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NCQA Seeks Public’s Help on New and Revised Measures

HEDIS®1 2017 Public Comment is February 16–March 16, 2016

WASHINGTON, DC— The National Committee for Quality Assurance (NCQA) invites the public to comment on 2017 Healthcare Effectiveness Data and Information Set (HEDIS®) measures. This is an opportunity for health plans, purchasers, consumers and other stakeholders to weigh in on the relevance, scientific soundness and feasibility of new and revised measures. 

NCQA proposes: 

• Two new measures on follow-up after emergency department visits for patients who have mental illness or alcohol and other drug dependence. 

• One new measure on standardized health care-associated infection ratio. 

• One new measure on depression remission or response for adolescents and adults. 

• Revisions to seven existing measures. 

About HEDIS and Public Comment 

HEDIS comprises measures of clinical quality and patient experience that are based on published clinical guidelines and published scientific evidence. When clinical guidelines change or new evidence becomes available in the scientific literature, NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory groups—including independent scientists, clinicians, consumers and purchasers—to ensure that the measures meet and balance the high standards of relevance, scientific soundness and feasibility. 

An important part of developing and updating HEDIS is to provide the opportunity for the public to review and comment on draft measures. NCQA reviews every comment received during public comment and presents results to its multi-stakeholder advisory groups and the NCQA Committee on Performance Measurement for deliberation. 

NCQA’s HEDIS measures do not constitute clinical practice guidelines, nor should they be used to determine insurance or coverage. 

Proposed New Measures 

Follow-Up After Emergency Department Visit for Mental Illness: Assesses the number of emergency department (ED) visits for patients 6 years and older with a primary diagnosis of mental illness, who received outpatient follow-up with a primary diagnosis of mental illness. 

Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence: Assesses the number of ED visits for patients 13 years and older with a primary diagnosis of alcohol and other drug dependence (AOD), who received outpatient follow-up with a primary diagnosis of AOD.

Standardized Healthcare-Associated Infection Ratio: Uses publicly available data from CMS Hospital Compare to assess the potential risk of infection or exposure to members admitted to health plan’s network hospitals. 

Depression Remission or Response for Adolescents and Adults: Assesses the percentage of members with depression who demonstrate significant improvement or remission of their symptoms, five to seven months after they had a PHQ-9 score indicating at least a moderate level of depression symptoms. This patient-reported outcome measure is specified for a new data collection method that leverages data from electronic clinical data systems for health plan reporting. 

Proposed Changes to Existing Measures 

Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly: NCQA proposes updating the medications included in these measures to align with recommendations in the American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. 

Fall Risk Management: NCQA proposes expanding the age range in the Discussing Fall Risk indicator to include all Medicare members 65 and older, and revising the Managing Fall Risk indicator to remove suggested interventions that were confusing to respondents. 

Pneumococcal Vaccination Status for Older Adults: NCQA proposes revising the current Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®2) survey question about vaccination for pneumococcal disease to align with the updated Advisory Committee on Immunization Practices guideline. 

Use of Imaging Studies for Low Back Pain: NCQA proposes updating the exclusions in this appropriateness measure and including physical therapy visits as a way to identify patients with low back pain. 

Immunizations for Adolescents and Human Papillomavirus Vaccine for Female Adolescents: NCQA currently assesses receipt of adolescent vaccines using two separate measures. We propose to combine these measures and report receipt of all recommended vaccines (meningococcal, Tdap and HPV) for female and male adolescents by their 13th birthday. 

How to Participate in Public Comment

To read and comment on the proposed changes, visit http://www.ncqa.org/HomePage/NCQAPublicComments.aspx. The public comment period begins at 12:00 PM (EST) on February 16 and ends at 11:59 PM (EST) on March 16. NCQA will review input from public comment and will publish new and updated measures and guidelines in HEDIS 2017, Volume 2, in summer 2016.

Media Contacts

Matt Brock
202-955-1739

Cindy Peña
202-735-3690