HEDIS season is fast approaching.  HEDIS 2018 (Health Effectiveness Data and Information Set) represents data collected through December 31st, 2017.  Are you familiar with the changes this year?  Let me start with a brief overview of the 7 new measures added to HEDIS 2018, Volume 2.

Transitions of Care (TRC) – (Medicare) - The percentage of discharges for members 18 years of age and older who had each of the following during the measurement year. 

Four rates are reported. 

(1) Notification of Inpatient Admission – Documentation of receipt of notification of inpatient admission on the day of admission or the following day.=

(2) Receipt of Discharge Information – Documentation of receipt of discharge information on the day of discharge or the following day.

(3) Patient Engagement After Discharge – Documentation of patient engagement provided within 30 days after discharge.

(4) Medication Reconciliation Post-Discharge – Documentation of medication reconciliation on the date of discharge through 30 days after discharge (31 total days).

Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions (FMC) – (Medicare) - The percentage of emergency department (ED) visits for members 18 years and older who have high-risk multiple chronic conditions who had a follow-up service within 7 days of the ED visit.

Use of Opioids at High Dosage (UOD) – (Commercial, Medicare, and Medicaid) - For members 18 years and older, the rate per 1,000 receiving prescription opioids for 15 days or more during the measurement year at a high dosage (average morphine equivalent dose (MED) >120 mg).  A lower number indicates better performance.

Use of Opioids from Multiple Providers (UOP) – (Commercial, Medicare, and Medicaid) - For members 18 years and older, the rate per 1,000 receiving prescription opioids for 15 days or more during the measurement year who received opioids from multiple providers.

Three rates are reported:

(1) Multiple Prescribers – The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers during the measurement year.

(2) Multiple Pharmacies – The rate per 1,000 of members receiving prescriptions for opioids from four or more pharmacies during the measurement year.

(3) Multiple Prescribers and Multiple Pharmacies – The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year.

A lower rate indicates better performance for all three of these rates.

Depression Screening and Follow-Up for Adolescents and Adults (DSF) – (Commercial, Medicare, and Medicaid) - The percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care.

(1) Depression Screening – The percentage of members who were screened for clinical depression using a standardized tool.

(2) Follow-Up on Positive Screen – The percentage of members who screened positive for depression and received follow-up care within 30 days.

Unhealthy Alcohol Use Screening and Follow-Up (ASF) – (Commercial, Medicare, and Medicaid) - The percentage of members 18 years of age and older who were screened for unhealthy alcohol use using a standardizes tool and, if screened positive, received appropriate follow-up care.

(1) Unhealthy Alcohol Use Screening – The percentage of members who had a systemic screening for unhealthy alcohol use.

(2) Counseling or Other Follow-Up – The percentage of members who screened positive for unhealthy alcohol use and received brief counseling or other follow-up care within 2 months of a positive screening.

Pneumococcal Vaccination Coverage for Older Adults (PVC) – (Commercial and Medicare) - The percentage of members 65 years of age and older who have received the recommended series of pneumococcal vaccines:  13-valent pneumococcal conjugate vaccine (PVC13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23).

I will go more into the specification of these measures in future articles.  I just wanted you to be aware of the new measures for 2018.  For details on these measures, you can review HEDIS 2018, Volume 2 published by NCQA (National Center for Quality Assurance).

About The Author

Jane Jackson has more than  25 years experience in healthcare, including hospital-based care, home health, and managed care. She enjoys sharing her knowledge and can she be reached at Jane.Jackson@DailyDoseHQ.com. Also visit her blog, Daily Dose HQ.

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