HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.
HEDIS 2018
No. Organizations may not use other data sources (e.g., supplemental or medical record data) when excluding members living long-term in an institution. The LTI flag in the Medicare Part C monthly membership file is the only source that may be used to identify this exclusion. NCQA was informed by CMS that all Medicare plans receive this file monthly and have access to this flag. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.
HEDIS 2018
If the prescriber and/or pharmacy NPI is missing, count each dispensing event with a missing NPI as a different prescriber and/or different pharmacy when reporting the measure. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.
HEDIS 2018
The intent is to identify diagnostic or therapeutic procedures that require a medication regimen, a change in diet or a change in medication. For example, colonoscopy requires a change in diet (NPO on the day of procedure) and a medication change (a medication is taken to prep the colon). Dialysis, infusions and chemotherapy are all therapeutic procedures that require a medication regimen. A nebulizer treatment with albuterol is considered a therapeutic procedure that requires a medication regimen (the albuterol). Injection of lidocaine prior to mole removal is considered a diagnostic procedure (if the mole is being tested) or a therapeutic procedure (if removal of the mole is the treatment) that requires a change in medication (lidocaine administered for pain control during the procedure). A patient forgetting to take regular medications on the day of the procedure is not considered a required change in medication, and therefore the BP reading is eligible.
A BP taken on the same day that the patient receives a vaccination is eligible for use. A vaccination is considered preventive medicine and is not considered a therapeutic or diagnostic procedure.
HEDIS 2017
The intent is to identify diagnostic or therapeutic procedures that require a medication regimen, a change in diet or a change in medication. For example, colonoscopy requires a change in diet (NPO on the day of procedure) and a medication change (a medication is taken to prep the colon). Dialysis, infusions and chemotherapy are all therapeutic procedures that require a medication regimen. A nebulizer treatment with albuterol is considered a therapeutic procedure that requires a medication regimen (the albuterol). Injection of lidocaine prior to mole removal is considered a diagnostic procedure (if the mole is being tested) or a therapeutic procedure (if removal of the mole is the treatment) that requires a change in medication (lidocaine administered for pain control during the procedure). A patient forgetting to take regular medications on the day of the procedure is not considered a required change in medication, and therefore the BP reading is eligible.
A BP taken on the same day that the patient receives a vaccination is eligible for use. A vaccination is considered preventive medicine and is not considered a therapeutic or diagnostic procedure.
HEDIS 2017
Yes. Documentation of Tanner stage meets criteria for the physical exam and physical developmental components, but should not be double-counted toward both (if used as evidence of physical exam, it may not be used as evidence of physical developmental, and vice versa). Documentation of Tanner stage does not meet criteria for the Well-Child Visits in the First 15 Months of Life (W15) or Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) measures as sexual maturity rating is not recommended until 7 years of age.
HEDIS 2017
Hospitals for which plans have discharges from but are not identifiable in Table HSIR should not be included in the hospitals reported in the category "Number of Contracted Hospitals With Reportable SIR." However, discharges from these hospitals should be included in “Total Inpatient Discharges” and in “Percentage of Total Discharges From Hospitals With Unavailable SIR.” Use Table HSIR posted on the NCQA Web site to make the determination; organizations do not need to refer to the Hospital Compare web site.
HEDIS 2017
No. NCQA has decided to retire the Aspirin Use and Discussion (ASP) measure due to misalignment with updated recommendations from the United States Preventive Services Task Force (USPSTF). The updated USPSTF aspirin recommendations include a calculation of 10-year cardiovascular risk and an estimate of 10-year life expectancy. This information would be required to identify the denominator of the ASP measure and because it cannot be captured in the Consumer Assessment of Healthcare Providers & Systems (CAHPS) Health Plan Survey or claims data, we are unable to adapt the measure to be consistent with the USPSTF findings.
The aspirin questions remain in the HEDIS 2017 CAHPS questionnaire but member responses to the questions will not be submitted to NCQA by the certified survey vendor. The questions will be removed from the HEDIS 2018 CAHPS questionnaire.
HEDIS 2017
Yes. Organizations may map NDC codes so that the same set of codes for high-intensity and moderate-intensity statins are used for both the SPC-B and SPD-A measures. An NDC code that is not on the HEDIS list may be used if its generic name, strength/dose and route match an NDC code on the HEDIS list. Organizations should document the method used to map codes: Mapping is subject to review during a HEDIS Compliance Audit. Requirements for mapping are described in General Guideline 50 in HEDIS 2017 Volume 2.
HEDIS 2017
