Quality ManagementAMH Health, LLC | Medicare AdvantageJune 5, 2024

Pharmacotherapy management of COPD exacerbation (PCE)

HEDIS® (Healthcare Effectiveness Data Information Set) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

This HEDIS measure evaluates the percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED visit on or between January 1 to November 30 of the measurement year and who were dispensed appropriate medications. Two rates are reported:

  • Dispensed a systemic corticosteroid (or there was evidence of an active prescription) within 14 days of the event
  • Dispensed a bronchodilator (or there was evidence of an active prescription) within 30 days of the event

The eligible population for this measure is based on acute inpatient discharges and ED visits, not on members. It is possible for the denominator to include multiple events for the same individual.

Refer to attachment to view full details

Note: The logical observation identifiers names and codes (LOINC) are for reporting clinical observations and laboratory testing. The codes listed are informational only; this information does not guarantee reimbursement. If applicable, refer to your provider contract or health plan contact for reimbursement information. For a complete list of CPT® codes, go to the American Medical Association website at ama-assn.org.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Plans offered by AMH Health, LLC., a joint venture between MaineHealth and Anthem Partnership Holding Company, LLC. AMH Health is an independent licensee of the Blue Cross Blue Shield Association.

MEAMH-CR-046535-23-CPN46413, MEAMH-CR-061064-24-SRS60940

ATTACHMENTS: Pharmacotherapy management of COPD exacerbation (PCE) (pdf - 0.56mb)