Topics
More on Quality and Safety

NCQA updates quality measures for HEDIS, adds 4 new measures

The new HEDIS technical specifications include four new measures, changes to seven existing measures and one that's been retired altogether.

Jeff Lagasse, Associate Editor

The National Committee for Quality Assurance has released new technical specifications for the 2017 edition of the Healthcare Effectiveness Data and Information Set, a performance improvement tool.

The new HEDIS technical specifications include four new measures, changes to seven existing measures and one that's been retired altogether.

Among the new measures is the "Standardized Healthcare-Associated Infection Ratio." This assesses publicly available data from the Centers for Medicare and Medicaid Services' Hospital Compare to gauge the potential infection exposure risk to members admitted to the health plan's network hospitals. It's the first time that NCQA is using facility-level infection data collected through the Centers for Disease Control and Prevention's National Healthcare Safety Network. The data, gathered from thousands of acute care facilities, represent hospital network safety at the health plan level.

[Also: 168 get 5 stars, 65 get 1 star in latest Hospital Compare patient experience ratings]

This safety measure reports standard infection ratios for four different healthcare-associated infections: central line-associated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus bloodstream infections, and Clostridium difficile intestinal infections.

Two follow-up measures have also been implemented. The first is a follow-up after an emergency department visit for mental illness, which assesses the percentage of ED visits for members 6 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. The second is a follow-up after an emergency department visit for alcohol and other drug dependence. This assesses the percentage of ED visits for members 13 years of age and older, with a principal diagnosis of alcohol or other drug dependence, who had a follow-up visit for AOD within seven days, and 30 days of the ED visit.

The last of the new measures is dubbed "Depression Remission or Response for Adolescents and Adults." It 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 score. This patient-reported outcome measure is specified to leverage data from electronic clinical data systems for health plan reporting.

Two of the existing measures given a slight facelift are entitled "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. Additionally, NCQA revised one reporting rate to assess at least two dispensing events for the same high-risk medication in "Use of High-Risk Medications in the Elderly"; and revised the exclusion criteria for the history of falls and dementia rates in the "Potentially Harmful Drug-Disease Interactions" measure so that individuals with delirium may be included.

[Also: CMS finalizes quality measures in support of MACRA]

The measure called "Fall Risk Management" is collected using the Medicare Health Outcomes Survey and includes two rates: Discussing Fall Risk and 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, and revised the examples in the Managing Fall Risk rate.

In "Pneumococcal Vaccination Status for Older Adults," NCQA revised the current Medicare Consumer Assessment of Healthcare Providers and Systems survey question about vaccination for pneumococcal disease, to better align with the updated Advisory Committee on Immunization Practices guidelines; they recommend that adults 65 and older receive two different pneumococcal vaccines.

NCQA updated the "Use of Imaging Studies for Low Back Pain" measure for members 18–50 years of age to exclude those who have prolonged use of corticosteroids, HIV, major organ transplant or spinal infection. The group also 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.

The last change effectively combines two pre-existing measures which, separately, assessed the receipt of adolescent vaccines. 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 and HPV -- for female and male adolescents. These vaccines are recommended for routine administration for adolescents, and NCQA maintains they're important for preventive health and cancer prevention.

Twitter: @JELagasse

Show All Comments