Premium Specialty: Cardiology Credentialed Specialties include: Cardiac Diagnostic, Cardiology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, and Interventional Cardiology This document is designed to be used in conjunction with the UnitedHealth Premium Program Methodology document. To understand the methodology used for the Premium program, it is important to review the entire methodology. Quality is the primary program measurement, evaluated using national standardized measures. Listed below by condition/procedure are the measures used to evaluate physicians in the Cardiology Premium specialty. Measures are applied to the commercial, Medicare and Medicaid patient populations, unless otherwise noted. For information regarding measure attribution, please refer to the Attribution Methods document in the Methodology Documents section on the Premium Methodology page. Condition/Procedure Measure Compliance Criteria Reference Attribution Method Annual Monitoring for s on Persistent Medications Atrial Fibrillation Adult patient(s) persistently taking angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) who received a serum potassium AND serum creatinine within the last 12 reported months Adult patient(s) persistently taking digoxin who received a serum potassium, serum creatinine, AND digoxin level test within the last 12 reported months Adult patient(s) persistently taking diuretics who received a serum potassium AND serum creatinine within the last 12 reported months (s) at high risk for thromboembolism who are currently taking warfarin, or an oral thrombin inhibitor, or an oral factor Xa inhibitor (s) compliant with prescribed oral factor Xa inhibitor (minimum compliance 80%) persistently taking angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) had a serum potassium AND serum creatinine test persistently taking digoxin had a serum potassium, serum creatinine, AND digoxin level test persistently taking diuretics had a serum potassium AND serum creatinine at high risk for thromboembolism had warfarin, or an oral thrombin inhibitor, or an oral factor Xa inhibitor medication dispensed was 80% or more compliant with prescribed oral factor Xa inhibitor medication Cerebral Vascular Accident & Transient Cerebral Ischemia (Stroke) (s) compliant with prescribed clopidogrel (minimum compliance 80%) (s) with a low-density lipoprotein (LDL cholesterol) test in last 24 reported months was 80% or more compliant with prescribed clopidogrel medication had an LDL cholesterol test
Cerebral Vascular Accident (s) with a recent acute cerebral ischemic event that & Transient Cerebral with an acute cerebral ischemic event had a had a carotid Doppler or head/neck angiography test in last Ischemia (Stroke) carotid Doppler or head/neck angiography test 12 reported months (continued) (s) currently taking a beta-blocker specifically recommended for congestive heart failure management had a beta-blocker medication dispensed for CHF (s) currently taking an ACE inhibitor or acceptable alternative had an ACE inhibitor or acceptable alternative medication dispensed Congestive Heart Failure (s) not taking contraindicated Class I antiarrhythmic medication (excludes patients with diastolic heart failure) did not have a contraindicated Class I antiarrhythmic medication dispensed (s) that did not have a congestive heart failure related emergency department encounter in last 12 reported months did not have a CHF-related emergency department encounter Congestive Heart Failure: Hospitalization (s) that did not have a congestive heart failure related hospitalization in last 12 reported months (s) with a recent hospitalization for congestive heart failure that had any provider visit within 7 days of hospital discharge 180 Day Redo: Measures whether patients did not have a redo procedure within 180 days after did not have a CHF-related hospitalization with a recent hospitalization for congestive heart failure had a visit with any provider did not have a redo procedure within 180 days after the assessed procedure Coronary Artery Catheterization - Diagnostic Major Restudy: Measures whether the patients did not have a major restudy did not have a hemorrhage, pneumonia, did not have advanced imaging (e.g., CT) within 365 days after the assessed procedure 31 to 365 Day Redo: Measures whether patients did not have a redo procedure within 31 and 365 days after a primary interventional cardiology procedure did not have a redo procedure within 31 and 365 days after the assessed procedure
did not have a hemorrhage, pneumonia, Major Restudy: Measures whether the patients did not have a major restudy did not have advanced imaging (e.g., CT) within 365 days after the assessed procedure Coronary Artery Catheterization with Drug Stent (continued) 31 to 365 Day Redo: Measures whether patients did not have a redo procedure within 31 and 365 days after a primary interventional cardiology procedure did not have a redo procedure within 31 and 365 days after the assessed procedure did not have a hemorrhage, pneumonia, Major Restudy: Measures whether the patients did not have a major restudy did not have advanced imaging (e.g., CT) within 365 days after the assessed procedure (s) compliant with prescribed beta-blocker-containing medication (minimum compliance 80%) was 80% or more compliant with prescribed beta-blocker-containing medication Coronary Artery Disease (s) currently taking an ace-inhibitor or angiotensin II receptor antagonist had an ACE-inhibitor or angiotensin receptor antagonist medication dispensed (s) that did not have a coronary artery disease related emergency department encounter in last 12 reported months did not have a coronary artery diseaserelated emergency department encounter (s) 18-75 years of age that had a HbA1c test in last 12 reported months had a HbA1c test Diabetes (s) 18-75 years of age that had annual screening for nephropathy or evidence of nephropathy (s) compliant with prescribed ACE-inhibitor-containing medication (minimum compliance 80%) (s) taking insulin with evidence of self-monitoring blood glucose testing had annual screening for nephropathy or evidence of nephropathy was 80% or more compliant with prescribed ACE-inhibitor-containing medication taking insulin had self-monitoring blood glucose testing
Diabetes (continued) Diabetes (Biguanide- (s) that did not have a diabetes related emergency department encounter in last 12 reported months (s) with a diagnosis of diabetic nephropathy, proteinuria, or chronic renal failure currently taking an angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (s) compliant with prescribed biguanide-containing medication (minimum compliance 80% or higher) (Medicare only) did not have a diabetes-related emergency department encounter with diabetic nephropathy, proteinuria, or chronic renal failure had an ACE inhibitor or angiotensin receptor antagonist medication dispensed was 80% or more compliant with prescribed biguanide-containing medication Diabetes (Dipeptidylpeptidase (DPP)-4- (NS) (s) compliant with prescribed dipeptidyl peptidase (DPP)-4 inhibitor-containing medication (minimum compliance 80% or higher) (Medicare only) was 80% or more compliant with prescribed dipeptidyl peptidase (DPP)-4 inhibitor-containing medication Diabetes (Sulfonylurea- (s) compliant with prescribed sulfonylurea-containing medication (minimum compliance 80% or higher) (Medicare only) was 80% or more compliant with prescribed sulfonylurea-containing medication Diabetes (Thiazolidinedione- (s) compliant with prescribed thiazolidinedionecontaining medication (minimum compliance 80% or higher) (Medicare only) was 80% or more compliant with prescribed thiazolidinedione-containing medication Diabetes Medications-Part D Medication (s) compliant with all prescribed diabetes medications (minimum compliance 80% or higher) (Medicare only) was 80% or more compliant with all prescribed diabetes medications Hypertension (s) that had a serum creatinine in last 12 reported months had a serum creatinine test Invasive Therapeutic Electrophysiology (Ablation) Ablation Redo: Measures whether patients did not have a redo ablation within 180 days after original ablation did not have a redo ablation within 180 days after the assessed ablation
Invasive Therapeutic Electrophysiology (Ablation) (continued) did not have a hemorrhage, pneumonia, Elderly patients who had an accidental fall or hip fracture who did not take an anticonvulsant; nonbenzodiazepine hypnotic; SSRI; antiemetic; antipsychotic; benzodiazepine; or tricyclic antidepressant after the incident with an accidental fall or hip fracture did not have an anticonvulsant, nonbenzodiazepine hypnotic, SSRI, antipsychotic, benzodiazepine, or tricyclic antidepressant medication dispensed after the incident Medication Safety Monitoring Elderly patients with chronic kidney disease who did not take a Cox-2 selective or nonaspirin nonsteroidal antiinflammatory drug (NSAID) after the earliest record of chronic kidney disease with chronic kidney disease did not have a Cox-2 selective or nonaspirin nonsteroidal antiinflammatory drug (NSAID) dispensed after the earliest record of chronic kidney disease Elderly patients with dementia who did not take an antiemetic; antipsychotic; benzodiazepine; tricyclic antidepressant; H2 receptor antagonist; nonbenzodiazepine hypnotic or anticholinergic agent after the earliest record of dementia with dementia did not have an antipsychotic, benzodiazepine, tricyclic antidepressant, H2 receptor antagonist, nonbenzodiazepine hypnotic or anticholinergic agent dispensed after the earliest record of dementia Persistence of Beta-Blocker (s) hospitalized with an acute myocardial infarction (AMI) persistently taking a beta-blocker for six months after discharge hospitalized with acute myocardial infarction (AMI) had persistent beta-blocker medication therapy for six months after discharge Renin Angiotensin System (RAS) Antagonists-Part D Medication (s) compliant with prescribed renin-angiotensin system antagonist medication (minimum compliance 80% or higher) (Medicare only) was 80% or more compliant with prescribed RAS antagonist medication Statin Therapy for s with Cardiovascular Disease Men 21-75 years of age with cardiovascular disease that received a high or moderate-intensity with cardiovascular disease had a high or moderate-intensity dispensed
Men 21-75 years of age with statin adherence (proportion of was 80% or more compliant with prescribed days covered) at least 80% during the treatment period Statin Therapy for s with Cardiovascular Disease (continued) Statin Therapy for s with Diabetes Statins- Use of High-Risk Medications in the Elderly Women 40-75 years of age with cardiovascular disease that received a high or moderate-intensity Women 40-75 years of age with statin adherence (proportion of days covered) at least 80% during the treatment period (s) 40-75 years of age with diabetes that received a (s) with statin adherence (proportion of days covered) at least 80% during the treatment period (s) compliant with prescribed (minimum compliance 80% or higher) (Medicare only) s 66 years of age and older who did not receive one or more high-risk medications in the elderly in the last 12 reported months (HEDIS criteria) with cardiovascular disease had a high or moderate-intensity dispensed was 80% or more compliant with prescribed with diabetes had a dispensed was 80% or more compliant with prescribed was 80% or more compliant with prescribed did not have a high-risk medication dispensed Recognition Programs The Premium program also counts National (NCQA) and Bridges to Excellence (BTE) recognition programs towards quality assessment. The Premium program adds the greater of 25 measures or 10 percent of the physician s total measures (whichever is larger) as compliant to the quality assessment for physicians who have achieved recognition in one or more of these programs applicable to their Premium specialty. National Diabetes Heart/Stroke Bridges to Excellence Program Cardiac Care Congestive Heart Failure Care Coronary Artery Disease Care Diabetes Care Hypertension Care 2018-2019 UnitedHealth Premium Program