internal Medicine, Family Practice, General Practice

Women's Health

Breast Cancer Screening *

Internal Medicine, Family Practice, General Practice

Diabetes

Retinal Eye Exam

Internal Medicine, Family Practice, General Practice

Hemoglobin A1C (HgA1C) Testing

Internal Medicine, Family Practice, General Practice

LDL-Cholesterol Screening

Internal Medicine, Family Practice, General Practice

Medical Attention for Nephropathy

Internal Medicine, Family Practice, General Practice

Respiratory Infections

Appropriate Treatment for Children with Pharyngitis

Pediatrics

Appropriate Treatment for Children with Upper Respiratory Infections

Pediatrics

* The Breast Cancer Screening measure falls in two categories, but is the same measure.

Based on feedback from our network providers and due to the recommended changes regarding the HEDIS measure for Breast Cancer Screening for 2014 after the U.S. Preventive Services Task Force's recommendations to begin mammography at 50 years of age instead of 40 years of age, BCBSLA has decided to remove this measure from the selected measures for public display on the national and local directories for this year. We anticipate adding this measure back to the selected list of PQM measures for public display in 2015 using an updated measure.


How can I see my doctor’s PQM data?
In our Find a Doctor or Hospital directory, when you look up the name of a physician in one of the specialty types listed above, click the link for that physician’s name. When the window with his/her information comes up, click the blue “Quality” tab to see any PQM star ratings data available for that physician. You can also see PQM ratings on the Blue Cross and Blue Shield National Doctor and Hospital Finder site.