In early June, BCBSRI held two webinars to discuss cardiology and orthopedic specialist performance ratings.  All cardiology and orthopedic providers were invited to attend. Following these events, cardiology and orthopedic practices were asked to contact BCBSRI to schedule time to receive and review their practice’s specialist performance rating profiles. If your practice has not scheduled a meeting yet, please do so by sending an email to ProviderRequests@bcbsri.org. Specialist performance rating profiles will be provided to systems of care (SOC) leadership upon request beginning in 20 de septiembre19 for further insights on specialist providers.

The specialist performance rating is made up of three components:

• Cost efficiency – Comparing the cost of an episode of care with the average cost of peers.
• Practice pattern variation (PPV) – PPV data originates from publically available Medicare claims that are analyzed to find specialist utilization patterns compared to peers. This allows for an evaluation of efficiency using price-neutral analytics.
• Quality – Quality is based on whether a provider participates in a Merit-based Incentive Payment System (MIPS) or a clinical practice registry. Participation in MIPS or clinical practice registry is based on provider attestation. If you have not yet attested, please contact ProviderRequests@bcbsri.org. If you do not attest, then you will not receive any credit for the quality component of the specialist performance ratings.