A Breath of Fresh Air | January 2023 | Clinical Corners

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January 15, 2023

“A Breath of Fresh Air”

 

McLaren Physician Partners (MPP) is participating in a Blue Cross Blue Shield (BCBSM) Collaborative Quality Initiative (CQI) called INHALE (Inspiring Health Advances in Lung Care).

Michigan has high prevalence rates of asthma and COPD. There are significant disparities in the burden of disease across the state. The economic burden of asthma alone in Michigan is approximately $3 billion per year driven by emergency department visits, hospitalizations, readmissions, medications, and loss of productivity. COPD is a leading cause of death by disease in the U.S.

The focus of INHALE is on the appropriate use of spirometry to diagnosis asthma and COPD; over reliance on short-acting beta-agonists (SABA); reduce utilization of oral corticosteroids (OCS); and patient education on inhaler use.

The adult asthma numbers for the entire CQI are 87,000+ patients and the pediatric asthma numbers are about 18,261 patients. The total COPD numbers are 51,000+ patients.

MPP adult asthma patients number 5,884 or 6.8% of the total. The MPP pediatric asthma patients number 1,971 or 10.7% of the total. MPP COPD patients number 2,014 patients or 4% of the total.

A summary of baseline measure results for inhaler education, spirometry use, emergency department visits, hospitalizations, observations, and urgent care visits include:

  • For the quality measures of inhaler education and spirometry, MPP met or exceeded the median for claims-based utilization.
  • For inhaler education and spirometry use, the CQI demonstrated overall poor utilization based on claims data.
  • For the utilization measures on ED use, hospitalization, observation use and urgent care use, MPP was at or slightly below the median.

     

     Key takeaways from INHALE based on early discussions:

  • Inhaler education is probably occurring in the practice settings, please use the CPT code 94664 on a claim when the education occurs to document the activity.
  • Provide a post-acute care visit within 3-5 days for patients with asthma and COPD.
  • Please use the CPT code 94010 on a claim for spirometry use to diagnosis asthma and COPD.
  • Reduce the use of oral corticosteroids in asthma.
  • Depending on the frequency and severity of symptoms for adults & adolescents with asthma, initial treatment should include an inhaled corticosteroid and long-acting beta agonists (ICS – LABA) as the preferred treatment for a controller and reliever (rescue) medication.
  • Depending on the frequency and severity of symptoms for children 6-11 years with asthma, initial treatment may include daily low dose ICS, low dose ICS taken whenever SABA taken, low dose ICS – LABA or low dose ICS – formoterol maintenance and reliever.

Asthma and COPD continue to plague the US and the world. Important aspects of these disorders are potentially preventable health care costs. Other considerations are also important – loss of school/study time, decreased productivity at work and early mortality. Raising awareness to the level of cardiac disease would be a breath of fresh air.

For your reference, MPP has provided a link to the 2022 GINA (Global Initiative for Asthma) guidelines for varied age groups: Uploads/Public/Documents/MPHO/documents/ClinicalCorner/2022 GINA Guidelines.pptx