Infection exposure risk one of the new measures for 2017
The Healthcare Effectiveness Data and Information Set – HEDIS – is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an “apples-to-apples” basis. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts.
HEDIS measures address a broad range of health issues. Among them are the following:
- Asthma medication use
- Persistence of beta-blocker treatment after a heart attack
- Controlling high blood pressure
- Comprehensive diabetes care
- Breast cancer screening
- Antidepressant medication management
- Childhood and adolescent immunization status
- Childhood and adult weight/BMI assessment
Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service. Employers, consultants, and consumers use HEDIS data, along with accreditation information, to help them select the best health plan for their needs. To ensure the validity of HEDIS results, all data are audited by certified auditors using a process designed by the National Committee for Quality Assurance, or NCQA.
Included in HEDIS is the CAHPS® 5.0 survey, which measures members’ satisfaction with their care in areas such as claims processing, customer service, and getting needed care quickly. “CAHPS” is an acronym for “Consumer Assessment of Healthcare Providers and Systems.”
HEDIS results are included in Quality Compass, a web-based comparison tool that allows users to view plan results and benchmark information.
New measures for 2017
This summer, NCQA released new technical specifications for the 2017 edition of the HEDIS. The new specifications include four new measures, changes to seven existing measures and retirement of one measure. The new measures are:
Standardized healthcare-associated infection ratio. This measure assesses publicly available data from CMS’ Hospital Compare to provide a gauge of the potential infection exposure risk to members admitted to the health plan’s network hospitals. This new measure represents the first time that NCQA is using facility-level healthcare-associated infection data collected through the CDC’s National Healthcare Safety Network (NHSN).
This measure reports standard infection ratios (SIR) for four different healthcare-associated infections:
- Central line-associated blood stream infections (CLABSI)
- Catheter-associated urinary tract infections (CAUTI)
- Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA)
- Clostridium difficile intestinal infections (CDIFF)
Follow-up after emergency department visit for mental illness. This measure assesses the percentage of ED visits for members six years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness within seven days and 30 days of the ED visit.
Follow-up after emergency department visit for alcohol and other drug dependence. This measure assesses the percentage of ED visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow-up visit for AOD within seven days and 30 days of the ED visit.
Depression remission or response for adolescents and adults. This measure assesses the percentage of members 12 years of age and older with a diagnosis of depression who had evidence of response or remission of their symptoms five to seven months after an elevated PHQ-9 (Patient Health Questionnaire) score. This patient-reported outcome measure is specified to leverage data from electronic clinical data systems for health plan reporting.
Changes to existing measures for 2017
Use of high-risk medications in the elderly, and potentially harmful drug-disease interactions in the elderly. NCQA updated the medications included in these two measures to align with the “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.”
Fall risk management. This measure is collected using the Medicare Health Outcomes Survey (HOS) and includes two rates: 1) discussing fall risk and 2) managing fall risk. NCQA expanded the age range in the “discussing fall risk” rate to include all Medicare members 65 years of age and older.
Pneumococcal vaccination status for older adults. NCQA revised the current CAHPS®2 survey question about vaccination for pneumococcal disease, to better align with the updated Advisory Committee on Immunization Practices (ACIP) guidelines recommending that adults 65 and older receive two different pneumococcal vaccines.
Use of imaging studies for low back pain. NCQA updated this overuse/appropriateness measure for members 18 to 50 years of age to exclude those who have prolonged use of corticosteroids, HIV, major organ transplant or spinal infection; shortened the look-back period for recent trauma claims from 12 months to three months; and added physical therapy and telehealth visits as a way to identify members with low back pain in the denominator.
Immunizations for adolescents, and human papillomavirus vaccine (HPV) for female adolescents. NCQA previously assessed the receipt of adolescent vaccines using two separate measures. The “Human papillomavirus for female adolescents” measure, which was developed before the HPV vaccine was recommended for males, assessed the proportion of female adolescents who had received three doses of the HPV vaccine by age 13. The “Immunizations for adolescents” measure assessed all adolescents’ receipt of the meningococcal and Tdap vaccines by age 13. These measures were combined in a single measure that reports receipt of all recommended vaccines (meningococcal, Tdap, HPV) for female and male adolescents. These vaccines are recommended for routine administration for adolescents.
Editor’s note: For basic information about HEDIS, go to http://www.ncqa.org/HEDISQualityMeasurement/WhatisHEDIS.aspx#sthash.n2PGbpM1.dpuf
For HEDIS 2017 measures, go to http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2017/HEDIS%202017%20Volume%202%20List%20of%20Measures.pdf?ver=2016-06-27-135433-350