Asked. Answered. Our HEDIS® Experts Take Your Questions

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You asked. We answered. If you missed our HEDIS® Updates Google Hangout, you missed a lot. Turns out so did we.

Because time was so short, we didn’t get to all the questions submitted. So, now we have all the answers to all 40 of our friends who sent their questions to the chat box. If you have any additional questions, feel free to ask them in the comments section below, we’ll get them answered too. Thanks for watching, and for giving us an opportunity to answer your questions.

Asked. Answered.

Lori

Q: I am curious to know why NCQA felt it necessary to clarify “that the pregnancy optional exclusion should be applied to only female members.”? Where else would you be able to apply this exclusion?

A: We agree with your assessment of the pregnancy exclusion and its application to female members. We occasionally found billing errors where these codes were used with male members. The HEDIS software certification program will be changing the way they test for pregnancy and will only be testing/allowing this exclusion for female members.

 

Scott

Q: Have there been any changes to the HEDIS software certification process? Aside from incorporating changes to measures, has the approach and standard for certification changed?

A: Please note that in 2013, for HEDIS 2014, NCQA clarified the scope of certification and change the name from Software Certification to Measure Certification. This is because NCQA certifies measure logic, not software.

In addition to incorporating yearly measure changes to the administrative component of measures and general guidelines, NCQA recently added the following enhancements to the program.

  • Deadlines for certification—originally March 1 of the reporting year, but changed to February 15 for HEDIS 2017 testing.
  • Requirement that measure identifiers must be assigned to certified code, and carried through to IDSS so auditors can verify the correct ID is loaded with preliminary and final rates.
  • Supplemental data testing; to ensure this data is not used when it is not allowed e.g., to identify the eligible population.
  • Deadlines for survey sample frames, XML files, PLD files, preliminary rates and supplemental data impact reports. These are deadlines to support NCQA Compliance Audit.
  • Check to verify that vendors can upload XML files into IDSS with no first tier warnings.

If you have additional questions about the Measure Certification program, please submit to pcs (my.ncqa.org) using the Measure Certification queue.

 

Eric

Q: Do we report MAP?

A: We are assuming you are referring to the MRP (Medication Reconciliation) measure. Both the MRP measure and the Transition of Care (TRC) measure will be reported to NCQA in HEDIS 2018. The MRP measure will retain public reporting status.

Q2: Do we report MRP and new transition measure or just 1?

A2: Yes. Both measures are reported to NCQA. However, only the Medication Reconciliation Post Discharge measure is publicly reported. The Transitions of Care (TRC) measure is a first year measure for HEDIS 2018 and NCQA does not publicly report data for first year measures. This measure will be assessed for public reporting in 2018 after NCQA has analyzed the first year results.

 

Rumpa

Q: For follow up after emergency department visit: Who is responsible for notifying the PCP?

A: The hospital or health plan may provide notification of the patient admission to the PCP. If the PCP ordered the admission, inpatient testing or performed a preadmission exam, this may also be used as notification of admission.

 

Amy

Q: TRC and MRP as a stand-alone measure. Will we be able to use the same denominator for MRP as we do for TRC?

A: If the organization is reporting the measures administratively, then the denominators for the MRP measure and the MRP indicator within the TRC measure (and the rest of the TRC measure) will be the same because the requirements are the same for the denominator. If the organization is reporting the measure using the hybrid method, then the denominator may not be the same if the organization decides to reduce the sample size for the MRP measure. Because the organization cannot reduce the sample size for the TRC measure, given that it is a first-year measure, the denominator will differ because the samples are not the same. The MRP measure numerator and TRC Medication Reconciliation numerator may also differ due to the TRC measure requirement that only one outpatient medical record be used for all four indicators.

 

Mandy​

Q: Is there any discussion about expanding the FMC measure to commercial and Medicaid product lines? It may be advantageous for measuring QI8 and identifying participants for population health management.

A: There are no current plans to expand this measure to other product lines. However, this may be something investigated as a part of first year analysis and/or for future HEDIS reporting.

 

Paula

Q: For locations with multiple hospitals, is it the PCP who is subject to this (do we know which one?) metric? If so, how can we get this information from the competing hospital?

A: The Transition of Care measure is reported at the health plan level. Either health plan or hospitals or the PCP may schedule/recommend this follow up visit.

 

Jose

Q: How long takes for the PCP to be notified after ER?

A: This will vary based on the different mechanisms plans, hospitals and case managers have in place. Please note that the FMC (please spell out) measure does not require PCP notification, as the measure specifies that behavioral health visits or case management visits are included in the numerator.

 

Jennifer

Q: Did you say if the med rec can be done over the phone?

A: A face-to-face visit is not required to meet criteria for the measure; the medication reconciliation can be performed without the patient present. If the prescribing practitioner, clinical pharmacist or registered nurse is actually performing the services for the measure (i.e., reconciling the medications via the telephone), then it is acceptable for the reconciliation to be done over the phone and it may count towards the measure if all the required components are documented and a part of the member’s outpatient chart. The phone conversation documentation must be a part of the member’s outpatient chart to meet criteria. Please keep in mind that only one outpatient medical record can be used for all four indicators in the Transitions of Care measure. The record selected may be from the member’s PCP or ongoing care provider.

 

Jan

Q: Does the Transition of Care measure require an in-person visit, or would a follow-up call from a care coordinator be allowed?

A: The Transition of Care measure does not require an in-person visit. A follow-up call from a care coordinator meets criteria for the Patient Engagement After Inpatient Discharge and Medication Reconciliation Post-Discharge indicators. Please note, the MRP must be conducted by a prescribing practitioner, clinical pharmacist or registered nurse, as documented through either administrative data or medical record review on the date of discharge through 30 days after discharge (31 total days).

 

Sheetal

Q: ED visit follow-up measure, can this be closed through care/disease management registry?

A: Care/Disease management services may be used to meet the ED follow up. If the registry provides the required documentation (e.g. codes as this is an administrative only measure), it may be used when reporting the measure. The information from the registry would be considered nonstandard supplemental data and would be subject to the criteria included in General Guideline 33 in HEDIS 2018 Volume 2. The health plan’s auditor will make the final determination about whether data collected via the registry can be used for HEDIS reporting.

 

Hardish

Q: How do we define [for the new opioid measures] high dose is there a guide?

A: For the UOD measure “high dosage” is defined as the average morphine equivalent dose [MED] >120 mg. The measure includes a conversion table for the opioids, Table UOD-A: Opioid Morphine Milligram Equivalent Conversion Factors and a MED daily dose calculation.

 

Keechia

Q: Will the TRC measure replace the current MRP measure?

A: The intent is to retire the MRP measure once the TRC measure is publicly reported. Any decisions will be made in future editions of the HEDIS Technical Specifications.

 

Ddancker

Q: Per the specs page 45 you may use the same sample for MRP as TRC, however if doing so you may not reduce the sample size since TRC is a first-year measure.

A: This is correct. TRC is a first year measure. If plans are choosing to reduce their MRP sample, they will have a different sample for TRC.

 

Praveen

Q: Is UOD an inverse measure?

A: Yes, the UOD (and UOP) measures are inverse and a lower rate indicates better performance.

 

Paul ​

Q: Prescribers must be from different groups correct?

A: The UOP measure uses the NPI to identify individual prescribers and pharmacies, therefore prescribers from the same group will be counted separately. Members receiving opioids from multiple prescribers within the same group may not be receiving coordinated care.

 

Tamara​

Q: Why are denied claims included in the EP (eligible population), but not the numerator for the Opioid measures?

A: Denied claims are included when identifying the denominator but are not included in the numerator for the UOP and UOD measures. The rationale for this is that prescribing opioids at high dosage and from multiple providers is not appropriate and a lower rate indicates better performance for these measures. Plans are held harmless for denied claims because it indicates they did not pay for inappropriate prescriptions.

 

Paula

Q: Does a negative PHQ-2 qualify for a negative screen?

A: Yes. PHQ-2 may be used for the depression screening in the ECDS Depression Screening and Follow-Up for Adolescents and Adults. However, PHQ2 is not sufficient for follow up after a positive screen and is not included in the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults and for the Depression Remission or Response for Adolescents and Adults.

 

LuAnn

Q: If there is a positive phq2; does a phq9 qualify as the follow up?

A: Yes. The PHQ-9 is appropriate to use for follow up and ongoing monitoring.

 

Leah

Q1: Will CMS require reporting of the new TRC measure for Medicare members?

A1: Medicare traditionally requires the reporting of first year measures, therefore it’s likely that the measure will be required for Medicare. We recommend you confirm with CMS. HEDISquestions@cms.hhs.gov

Q2: Will CMS require reporting of the new TRC measure for Medicare SNP members?

A2: While Medicare traditionally requires reporting for first year measures, this is not always the case for Medicare SNPs. This should be confirmed with CMS. HEDISquestions@cms.hhs.gov

Q3: Please explain the rationale why the numerator elements of the TRC measure did not get incorporated into the existing MRP metric?

A3: It was the intent of NCQA and CMS to have a Care Coordination measure which was more broad than just Medication Reconciliation. The intent is to retire the MRP measure once the TRC measure is publicly reported. Any decisions will be communicated in future editions of the HEDIS Technical Specifications.

Q4: Is the MRP rate the same as the reconciliation rate for the TRC metric when the plan chooses to use the same denominator?

A4: If the organization is reporting the measure administratively, then the numerators will be the same because the requirements are the same for the denominator and numerator.

 

Lori

Q: The Transitions of Care Measure, does it include Medicare Advantage as well as Traditional Medicare?

A: The TRC measure is a Medicare measure. Therefore, those members enrolled in your Medicare contract should be included in the population for the measure. You can refer to General Guideline 7 in Volume 2 and the CMS Reporting memo for the organizations and plan benefit packages that are required to report.

 

Colleen

Q: Will the MRP measure be retired, given that the new TRC measure covers medication reconciliation along with other metrics?

A: The intent is to retire the MRP measure once the TRC measure is publicly reported. Any decisions will be communicated in future editions of the HEDIS Technical Specifications.

 

Matthew

Q: For accreditation, when will the commercial exchanges be included for HEDIS/CAHPS in addition to the standards scoring (already measured)?

A: For accreditation, for Renewal Surveys and applicable First Surveys, NCQA will continue to score the Marketplace product line on accreditation standards only, and will evaluate whether the organization continues to be a Qualified Health Plan under CMS requirements. If the organization did not submit Quality Rating System (QRS) measures to CMS and is not listed on Healthcare.gov, NCQA will not accredit the Marketplace product line or, if the organization is accredited, will revoke its accreditation status. If the organization is not required by CMS to report QRS measures but is listed on Healthcare.gov, NCQA will discuss the issue with the organization before revoking accreditation status.

As this is a CMS decision, NCQA does not yet have an anticipated date or standards year when changes will be made to this policy/requirement.

 

Francine

Q: I was wondering, in looking at opioids, are we including standard supplemental pharmacy data?

A: Outside of pharmacy claims, pharmacy data may be considered supplemental data when reporting the UOP and UOD measures. Organizations must follow the requirements of General Guideline 33 when using Supplemental Data. When pharmacy data are classified as supplemental data, all data elements from the Opioid Medication List must be present: the generic name, strength/dose, route and date when the medication was dispensed to the member. Measures are based on filled prescriptions only. Organizations should work with their HEDIS compliance auditor to ensure all supplemental data and measure requirements are met.

 

Milly

Q: Is the transitions of care an administrative measure and how is it measured/verified?

A: The Transitions of Care (TRC) measure, includes 4 indicators. Two of the indicators, Patient Engagement After Inpatient Discharge and Medication Reconciliation Post-Discharge can be reported either administratively or as a hybrid.

The Notification of Inpatient Admission and Receipt of Discharge Information indicators are hybrid only. These two indicators require a medical record review. The same medical record is used for data collection for all four indicators.

 

Mary Jane

Q: On the Opioid measure, are the 4 or more practitioners, 4 or more pharmacies, or 4 or more practitioners and pharmacies mutually exclusive categories?

A: This measure reports 3 different indicators. The first indicator evaluates members who received opioid medications from 4 different practitioners. The second indicator, independent of the first, evaluates members who received opioid medications from 4 different pharmacies. The final indicator evaluates members who received opioid medications from both 4 different physicians and 4 different pharmacies- so is the intersection, or overlap of the first two indicators.

 

Tina

Q: Will PHQ-2 satisfy the new depression measure?

A: PHQ-2 may be used for the depression screening in the new measure, ECDS Depression Screening and Follow-Up for Adolescents and Adults. However, PHQ2 may not be used for follow up and is not included in the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults and for the Depression Remission or Response for Adolescents and Adults.

 

Kathy

Q: Members in an institution, please advise if this includes assisted living?

A: Assisted living facilities provide different levels of services. For the new I-SNP and Long Term Institutional Care (LTI) exclusions, the exclusions use the CMS/Medicare enrollment files. The member must be enrolled in an ISNP or have a LTI flag in their Medicare enrollment files to be excluded. In this way, the CMS Enrollment file is defining the level of service and subsequent exclusion.

 

Paula

Q: Unfortunately, we don’t get the claim for months after the discharge and it is too late to contact the patient for compliance.

A: Many organizations will use their authorization systems and health plan inpatient census data to complete interventions related to the Transition of Care measure.

 

Ritesh

Q: Who would inform PCP, that his/her patient has got discharged?

A: This measure evaluates hospitals and health plans providing notification to the PCP of both the admission and the discharge.

 

Philip

Q: I’d like to make sure LuAnn‘s question gets answered. Because PHQ-2s were mentioned as valid depression screens, would a PHQ-9 be considered valid follow up to a positive PHQ-2? In other words, if a PHQ-2 is positive, but the following PHQ-9 is negative, would any more follow-up be necessary?

A: If the PHQ-2 was positive, and was followed-up with a positive PHQ-9, which showed the member was not depressed, then the negative PHQ-9 test would count towards the Follow-Up on Positive Screen indicator. No further follow up is required for this patient. The completed PHQ-9 fulfills the requirements for follow up.

 

Dayne

Q: Can more be provided about FPC’s retirement? Notes state that it is “redundant yet less stringent than Timeliness,” which is not the case. FPC measures continued, proper care, just as critical.

A: NCQA is considering retiring the Frequency of Ongoing Prenatal Care measure. Some feedback has suggested the measure is not providing information that is as useful as other measures, such as the Prenatal and Postpartum Care measure, which assesses whether a visit occurred at key times during a woman’s pregnancy.

 

Christopher

Q: What does RRU being suspended mean?

A: The HEDIS 2018 Relative Resource Use (RRU) measures are suspended and will not be collected. Due to the suspended status, the specifications, Value Set Directories (VSD) and Standard Pricing Tables (SPT) are not included in HEDIS 2018 Volume 2. Complete RRU specifications are available in the HEDIS 2017 Technical Specifications.

 

Anonymous:

Q: The issue would be how does the PCP office share the information with the BH office…. issue around with sharing information.

A: We assume the question above is referencing the new ECDS Depression and Screening measure. This measure uses the Electronic Clinical Data system (ECDS) method. ECDS includes the use of EHR data, case management, disease management and registry data. NCQA recognizes not all providers and plans may report this method.

 

Lori

Q: Can you explain whether what Lisa discussed about a validated vendor which information is sent thru? I this from the plan perspective or the practice perspective.

A: What Lisa referred to in the webinar is certification for vendors/HIEs pulling data directly from providers’ EHRs and providing that member level data to a health plan. Since the data format would be validated during the certification process, the data that plans would ingest from NCQA-certified vendors/HIEs would not be subject to Primary Source Verification during the HEDIS audit because they would be considered a standard supplemental data feed. These data would be subject to the audit requirements for supplemental data as discussed in Volume 5, HEDIS Compliance Audit: Standards, Policies and Procedures. Currently there are 14 hybrid measures within this certification. CBP (Controlling High Blood Pressure) remains obligatory chart review only at this time. Additional efforts are under way to reduce the chart review burden over the long term.

For more information: NCQA’s eMeasure Certification (eMC) program is designed for organizations that develop, license, and sell quality-measure reporting software that calculate electronic clinical quality measures (eCQMs) using electronic clinical data. Additional information can be found on our Web site.

 

Leah

Q: Can the Whooley Tool be used as one of the tools for DSF. It’s similar to PHQ9.

A: The screening indicator of DSF (Depression Screening and Follow-Up) includes PHQ-2 as well as several other screening tools including the Whooley Tool and Beck Depression Inventory.

We recognize there are other depression screening tools which are similar to the PHQ-9. HEDIS allows depression screening captured in health risk assessments or other types of health assessments/tools when the questions align with the PHQ9 tools included in the specifications.

 

Ralph

Q: You mentioned in the presentation that a certification is available to vendors who want to conduct chart chasing on behalf of health plans. What is the certification. Is there a link on your website that provides more information? Thanks for this great presentation

A: What Lisa referred to in the webinar is certification for vendors/HIEs pulling data directly from providers’ EHRs. Since the data format would be validated during the certification process, the data that plans would ingest from NCQA certified vendors/HIEs would not be subject to Primary Source Verification during the HEDIS audit because they would be considered a standard supplemental data feed. These data would be subject to the audit requirements for supplemental data as discussed in Volume 5, HEDIS Compliance Audit: Standards, Policies and Procedures. Currently there are 14 hybrid measures within this certification. CBP remains obligatory chart review at this time. Additional efforts are under way to reduce the chart review burden over the long term.

For more information: NCQA’s eMeasure Certification (eMC) program is designed for organizations that develop, license, and sell quality-measure reporting software that calculate electronic clinical quality measures (eCQMs) using electronic clinical data. Additional information can be found on our Web site.

 

Paula

Q1: Can you share the portions of your new roadmap to help us do less office abrasions with doing less chart chase? and

A1: Our roadmap is currently under construction, and we will be sharing details once completed.

Q2: How can we get certified for obtaining clinical data from nontraditional ways?

A2: In reference to certification, What Lisa referred to in the webinar is certification for vendors/HIEs pulling data directly from providers’ EHRs. Since the data format would be validated during the certification process, the data that health plans would ingest from NCQA certified vendors/HIEs would not be subject to Primary Source Verification during the HEDIS audit because they would be considered a standard supplemental data feed.

These data would be subject to the audit requirements for supplemental data as discussed in Volume 5, HEDIS Compliance Audit: Standards, Policies and Procedures. Currently there are 14 hybrid measures within this certification. CBP remains obligatory chart review at this time. If you are a data intermediary or vendor that extracts data from EMRs, please send your contact information and we will be happy to connect with you. In the meantime, please see the link below.

For more information: NCQA’s eMeasure Certification (eMC) program is designed for organizations that develop, license, and sell quality-measure reporting software that calculate electronic clinical quality measures (eCQMs) using electronic clinical data (typically EHR data). Additional information can be found on our Web site.

Q3: The claims for ER/Hospital visits may come 30 days after discharge and how does that help. Some physicians are not notified of ER/Hospital visits so how do they find out about this?? We have competing hospitals and as we all know the ER and hospital admission are revenue generating and if any one comes in and will probably get admitted so is there a way NCQA can do some work at the hospital level for them to understand?

A3: Many health plans will use their authorization systems and health plan inpatient census data to complete interventions related to the Transition of Care measure.

NCQA is discussing these measures in our fall conferences and speaking engagements which include both hospitals and health plans.

 

Jennifer

Q1: How does this measure relate to MRP. Does it replace it? Also, why was the ISNP and Long Term care exclusion not included in excluding MRP?

A1: The Medication Reconciliation Post-Discharge indicator in the TRC measure is identical to the original MRP measure numerator. The intent is to retire the MRP measure once the TRC measure is publicly reported. Any decisions will be communicated in future editions of the HEDIS Technical Specifications.

Q2: Will they both be done using the same members?

A2: The intent of the TRC measure is that it should map precisely onto the denominator of the MRP measure. Both are focused on recently discharged persons. Because the organization cannot reduce the sample size for the TRC measure, given that it’s a first-year measure, for this year the denominators could be different.

Q3: Why was the ISNP and Long Term care exclusion not included in excluding MRP?

A3: This exclusion only applies to 4 measures (Colorectal Cancer Screening (COL), Breast Cancer Screening (BCS), Osteoporosis in Women who Had a Fracture (OMW), and Controlling High Blood Pressure (CBP)). The purpose of the new exclusion for the institutionalized members is to remove members from the measures when screening may not be indicated (as I-SNP members are more likely to have higher levels of morbidity and frailty, screenings intended for a general population may not be appropriate). Therefore, these members are only excluded from measures as specified. While it may cause more harm than benefit to perform a mammogram or colonoscopy on these members, non-invasive services such as medication reconciliation are not considered inappropriate for these members.

Matt Brock
Matt Brock is the Director of Communications at NCQA. After more than two decades working in broadcast journalism, Matt now leads NCQA’s efforts to develop unique content that engages and informs consumers as well as providers, plans and policymakers via this blog, our website, NCQA.org and numerous social media platforms. Matt’s goal is to educate consumers and to direct them to the best resources when considering quality in their health care decisions.

11 thoughts on “Asked. Answered. Our HEDIS® Experts Take Your Questions

  1. Great presentation and Thanks you for sharing the questions. Jackie

  2. During the HEDIS Update webinar Dr. Barton mentioned there were 3 “optional”measures when discussing Depression Screening and Follow up for Adolescents and Adults. What are the other 2 measures that are “optional” for HEDIS 2018?

    1. Hi Susan:
      Here are the “optional” measures in HEDIS 2018:
      Depression Screening and Follow-Up for Adolescents and Adults (covered in the Hangout)
      Utilization of PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
      Depression Remission or response for Adolescents and Adults

      Let us know if you have any other questions!

  3. Q: Did you say if the med rec can be done over the phone?

    A: A face-to-face visit is not required to meet criteria for the measure; the medication reconciliation can be performed without the patient present. If the prescribing practitioner, clinical pharmacist or registered nurse is actually performing the services for the measure (i.e., reconciling the medications via the telephone), then it is acceptable for the reconciliation to be done over the phone and it may count towards the measure if all the required components are documented and a part of the member’s outpatient chart. The phone conversation documentation must be a part of the member’s outpatient chart to meet criteria. Please keep in mind that only one outpatient medical record can be used for all four indicators in the Transitions of Care measure. The record selected may be from the member’s PCP or ongoing care provider.

    Does the above mean that LPN’s and Medical Assistants are only allowed to reconcile meds at a visit?

    1. Hi Jenny:
      From Cindy Ottone, Director, Policy Measures:
      LPN and Medical Assistants are not prescribing practitioners and thus are not able to perform the medication reconciliation. The purpose of having a prescribing practitioner complete the medication reconciliation is that if there is an issue, the practitioner is able to address it by making the necessary medication change.

      Hope that helps. Thanks for commenting!

  4. Hello,

    Could anyone tell me if a signature is required on procedure reports ie: Colonoscopy at Kaiser

    1. Hi Tiana~
      NCQA does not have a signature requirement for this measure. Organizations will need to find a date of colonoscopy and if using medical record data a result for the colonoscopy test. Patient reported data cannot be used unless it is part of the legal health record.

  5. Are there any HEDIS measures that have a “REQUIRED Exclusion vs. optional exclusion” and where in the HEDIS Tech Specs can I find that list Required exclusions?

    1. Required exclusions are built into the eligible population specification. They are sometimes listed as “required exclusions” but not always.

  6. For the measure: Osteoporosis Management in Women who had a Fracture – (Bone mineral density screening/Dexa Scan) require providers signature if results are sent to Health plan via a vendor?

    1. Thank you for your question Virginia! Unless stated in the measure specification, a practitioner signature is not required for HEDIS reporting. The OMW numerator does not require a signature, therefore a Bone mineral density screening/Dexa Scan sent to the plan from a vendor does not require a signature.

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