Relative Resource Use (RRU) Standard Price Tables

NCQA is pleased to announce the posting of the HEDIS 2008 Relative Resource Use (RRU) standard price and supporting tables. The tables will allow organizations to match resource use within service categories (Inpatient Facility, Surgery and Procedure, Evaluation and Management, and Pharmacy) to a standardized allowed payment in order to calculate total standard costs for their eligible members across different areas of clinical care. The following measures will be calculated using the standard price and supporting tables.

• Relative Resource Use for People With Diabetes
• Relative Resource Use for People With Asthma
• Relative Resource Use for People With Acute Low Back Pain
• Relative Resource Use for People With Cardiovascular Conditions
• Relative Resource Use for People With Uncomplicated Hypertension
• Relative Resource Use for People With COPD

Note: These tables have been removed from NCQA's Web site as they have been updated for HEDIS 2009. To request a copy of the 2008 SPTs, email HEDIS RRU Help. The use of these tables is subject to the terms of a user agreement; users must agree to the terms of the User Agreement to access the RRU standard price and supporting tables. 

Changes to note from HEDIS 2007

MS-DRG Addition – The Medicare Severity DRG (MS-DRG) codes have been incorporated into the standard price tables for HEDIS 2008. The MS-DRGs are located in the same inpatient pricing Excel workbook that contains the CMS-DRGs. Additional instructions for using the MS-DRG codes are included in the Volume 2 Technical Update.

Calculating Pharmacy Standard Cost – Plans should continue using the metric quantity to determine standard pricing for prescriptions. If metric quantity is not available, organizations should apply a new pricing method in order to determine standard costs. For each prescription, organizations should multiply the standard unit price per day by that prescription’s days supply. Organizations should no longer assign prescription prices based on the average standard unit price. Both the standard price per metric quantity and the standard price per day are included in the 2008 RRU Pharmacy Tables.
The example below includes a standard cost calculation using the new pricing method, when metric quantity is not available.

The example below includes a standard cost calculation using the new pricing method, when metric quantity is not available.

Member Prescriptions	Metric Quantity Prescribed	Days Supply	Standard Unit Price per Day ($)	Standard Cost per Prescription ($)
11111111111	NA	30	2.2799	68.397
22222222222	NA	30	6.1906	185.718
33333333333	NA	90	5.4063	486.567

Example: Total Standard Cost for NDC 11111111111 is $68.397. (Multiply 30 days by $2.2799.)

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).