Palliative care is not the same as hospice care because it can begin when a patient is diagnosed or is undergoing treatment and may not indicate being near end of life. The hospice exclusion requires evidence that the member is receiving hospices services. Documentation that a member is in palliative care is not part of the exclusion.
HEDIS 2019
HEDIS ECDS measures are similar to eCQMs in structure, but although eCQMs are reported at the provider level, using data from an EHR, ECDS measures are reported at the health-plan level, using data from multiple sources to form a complete picture of the patient’s experience across the care continuum.
HEDIS 2018
The calculation for the Count of Expected 30-Day Readmissions is incorrect in Volume 2. IDSS currently calculates this field by using the formula "Count of Expected 30-Day Readmissions" = "Expected Readmission Rate" * "Count of Index Stays".
Please provide data for the Expected Readmission Rate and the Count of Index Stays and IDSS will use these values to generate the correct calculation.
HEDIS 2018
No. The Notification of Inpatient Admission and Receipt of Discharge Information indicators do not have to be documented in the same provider chart as the indicators that were reported administratively. Organizations may search the medical record of a different provider for those indicators that were not reported using administrative data.
HEDIS 2018
Organizations must use the formula in Step 7 to calculate the Expected Readmissions Rate for PCR. The reference in the PCR reporting tables of the “(Expected Readmissions/Den)” is incorrect. The data element should only be “Expected Readmissions Rate.” This removal of the incorrect calculation instruction will be made in the Interactive Data Submission System (IDSS) and data dictionaries.
HEDIS 2018
If “yes” is documented for a type of advance care plan, this is considered evidence that a member has an advance care plan in place and meets criteria. If “no” is documented, this is considered evidence that the member does not have this type of advance care plan in place and does not meet criteria. For example, documentation of “DNR – No” indicates “the member does not have a DNR,” and does not meet criteria. In addition, documentation of “no” is not considered evidence of an advance care planning discussion (asking if a member has an advance care plan in place and documenting “no” is not considered a discussion).
HEDIS 2018
Yes. In the scenario above, Notification of Inpatient Admission may be on the admission date or on the following date, even if it occurs in the year prior to the measurement year. The member in this example remains in the measure because the discharge date was in January 2017. Unless the patient’s PCP or ongoing care provider was involved in the patient’s care prior to the admission (e.g., conducted the patient’s pre-admission exam), a communication on the admission date or the date following meets criteria for the Notification of Inpatient Admission numerator.
HEDIS 2018
Yes. Documentation of participation in sports or in physical activity meets the criterion for physical developmental history. Bright Futures states that a goal of observing development in adolescents is to determine whether they are developing skills for becoming healthy adults—such as good nutrition and physical activity.
HEDIS 2018
No. Organizations must include all paid, suspended, pending and denied claims for ECDS measures. Currently, ECDS General Guideline 4 states to include only services for which the reporting entity has paid or expects to pay, but because none of the other eligible sources require payment status, any claims should be accepted. The guideline is incorrect and will be corrected for HEDIS 2019
HEDIS 2018
