Problems In HEDIS 2017: What Is Wrong? | Jane Jackson, RN, CRC | RxEconsult

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Problems With HEDIS 2017 Category: Healthcare Administration by - May 30, 2017 | Views: 20936 | Likes: 0 | Comment: 0  


The providers are still reluctant to expend the time, manpower and resources to furnish the charts.  Or we get charts that are incomplete.  Some of this was the provider’s fault and some was the health plan’s fault.  If the health plan doesn’t request the labs AND the progress notes – odds are -- you will only get the one you request.  Then if the medical records staff at the provider’s office only skims the request and doesn’t send the complete chart information – it is mostly useless.  In reviewing Comprehensive Diabetes Care – I had tons of progress notes but no labs. 

We did not offer an incentive for the providers to surrender charts.  We could pay them for the charts but they had to request the payment.  It seems to me that to offer an incentive for correct information would increase interest in HEDIS as well as improve compliance with accurate documentation and chart submissions.

I work for a large healthcare organization.  Unfortunately, we are not adequately staffed to educate the providers on HEDIS matters.  Most of our office season energies are expended on gathering data for the year round HEDIS review.  Essentially, I am a chart chaser.  This is a vicious cycle – I gather charts but don’t educate.  How will the charts improve?  Most often, I don’t even review the charts I gather.  Someone in another state reviews and enters the information.  I don’t receive feedback regarding the data that was or was not found. 

I see many charts where the provider has referred a patient for service.  I don’t often see a follow-up on this referral.  There is no note mentioning whether that member had the testing.  There is no copy of the completed consult.  So a referral was made to a GI Specialist for Colorectal Cancer Screening or to an eye care professional but I can’t tell if the member ever went or not. 


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