BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.

Hints for HEDIS® (and more) is a reference tool developed to explore various quality topics, including:

• Definitions, specifications, and exclusions of the many quality measures;
• Billing codes used to report gap closure;
• Collection and reporting methodologies; and
• Tips and best practices to maximize gap closure.

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap in care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.

Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART)

The ART HEDIS® measure is now part of our 2020 Physician Quality Incentive Program and is included in the monthly Gap in Care reports.

Eligible population

Percentage of patients ages 18 and older who were diagnosed with rheumatoid arthritis (RA) and were dispensed at least one ambulatory prescription(s) for a disease-modifying anti-rheumatic drug (DMARD) during the measurement year.

Dates of Service: 1 de enero- 31 de diciembre de 2020.

Process outline

1. PCP reviews monthly Gap in Care reports for eligible patients.
2. Review RA diagnosis for accuracy.
   1. If RA has been coded in error, please submit a Physician/Provider Claim Adjustment Request Form for correction.
3. PCP determines if the patient is currently prescribed a DMARD medication. Note: if the patient is followed by a specialist (e.g., rheumatology), obtain appropriate documentation.
4. If not currently prescribed a DMARD medication, follow up with the patient and/or refer to specialist.

Exclusions: Frailty/advanced illness; pregnancy; hospice; HIV; and dispensed dementia medications:

Best practices

Proper coding is important as it helps avoid non-applicable members from appearing in this measure denominator. Common miscoding issues include:

• Coding for rheumatoid arthritis when performing a “rule-out work-up;"
• Coding for rheumatoid arthritis when a member has another condition, such as osteoarthritis or polymyalgia rheumatica; and
• Confusion over which code to use.

If a patient is seen by a specialist, include appropriate documentation in the primary care medical record.

Closing the gap

The patient must have at least one prescription dispensed during the measurement year for any of the following DMARDS:

Disclaimer: HEDIS indicators are intended to standardize performance measurement and do not necessarily represent the ideal standard of care. If you have any questions, please contact your quality concierge representative at (401) 459-1005 or QualityHEDIS@bcbsri.org.