Providers of Distinction
Quality and Performance Measures
Program Criteria
The provider review period runs annually. Providers selected will become Providers of Distinction, effective November 15, 2024.
Endoscopy and Colonoscopy
- ED visit within 7 days after colonoscopy
- Adenoma detection rate in screening colonoscopy
- ED visit within 7 days after upper endoscopy
- Admission within 7 days after upper endoscopy
- Repeat screening colonoscopy within 1 year.
- Upper and lower endoscopy on separate days
- Upper endoscopy overuse in GERD patients without alarm symptoms
- Upper endoscopy use in GERD patients with alarm symptoms
Maternity Care
- Cesarean delivery rate in low-risk delivery
- Percent of stays of 3 days or less
- Transfusion after delivery in low-risk pregnancy
- ICU admission within 30 days after delivery in low-risk pregnancy
- Infection after delivery in low-risk pregnancy
- ED visit or readmission within 30 days after delivery in low-risk pregnancy
- Overly frequent use of ultrasounds in low-risk pregnancy
- Receipt of appropriate prenatal testing
- Overly frequent use of forceps or vacuum in low-risk pregnancy.
- Overly frequent use of episiotomy in low-risk pregnancy
- Follow-up for behavioral health diagnosis
Hip Care and Hip Replacement
- PT within 4 months prior to hip replacement
- Overly frequent use of preoperative stress testing
- MRI within 4 months prior to hip replacement
- PT within 4 months prior to elective hip arthroscopy
- SNF admission after hip replacement
- Surgical revision after hip replacement
- Hip replacement within 1 year of new osteoarthritis diagnosis.
- MRI in the first year after diagnosis of hip pain
- PT in the first 4 months of new hip pain
- Opioid prescribing within 28 days in patients with new joint pain
- Complication rate after hip replacement
Knee Care and Knee Replacement
- PT within 4 months prior to knee replacement
- Overly frequent use of preoperative stress testing
- MRI within 4 months prior to knee replacement
- PT within 4 months prior to elective knee arthroscopy
- SNF admission after knee replacement
- Surgical revision after knee replacement
- Arthroscopy overuse in patients with new osteoarthritis
- Knee replacement within 1 year of new osteoarthritis diagnosis.
- MRI in the first year after diagnosis of knee pain
- PT in the first 4 months of new knee pain
- Opioid prescribing within 28 days in patients with new joint pain
- Complication rate after knee replacement
Spine Pain Management
- PT within 4 months prior to cervical spine surgery
- PT within 4 months prior to lumbar spine surgery
- Surgery within 1 year for new lumbar degenerative disc disease
- Surgery within 1 year for new cervical degenerative disc disease
- Surgery within 1 year for new lumbar pain
- Surgery within 1 year for new cervical pain
- PT in the first 4 months of new lumbar spine pain
- PT in the first 4 months of new cervical spine pain
- Opioid prescribing in patients with new lumbar spine pain
- Opioid prescribing in patients with new cervical spine pain
Lumbar Spine Surgery
- PT within 4 months prior to lumbar spine surgery
- Skilled nursing facility admission after lumbar spine surgery
- Complication rate after lumbar spinal surgery
- Hardware removal after lumbar spine surgery
- Surgery within 1 year for spondylolisthesis
- Surgery within 1 year for new lumbar degenerative disc disease
- Surgery within 1 year for new lumbar pain
- PT in the first 4 months of new lumbar spine pain
- Opioid prescribing in patients with new lumbar spine pain
Benefits Enrollment