PUBLIC INVITED TO HELP SHAPE NEW QUALITY MEASURE FOCUSING ON
PLAN ALL-CAUSE READMISSIONS

WASHINGTON —The National Committee for Quality Assurance seeks public comment on a proposed new measure of care that is intended to improve health care quality by evaluating health plan acute inpatient readmission rates.  The new measure is a proposed addition to the 2011 edition of NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS ®).  By opening the proposed measure for public comment, NCQA is giving health plans and other stakeholders an opportunity to help design a metric that has the potential to improve quality and reduce costs by reducing avoidable readmissions.

A 2005 Medicare Provider Analysis and Review report, conducted by MedPAC, documented that 17.5 percent of Medicare patients were readmitted to a hospital within 30 days of discharge. Over half of these readmissions appeared preventable, equating to $12 billion in avoidable costs.

“Avoidable re-hospitalizations that waste billions of dollars often result from lack of transitional and ongoing care coordination,” said NCQA Executive Vice President Greg Pawlson, MD, MPH. “NCQA believes that this new measure will help focus efforts of health plans in working with hospitals and physicians, as well through disease and care management programs, to identify opportunities to reduce waste and improve quality for patients with serious chronic illness that result in hospitalization. Public comment on the proposed readmission measure will help ensure that we have the best measure possible to guide these improvement efforts.”

The proposed measure examines all-cause discharges and readmissions and adjusts rates of readmissions based on past comorbidities, primary discharge conditions, age and gender.
In addition to the proposed measure, seven existing HEDIS measures have been re-evaluated and are open for public comment. These measures include:

• Ambulatory Care
• Frequency of Selected Procedures
• Race/Ethnicity of Membership and Language Diversity of Membership
• Relative Resource Use measures – Pharmacy, Risk Adjustment and Utilization Updates
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD

Interested parties are invited to comment on the measures open for public through March 22. Details and instructions are available at www.ncqa.org/publiccomment.aspx. Public comment will shape the final version of the measures that NCQA’s Committee on Performance Measurement and Board of Directors approve in the spring 2010. NCQA will release final versions of the measures in July 2010. Data for the new HEDIS measure assessing hospital readmissions will be collected in 2010 and publicly reported in 2011.

Purchasers, consumers and others use HEDIS measures to evaluate performance of health care organizations on key dimensions of care and service. Used by more than 90 percent of America’s health plans, HEDIS makes it possible to compare the performance of health plans, HEDIS is also  a significant component of NCQA’s Health Plan Accreditation and other NCQA evaluations of health care quality, including physician recognition programs.

Celebrating its 20th anniversary in 2010, NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

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