NCQA UPDATES AND ADDS NEW HEDIS MEASURES 

WASHINGTON, D.C.—In July 2010, the National Committee for Quality Assurance (NCQA) will revise six measures, retire two measures and add one measure to the newest edition of the Healthcare Effectiveness Data and Information Set (HEDIS®), known as HEDIS 2011, Volume 2.

Revised Measures

The six existing measures NCQA will modify to reflect the latest science are: 

• Use of Spirometry Testing for COPD:  NCQA will add evaluation and management codes to identify COPD diagnosis.
• Relative Resource Use (RRU): NCQA will classify inpatient stays into acute, medicine, surgery and non-acute and allow reporting of generic versus name brand prescriptions.
• Language Diversity of Membership: NCQA will: extend reporting to commercial plans; remove gender stratification; simplify the language categories into English, Non-English, Unknown and Declined; capture data on language needs; and allow for reporting from additional data sources, including Medicare and Medicaid.
• Race/Ethnicity Diversity of Membership: NCQA will extend reporting to commercial plans, remove gender stratification and allow for reporting from additional data sources including Medicare and Medicaid.
• Frequency of Selected Procedures: NCQA will add reporting of bariatric weight loss surgery, retire reporting of myringotomy, non-obstetric D&C, partial excision of large intestine, and reduction of fracture femur.
• Ambulatory Care: NCQA will remove reporting of ambulatory surgery/procedures and observation room stays measures.

Retired Measures

The two obsolete measures that NCQA will remove from HEDIS 2011, Volume 2 are Non-Acute Inpatient Utilization and Outpatient Prescription Utilization.

New Measure

The new Plan All-Cause Readmission measure tracks reasons for hospital readmissions with plans and adjusts rates based on past comorbidities, primary discharge conditions, presence of major surgery, age and gender.

“Potentially preventable readmissions are one of the most critical areas to monitor for both quality improvement and possible cost savings,” said NCQA Executive Vice President Greg Pawlson, MD, MPH. “Readmissions that occur because of improper planning and coordination of care are burdensome on patients, as well as those who pay for health care. The new measure helps health plans, hospitals and others compare readmission rates to hospitals between health plans, and take actions to provide optimal care to reduce unnecessary readmission.” 

NCQA will also offer educational seminars for RRU and Plan All-Cause Readmission measures later this summer.

HEDIS 2011, Volume 2: Technical Specifications is now available in print and electronic formats. To order, call (888) 275-7585 or visit NCQA’s Publications Web page at www.ncqa.org/publications. For a summary of new, modified and retired measures in HEDIS 2011, visit NCQA’s Web site at www.ncqa.org.

About HEDIS

NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. 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.


About NCQA

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 and recognizes physicians in key clinical areas. 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 through the Web, media and data licensing agreements in order to help consumers, employers and others make informed health care choices.

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