July 5, 2016
WASHINGTON, D.C.—Today, the National Committee for Quality Assurance (NCQA) released new technical specifications for the 2017 edition of health care’s most widely used performance improvement tool, the Healthcare Effectiveness Data and Information Set (HEDIS1).
The new HEDIS technical specifications include four new measures, changes to seven existing measures and retirement of one measure.
Standardized Healthcare-Associated Infection Ratio: This measure assesses publicly available data from CMS’ Hospital Compare to provide a gauge of the potential infection exposure risk to members admitted to the health plan’s network hospitals. This new measure represents the first time that NCQA is using facility-level healthcare-associated infection data collected through the CDC’s National Healthcare Safety Network (NHSN). These data, gathered from thousands of acute care facilities, represent hospital network safety at the health-plan level.
This patient safety measure reports standard infection ratios (SIR) for four different healthcare-associated infections (HAI): central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA), and Clostridium difficile intestinal infections (CDIFF.)
Follow-Up After Emergency Department Visit for Mental Illness: This measure assesses the percentage of ED visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow up visit for mental illness within 7 days and 30 days of the ED visit.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence: This measure assesses the percentage of ED visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow up visit for AOD within 7 days and 30 days of the ED visit.
Depression Remission or Response for Adolescents and Adults: This measure assesses the percentage of members 12 years of age and older with a diagnosis of depression who had evidence of response or remission of their symptoms 5–7 months after an elevated PHQ-9 score. This patient-reported outcome measure is specified to leverage data from electronic clinical data systems (ECDS) for health plan reporting. For more information, go to http://ncqa.org/ECDS.
Changes to Existing Measures
Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly: NCQA updated the medications included in these two measures to align with the American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Additionally, NCQA:
- Revised one reporting rate to assess at least two dispensing events for the same high-risk medication in Use of High-Risk Medications in the Elderly.
- Revised the exclusion criteria for the History of Falls and Dementia rates in the Potentially Harmful Drug-Disease Interactions measure so that individuals with delirium may be included.
Fall Risk Management: This measure is collected using the Medicare Health Outcomes Survey (HOS) and includes two rates: Discussing Fall Risk and Managing Fall Risk. NCQA expanded the age range in the Discussing Fall Risk rate to include all Medicare members 65 years of age and older, and revised the examples in the Managing Fall Risk rate.
Pneumococcal Vaccination Status for Older Adults: NCQA revised the current Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®2) survey question about vaccination for pneumococcal disease, to better align with the updated Advisory Committee on Immunization Practices (ACIP) guidelines recommending that adults 65 and older receive two different pneumococcal vaccines.
Use of Imaging Studies for Low Back Pain: NCQA updated this overuse/ appropriateness measure for members 18–50 years of age to exclude those who have prolonged use of corticosteroids, HIV, major organ transplant or spinal infection; shortened the look-back period for recent trauma claims from 12 months to 3 months; and added physical therapy and telehealth visits as a way to identify members with low back pain in the denominator.
Immunizations for Adolescents and Human Papillomavirus Vaccine for Female Adolescents: NCQA previously assessed the receipt of adolescent vaccines using two separate measures. The Human Papillomavirus for Female Adolescents measure, which was developed before the HPV vaccine was recommended for males, assessed the proportion of female adolescents who had received three doses of the HPV vaccine by age 13. The Immunizations for Adolescents measure assessed all adolescents’ receipt of the meningococcal and Tdap vaccines by age 13. These measures were combined in a single measure that reports receipt of all recommended vaccines (meningococcal, Tdap, HPV) for female and male adolescents. These vaccines are recommended for routine administration for adolescents and are important for preventive health and cancer prevention.
For more information, refer to the full measure specifications in HEDIS 2017, Volume 2. HEDIS publications are available in print and electronically. To order, call 888-275-7585 or visit NCQA’s Publications Web page at http://store.ncqa.org/.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA’s Web site (ncqa.org) contains information to help consumers, employers and others make more informed health care choices.
- HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
- CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).