HEDIS® Public Comment Period Is Now Open

February 13, 2024 · NCQA Communications

NCQA’s public comment period is open and ready for your input.

Public comment is your opportunity to weigh in on the relevance, scientific soundness and feasibility of new and revised HEDIS measures. Your feedback helps us determine changes to our content and programs.

NCQA seeks comments on the following:

  • Five new measures.
  • Revisions to five existing measures.
  • Two cross-cutting topics on advancing gender-inclusion measurement and race and ethnicity stratifications.

About HEDIS and Public Comment

HEDIS measures of clinical quality and patient experience are based on scientific evidence. When new evidence becomes available, NCQA reviews the measures to determine if changes may be needed. NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is hearing from the public. NCQA reviews all comments received during public comment, and discusses results with stakeholder advisors.

HEDIS measures do not constitute clinical practice guidelines, and should not be used to determine insurance or coverage.

Proposed New Measures

Acute Hospitalization Following Outpatient Surgery: Assesses the risk adjusted ratio of observed-to-expected outpatient procedures (colonoscopy, general surgery, orthopedic procedures, urology procedures) for Medicare members 65 and older that were followed by an unplanned acute hospitalization within 15 days (inpatient and observation stays) for any diagnosis.

Importance: Most surgeries now take place in an outpatient setting. Health plans have an important role in providing services to prevent adverse outcomes and ensure proper care coordination during the post-surgical period.

Blood Pressure Control for Patients With Hypertension: Assesses the percentage of adults 18–85 years of age who had a diagnosis of hypertension and whose most recent blood pressure was under control during the measurement period. Blood pressure control is assessed in two measure rates: Blood Pressure <140/90 mm Hg; . Blood Pressure <130/80 mm Hg

Importance: Controlling high blood pressure, known as hypertension, reduces cardiovascular events and mortality.

Documented BI-RADS Assessment After Mammogram: Assesses the percentage of mammograms with appropriate documentation in the form of a BI-RADS assessment for members 40–74 years of age.

Importance: Standardized and timely documentation of breast cancer screening results is crucial to ensure appropriate follow-up after abnormal assessment results.

Follow-Up After Abnormal Breast Cancer Assessment: Assesses the percentage of inconclusive or high-risk BI-RADS assessments for eligible members 40–74 years of age that received appropriate follow-up within 90 days of assessment.

Importance: Successful identification of cancer relies on appropriate follow-up of abnormal results; failure to complete timely diagnostic testing can undermine the significance of screening.

Cervical Cancer Screening and Follow-Up: Assesses the percentage of members 21–64 years of age with possible or confirmed higher-risk cervical cancer screening results who receive appropriate and timely follow-up.

Importance: Cervical cancer causes a significant disease burden in the U.S., but is also one of the most successfully treated cancers if detected early through screening and follow-up. Failure to complete timely follow-up can undermine the ability of screening to prevent development and progression of cervical cancer.

Proposed Changes to Existing Measures

Acute Hospital Utilization: Assesses the risk-adjusted ratio of observed-to-expected acute inpatient and observation stay discharges for members 18 years of age and older. NCQA proposes to expand this measure into the Medicaid product line for members 18–64.

Adult Immunization Status: Assesses whether adults 19 years of age and older are up to date on routine immunizations, and includes separate rates for influenza; tetanus, diphtheria and acellular pertussis (Tdap) or tetanus and diphtheria (Td); zoster; and pneumococcal immunization. NCQA proposes: 1.) adding a new indicator for hepatitis B immunization for adults 19–59; 2.) changing the pneumococcal denominator to start at age 65 rather than 66 (resulting in changes to age stratification cutoffs for the influenza, Td/Tdap and zoster indicators 3.) removing the herpes zoster live vaccine as a numerator option in the zoster indicator.

Follow-Up After Emergency Department Visit for Mental Illness: Assesses the percentage of ED visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm who had a follow-up visit for mental illness. NCQA proposes modifications to the numerator and denominator for this measure that expand diagnoses allowed and follow-up options.

Follow-Up After Hospitalization for Mental Illness: Assesses the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider. NCQA proposes modifications to the numerator and denominator for this measure that expand diagnoses allowed and follow-up options.

Potentially Harmful Drug-Disease Interactions in Older Adults: Assesses the rate in which Medicare members 65 years and older with certain high-risk diseases and/or conditions (history of falls, dementia, chronic kidney disease) are prescribed drugs that may have potentially harmful interactions with their existing condition. NCQA proposes a change to align with the latest American Geriatrics Society Beers Criteria recommendations and to retire the total rate.

Cross-Cutting Topics

Gender-Inclusive Measurement in HEDIS: NCQA seeks public comment on proposed gender-inclusive changes to the Chlamydia Screening in Women measure. The changes aim to ensure everyone who should get routine chlamydia screening is included in the measure—specifically, transgender and gender-diverse members. This is part of a larger effort to make NCQA’s measures inclusive, gender affirming and address care for all populations.

Race-Ethnicity Stratifications: NCQA seeks public comment on the proposed removal of the data source reporting requirement from HEDIS measures stratified by race and ethnicity in MY 2025, in order to reduce stratification reporting burden. NCQA will retain the data source reporting requirement in the Race and Ethnicity Diversity of Membership descriptive measure only, to allow transparency into types of race and ethnicity data health plans leverage.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on March 13. Visit https://my.ncqa.org/ to submit comments. For details on proposed changes, visit the NCQA website.

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

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