The PULSE of The Physician Alliance
Friday, Feb. 15, 2019
Exclusions to HEDIS measures for 2019
Every year the National Committee for Quality Assurance (NCQA) reviews, updates, and makes changes to the Healthcare Effectiveness Data and Information Set (HEDIS). This ensures that these measures are relevant and feasible for implementation and helps focus on the population who are most likely to benefit from the measured services.

Nine HEDIS measures were recently updated to exclude individuals 65 and older who have an advanced illness and frailty or who live long-term in nursing home settings. Four of these measures also exclude those age 80 and older with frailty. These measures include:
  1. Breast cancer screening
  2. Colorectal cancer screening
  3. Controlling high blood pressure
  4. Comprehensive diabetes care
  5. Osteoporosis management in women who had a fracture
  6. Disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis 
  7. Persistence of beta-blocker treatment after heart attack
  8. Statin therapy for patients with cardiovascular disease
  9. Statin therapy for patients with diabetes

Patients that fall into these exclusions will be removed from physician lists. For more information on these HEDIS exclusions for advanced illness, frailty, and living in long term facility, download the tip sheet . Find other coding and billing tip sheets on TPA's website . For assistance with diagnostic coding education, chart review for coding opportunities, and more, contact .

*Ethica is a wholly-owned subsidiary of The Physician Alliance.
Learn how to manage online information, reputation at seminar
Why every physician practice needs social media seminar
Wednesday, Feb. 20, 2019; 8-9:30am

Patients use social media to learn about health issues, share information and have conversations…about you. Learn how your practice can use social media to better engage with patients and promote your brand and services. This seminar will help you:

  • Control the online conversation about your practice and reputation
  • Educate your patients about important health topics and screenings
  • Build a stronger community through digital networking

This seminar is great for physicians, office managers and staff engaged in social media/marketing and patient engagement.

Location: Ascension Oakland Hospital-Education Building, Madison Heights

Space is limited. Click here to register.
Discounted prescription card available to patients
The Michigan Rx Card is a free statewide discount prescription assistance program created to help uninsured and under-insured residents afford their prescriptions. The discount card can provide savings up to 75 percent off medications.

There are no requirements to use the Michigan Rx Card program (no income, age, preexisting condition, deductible, or waiting period restrictions). Patients with insurance may also use Michigan Rx Card for discounts on medications not covered by their insurance (non-covered prescriptions) or if the discount price is lower than the co-pay.

Click here to download a flyer to share with patients. Visit to print coupons.
Practice Spotlight: Eastside Eye Physicians
Congratulations to  Eastside Eye Physicians  in St. Clair Shores for working to improve patient quality of care in diabetes. The practice created a plan to ensure all diabetic retinal eye exams performed are closed in Health eBlue, Blue Cross Blue Shield of Michigan's electronic treatment opportunity tool.
On a monthly basis, the office provides a billing summary of completed retinal eye exams to their practice resource team member. This summary is then reviewed and compared to the information listed in Health eBlue. Any date or test not showing in Health eBlue is relayed back to the office, as well as any changes to primary care physicians for the office to update in their practice management system.

The Physician Alliance created a variety of materials to assist in educating patients on the importance of preventing and managing diabetes. Posters, an action plan and more are available here .
News You Can Use
Featured Affiliate Partner
Kona Medical Consulting offers full scope consulting services and business process outsourcing to our physicians. The Physician Alliance members receive a 40% discount off the hourly consulting rate and a complimentary initial consultation.

Learn more about these services.
The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians. - (586) 498-3555