Cardiac Selection Criteria
Program Selection Criteria:Cardiac CareReleased August 2018Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document. 1About the Blue DistinctionSpecialty Care Program . 1About This DocumentExecutive Summary . 1The Program Selection Criteria outlines the selection criteria and evaluation process usedto determine eligibility for the Blue Distinction Centers for Cardiac Care program (theProgram).Understanding the EvaluationProcess . 2This document is organized into five sections:Quality Selection Criteria . 4Business Selection Criteria 8Cost of Care Selection Criteria. 9Questions . 121. Overview of the Blue Distinction Specialty Care Program2. Evaluation Process and Data Sources3. Quality Selection Criteria4. Business Selection Criteria5. Cost of Care Selection CriteriaAbout the Blue Distinction Specialty Care ProgramBlue Distinction Specialty Care is a national designation program recognizing healthcareproviders that demonstrate expertise in delivering quality specialty care — safely,effectively, and cost efficiently. The goal of the program is to help consumers find bothquality and value for their specialty care needs, while encouraging healthcare professionalsto improve the overall quality and delivery of care nationwide, and providing a crediblefoundation for local Blue Cross and/or Blue Shield Plans (Blue Plans) to design benefitstailored to meet employers’ own quality and cost objectives 1. The Blue Distinction SpecialtyCare Program includes two levels of designation: Blue Distinction Centers (BDC): Healthcare providers recognized for theirexpertise in delivering specialty care. Blue Distinction Centers (BDC ): Healthcare providers recognized for theirexpertise and cost efficiency in specialty care.Quality is key: only those providers that first meet nationally established quality measuresfor BDC will be considered for designation as a BDC .Executive SummaryIn early 2018, local Blue Plans invited 2,400 providers across the country to beconsidered for the Cardiac Care designation under this Program; over 800 providersapplied and were evaluated on objective, transparent selection criteria with Quality,Business, and Cost of Care components. This Program focuses on PercutaneousCoronary Interventions (PCI), Coronary Artery Bypass Graft (CABG), and cardiac valvesurgery episodes of care performed at comprehensive inpatient acute care hospitals. Theapplicant provider must perform both PCI and cardiac surgery procedures (CABG andvalve), for patients ages 18 years and older, to be considered for designation. Table 1outlines the Cardiac Care Program highlights.1Benefit design is determined independently by the local Blue Plan and is not a feature of any Blue Distinction program.Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.1
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document . 1Table 1: Program HighlightsAbout the Blue DistinctionSpecialty Care Program . 1PROGRAM HIGHLIGHTSExecutive Summary. 1Designation LevelsUnderstanding the EvaluationProcess. 2AccreditationsConsideredQuality Selection Criteria . 4Business Selection Criteria 8Cost of Care Selection Criteria. 9Provider typesconsidered for thisProgramEvaluated ProceduresQuestions . 12 BDCBDC National Accreditation Organizations (see Table 4) Comprehensive Inpatient Acute Care Hospitals Percutaneous Coronary Interventions (PCI)Coronary Artery Bypass Graft (CABG)Aortic Valve Replacement (AVR)Mitral Valve Repair and Replacement (MVR,MVRR)Quality: Provider Survey and Third Party RegistryData from the American College of Cardiology(ACC), Society of Thoracic Surgeons (STS), andpublicly available Provider Compare data fromCenters of Medicare and Medicaid (CMS)Business: Plan Survey and Blue Brands evaluation;plus Local Blue Plan Criteria (if applicable)Cost: Blue Plans’ healthcare claims dataThird Party Registry Data:o ACC NCDR CathPCI InstitutionalOutcomes Report, Released October 2017o STS Adult Cardiac Surgery Database 2017Quarter 3 Report, Released October 2017o Hospital Compare, Publicly Available Data asof January 2018Blue Plans’ healthcare claims data, with servicesoccurring between January 1, 2014 throughDecember 31, 2016 and paid through March 31,2017.Blue Patients ages 25 - 64 years Data Sources Quality Data Cost Data Note: The complete Selection Criteria and evaluation process are described fully throughout theremainder of this document.Understanding the Evaluation ProcessSelection ProcessThe selection process balances Quality, cost, and access considerations to offerconsumers meaningful differentiation in Quality and value for specialty care providers thatare designated as BDC and BDC . Guiding principles for the selection process include:Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.2
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document. 1About the Blue DistinctionSpecialty Care Program . 1Executive Summary . 1Understanding the EvaluationProcess . 2Quality Selection Criteria . 4Business Selection Criteria 8Cost of Care Selection Criteria. 9Questions . 12QualityNationally consistent approach to evaluating quality and safety was used, incorporatingquality measures with meaningful impact, including delivery system features andspecific quality outcomes to which all can aspire.CostNationally consistent and objective approach for selecting BDC was used to addressmarket and consumer demand for cost savings and affordable healthcare.AccessBlue members’ access to Blue Distinction Centers was considered, to achieve theProgram’s overall goal of providing differentiated performance on quality and, for theBDC designation, cost of care.Data SourcesObjective data from detailed Provider Survey, Third Party Registry Data, Plan Survey andBlue Plans’ healthcare claims data information were used to evaluate and identifyproviders that meet the Program’s Selection Criteria. Table 2 below outlines the datasources used for evaluation under this Program.Table 2: Data SourcesEVALUATIONCOMPONENTDATA SOURCEInformation obtained from aprovider in the Provider CTIONCENTERS (BDC ) Publicly available data fromHospital tion obtained from thelocal Blue Plan in the Plan Surveyand Blue Brands evaluation.Cost of CareBlue Plan Healthcare ClaimsData. Measurement FrameworkBlue Distinction Specialty Care programs establish a nationally consistent approach toevaluating quality and safety by incorporating quality measures with meaningful impact.Selection Criteria continue to evolve through each evaluation cycle, consistent with medicaladvances and measurement in this specialty area. The measurement framework for thisand other Blue Distinction value-based initiatives were developed using the followingguiding principles:Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.3
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document. 1About the Blue DistinctionSpecialty Care Program . 1Executive Summary . 1Understanding the EvaluationProcess . 2Quality Selection Criteria . 4Business Selection Criteria 8Cost of Care Selection Criteria. 9Questions . 12 Utilize a credible process and produce credible results with meaningful,differentiated outcomes. Align with other national efforts using established measures, where appropriateand feasible. Simplify and streamline measures and reporting processes. Enhance transparency and ease of explaining program methods. Utilize existing resources effectively, to minimize costs and redundancies. Meet existing and future demands from Blue Plans, national accounts, and Bluemembers.Quality Selection CriteriaProviders were evaluated on quality metrics developed through a process that included:input from the medical community and quality measurement experts; review of medicalliterature, together with national quality and safety initiatives; and a thorough analysis ofmeaningful quality measures. The quality evaluation was based on provider responses tothe Provider Survey and publicly available Hospital Compare data.The Quality Selection Criteria includes structure, process, and outcome metrics specific toCardiac Care. Most provider metrics were analyzed using a confidence interval (CI) of 90percent around the point estimate (e.g., observed rate). “Confidence Interval” is a termused in statistics that measures the probability that a result will fall between two setvalues. The lower confidence limit (LCL) or upper confidence limit (UCL) was thencompared to the national Selection Criteria thresholds, depending on whether lowerresults or higher results represent better performance (e.g., lower mortality is better, buthigher adherence to medication is better). Other metrics, where a CI was not calculated,were compared against the Selection Criteria threshold.Tables 3a and 3b below translate CI results into “meets criteria” or “does not meet criteria”categories. Additionally, interpretation into three statistical categories of performance isprovided for comparison (“statistically better,” “no different,” or “statistically worse” than thethreshold).Table 3a –Lower Confidence Limit (LCL) Evaluation: Lower Results are BetterLOWER RESULTS ARE BETTERFACILITYEVALUATIONRESULTFACILITY’SLOWER CONFIDENCE LIMIT(LCL)FACILITY’S PERFORMANCECATEGORYMEETSCRITERIALCL is Below or Equalto the ThresholdStatistically Better or No Differentthan the ThresholdDOES NOTMEETCRITERIALCL is Abovethe ThresholdStatistically Worsethan the ThresholdBlue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.4
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document .1Table 3b – Upper Confidence Limit (UCL) Evaluation: Higher Results are BetterAbout the Blue DistinctionSpecialty Care Program.1Executive Summary .1Understanding the EvaluationProcess .2HIGHER RESULTS ARE Y’SUPPER CONFIDENCE LIMIT(UCL)FACILITY’S PERFORMANCECATEGORYUCL is Above or EqualStatistically Better or No Differentto the Thresholdthan the ThresholdUCL is Belowthe ThresholdStatistically Worsethan the ThresholdQuality Selection Criteria.4Business Selection Criteria 8Cost of Care Selection Criteria.9Questions.12DOES NOTMEETCRITERIAQuality Selection CriteriaTable 4 below identifies the Quality Selection Criteria used in the evaluation of eachprovider. A provider must meet all Quality Selection Criteria requirements, as well as allBusiness Selection Criteria (outlined below in Table 5) to be considered eligible for theBlue Distinction Centers for Cardiac Care designation.Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.5
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document. 1About the Blue DistinctionSpecialty Care Program . 1Executive Summary . 1Table 4 – Quality Selection CriteriaALL SELECTION CRITERIA MUST BE MET FOR ELIGIBILITY ding the EvaluationProcess . 2SOURCEProviderSurveyQ#7Quality Selection Criteria . 4QUALITY SELECTION CRITERIAThe provider is fully accredited by at least one of thefollowing national accreditation organizations*: The Joint Commission (TJC) (without provision orcondition) in the Hospital Accreditation Program. Healthcare Facilities Accreditation Program(HFAP) of the American Association for Hospitaland Health Systems (AAHHS) as an acute carehospital. DNV GL Healthcare in the National IntegratedAccreditation Program (NIAHO ) HospitalAccreditation Program. Center for Improvement in Healthcare Quality(CIHQ) in the Hospital Accreditation Program.Business Selection Criteria 8Cost of Care Selection Criteria. 9Questions . 12*NOTE: To enhance quality while improving BCBS members' access toqualified providers, alternate local Accreditations that are at least asstringent as any National Accreditations, above, may be offered underthe local Blue Plan Criteria; for details, contact the provider's local cutaneousCoronaryIntervention(PCI) VolumeProviderSurveyThe provider is a comprehensive acute care provider thatoffers ALL of the following services on site: Intensive care unit; Emergency Room or Emergency Services thatinclude plans or systems for onsite emergencyadmission of post-operative patients with 24/7availability of onsite medical response teams; 24/7 availability of in-house emergency physiciancoverage; Diagnostic radiology, including MRI and CT; 24/7 availability of inpatient pharmacy services (mayinclude alternative night-time access when pharmacyis closed); Blood bank or 24/7 access to blood bank services;AND 24/7 availability of Clinical Laboratory ImprovementAmendments (CLIA) accredited laboratory services.The provider reports a PCI minimum sample size of 100or greater for outcome reliability.Q#13aBlue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.6
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyAbout This Document . 1About the Blue DistinctionSpecialty Care Program . 1ALL SELECTION CRITERIA MUST BE MET FOR ELIGIBILITY CONSIDERATIONDOMAINSOURCEQUALITY SELECTION CRITERIAThe following NCDR CathPCI Executive Summary Measures arecalculated, using a Lower Confidence Limit (LCL):Executive Summary. 1ProviderSurveyQ#13bUnderstanding the EvaluationProcess. 2Quality Selection Criteria . 4ProviderSurveyBusiness Selection Criteria 8Q#13jCost of Care Selection Criteria. 9ProviderSurveyQ#13kQuestions . 12ACC NCDRCathPCIRegistryExecutiveSummaryMeasuresSTS AdultCardiac SurgeryDatabaseRegistry*ProviderSurveyQ#13l Executive Summary Measure #1:PCI In-Hospital Risk Adjusted Mortality (All Patients)90% Lower Confidence Limit is at or below 1.70. Executive Summary Measure #30:Proportion of PCI Procedures Not Classifiable forAppropriate Use Criteria (AUC) Reporting 90% LowerConfidence Limit is at or below 11.60. Executive Summary Measure #36:Patients WITHOUT Acute Coronary Syndrome:Proportion of Evaluated PCI Procedures that wereInappropriate 90% Lower Confidence Limit is at orbelow 36.50. Executive Summary Measure #37:PCI In-Hospital Risk Adjusted Rate of BleedingEvents 90% Lower Confidence Limit is at or below5.4.The following NCDR CathPCI Executive Summary Measures arecalculated, using a Upper Confidence Limit (UCL):ProviderSurveyQ#13c Executive Summary Measure #4:Proportion of STEMI Patients Receiving ImmediatePCI w/in 90 Minutes 90% Upper Confidence Limit isat or above 90.00.ProviderSurveyQ#13d Executive Summary Measure #9: Proportion ofPatients with a P2Y12 Inhibitor Prescribed atDischarge 90% Upper Confidence Limit is at orabove 90.00.ProviderSurveyQ#13e Executive Summary Measure #10: Statins Prescribedat Discharge 90% Upper Confidence Limit is at orabove 90.00.ProviderSurveyQ#13m Executive Summary Measure #38:Composite Discharge Medications in Eligible PCIPatients 90% Upper Confidence Limit is at or above90.00.ProviderSurveyQ#16c, 17cProvider’s STS Isolated CABG Mortality Star Rating is atleast 2 Stars.*NOTE: Providers with more than 1 STS Participant must meet thisCardiac Care Selection Criteria for each STS Participant.Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.7
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyALL SELECTION CRITERIA MUST BE MET FOR ELIGIBILITY CONSIDERATIONAbout This Document .1About the Blue DistinctionSpecialty Care Program.1DOMAINSOURCEQUALITY SELECTION CRITERIAStar RatingsProviderSurveyQ#16c, 17cProvider’s STS Isolated CABG Morbidity Star Rating is atleast 2 Stars.ProviderSurveyQ#16e, 17eProvider’s STS Isolated Aortic Valve Replacement (AVR)Mortality Star Rating is at least 2 Stars.ProviderSurveyQ#16e, 17eProvider’s STS Isolated Aortic Valve Replacement (AVR)Morbidity Star Rating is at least 2 Stars.PubliclyAvailableCoronary Artery Bypass Graft (CABG) 30 day riskadjusted mortality rate is reported as “better than or nodifferent than the national rate.”Executive Summary .1Understanding the EvaluationProcess .2Quality Selection Criteria.4Business Selection Criteria 8Cost of Care Selection Criteria.9Questions.12HospitalCompareMeasures(Data fromJanuary2018)*NOTE: Providers with more than 1 STS Participant must meet thisCardiac Care Selection Criteria for each STS Participant.*NOTE: Providers with more than 1 STS Participant must meet thisCardiac Care Selection Criteria for each STS Participant.*NOTE: Providers with more than 1 STS Participant must meet thisCardiac Care Selection Criteria for each STS Participant.Coronary Artery Bypass Graft (CABG) 30 day riskadjusted readmission rate is reported as “better than orno different than the national rate.”Acute Myocardial Infarction (AMI) 30 day risk adjustedmortality rate is reported as “better than or no differentthan the national rate.”Acute Myocardial Infarction (AMI) 30 day risk adjustedreadmission rate is reported as “better than or nodifferent than the national rate.”Business Selection CriteriaThe Business Selection Criteria (Table 5) consists of the following components:1. Provider Participation;2. Physician and Surgeon Participation;3. Blue Brands Criteria; and4. Local Blue Plan Criteria (if applicable)A provider must meet all components listed in Table 5 to meet the Business SelectionCriteria for the Blue Distinction Centers for Cardiac Care designation.Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.8
Blue Distinction Centers for Cardiac Care Program Selection Criteriap2013 Benefit Design Plan Capabilities SurveyTable 5: Business Selection CriteriaAbout This Document . 1BUSINESS SELECTION CRITERIAAbout the Blue DistinctionSpecialty Care Program . 1ProviderParticipationAll providers are required to participate in the local Blue Plan’sBlueCard Preferred Provider Organization (PPO) Network.Physician Medicaland SurgicalSpecialistsParticipationAll physician medical and surgical specialists identified in the ProviderSurvey are required to participate in the local Blue Plan’s BlueCardPPO Network.Blue BrandsCriteriaProvider and its corporate family meets BCBSA criteria for avoidingconflicts with BCBSA logos and
compared to the national Selection Criteria thresholds , depending on whether lower results or higher results represent better performance (e.g. , lower mortality is better, but higher adherence to medication is better). Other metrics, where a CI was not calculated, were compared against the Selection Criteria threshold.
7 Introduction UHS Cardiac ICU Handbook – Second edition 2016 dependency unit, the coronary care unit (both on D-level), and cardiothoracic theatres, cardiac pre and post-op wards and cardiac catheter laboratories (all on E level). Familiarisation with Equipment There is a large array of equipment used on the cardiac intensive care unit.
Advanced cardiac life support (ACLS) is a two day course that teaches students to recognize and treat cardiac arrest, arrhythmias, acute coronary syndromes, stroke, cardiac arrest in the pregnant woman, and cardiac arrest in situations involvi
Cardiac rhythm & heart failure, cardiac catheter ablations, and cardiac diagnostic services . This highlights the percent of change in payment for major cardiac rhythm and heart failure, and cardiac catheter ablation therapies between OPPS 2021 payment . "Lifecycle of a Code: How the CPT and RUC Process Works." American Medical .
THE CARDIAC CYCLE 1. The cardiac cycle is the sequence of events in one heartbeat. In its simplest form, the cardiac cycle is the simultaneous contraction of both atria, followed a fraction of a second later by the simultaneous contraction of both ventricles. 2. The heart consists of cardiac muscle cells that connect with each other – they are branched – and
Our cases demonstrate that cardiac sarcoidosis may manifest for the first time during pregnancy. Reports on cardiac sarcoidosis related to pregnancy are rare. 1,2 Cardiac sarcoidosis, a potentially Fig. 1. ECG of case 1, performed when the patient was 16 weeks pregnant, showing intermittent atrial fibrillation.
Cardiac monitoring is a useful diagnostic tool for managing patients with cardiac arrhythmia or acute ischaemic changes (actual or potential). However, it has no therapeutic value unless the clinicians supervising the patient are skilled
Cardiac event monitors were developed to provide longer periods of monitoring and may be useful when the initial evaluation by Holter monitoring is non-diagnostic or when symptoms are infrequent. Remote cardiac monitoring technologies allow home electrocardiographic (EKG) monitoring of indivi
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