February 22, 2005

HEDIS® 2006 Draft Measures Focus on Overuse;
Monitoring, Follow-up Visits Also Addressed  

Seniors often receive inappropriate drugs; overuse of antibiotics costs
at least $1.2 billion annually

WASHINGTON—The National Committee for Quality Assurance (NCQA) today released for public comment proposed new measures for inclusion in its Health Plan Employer Data and Information Set (HEDIS®), the tool used by most of the health care industry to measure performance.  The draft measures include several that look at an underreported yet serious problem: the overuse of health care.  Overuse is associated with serious risks and contributes to avoidable deaths, complications, extended hospital stays and rising costs.  Antibiotics prescribed for viral illnesses and the use of medications that are contraindicated in older persons – both the subject of new measures – are clear examples of care that may be harmful as well as expensive.  Other new measures emphasize accurate diagnosis, health among the elderly, and monitoring of medications used for attention deficit hyperactivity disorder in children.

“When it comes to health care, there really is such a thing as too much,” said NCQA Executive Vice President Greg Pawlson , M.D., M.P.H. “Examples of excess care abound – antibiotics and other drugs are often prescribed to patients for whom they were never intended or for conditions for which they are not effective.  This just adds to the risk and expense.  These new measures will help limit waste and enhance safety.”

Interested parties are encouraged to comment on the draft February 22 - March 22. The new measures proposed for 2006 include:

• Two measures that address chronic obstructive pulmonary disorder (COPD), the fourth-leading cause of death in the United States . One measure asks whether diagnoses of COPD involved spirometry, which is widely agreed to be the most accurate means of diagnosing the disease. Another measure assesses whether COPD patients receive prescriptions for corticosteroids, which have been shown to shorten recovery periods, prevent relapses, and reduce COPD-related mortality.
• A measure stressing follow-up with physicians that assesses whether children 6 to 12 who have been prescribed ADHD medication have received systematic follow-up office visits with their pediatrician to ensure that adverse side effects are avoided. Up to 12 percent of school age children are thought to suffer from ADHD.
• A patient safety measure that asks whether patients 65 and older have received prescriptions for drugs such as barbiturates that have been determined to be potentially harmful to elderly patients. The safe use of prescription drugs among Medicare recipients is an issue of special interest with the prescription drug benefit set to take effect in the near future. 
• A measure that assesses whether users of certain medications receive regular checkups to prevent potential harms associated with long term use of those drugs.
• A measure developed in conjunction with the Council for Affordable Quality Healthcare (CAQH) and supported by the Centers for Disease Control and Prevention (CDC) that seeks to reduce overuse of antibiotics to treat acute bronchitis. Overuse of antibiotics increases antibiotic resistance among bacterial pathogens and costs billions of dollars annually.

With the release of the 2006 draft, NCQA is also soliciting comments on its proposal to change a number of existing measures.  Notable among them, the existing Outpatient Drug Utilization measure will be expanded to include a separate rate for antibiotic utilization to monitor use of antibiotics, especially antibiotics known to contribute to drug resistance.

The six new measures were developed with the input of NCQA’s Committee on Performance Measurement, which comprises a diverse array of stakeholders—including physicians, purchasers, consumers, labor and plan representatives. In accordance with NCQA policy, the new measures will be collected, reported and audited in 2006, but the results of the first year of measurement will not be publicly reported.

Relevant sections of the HEDIS 2006 draft can be downloaded from NCQA’s Web site at www.ncqa.org.  Those who wish to comment on the new measures may do so by sending an e-mail to hediscomment@ncqa.org. 

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. 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 more informed health care choices.

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HEDIS® is a registered trademark of the National Committee for Quality Assurance. All rights reserved.