WASHINGTON--()--The National Committee for Quality Assurance (NCQA) invites the public to comment on its 2014 Healthcare Effectiveness Data and Information Set (HEDIS®) measures. This is an opportunity for health plans, purchasers, consumers and other stakeholders to ensure that new and existing measures are relevant, scientifically sound and feasible.
“Flu Vaccinations for Adults Ages 65 and Older”
This year, NCQA proposes one new measure, Inappropriate Cervical Cancer Screening in Adolescent Females; reevaluates several existing measures, including Breast Cancer Screening; and makes changes to the Effectiveness of Care measures.
About HEDIS and Public Comment
NCQA produces the Healthcare Effectiveness Data and Information Set (HEDIS). These are measures of clinical quality and patient experience that are supported by the best available scientific evidence on what works in healthcare. NCQA creates new HEDIS measures and updates existing measures when new evidence becomes available in the scientific literature. NCQA convenes multi-stakeholder groups (made up of scientists, clinicians, consumers and purchasers) to ensure that the measures meet the high standards of relevance, scientific soundness and feasibility.
Purchasers use HEDIS measures. Examples of initiatives that include HEDIS are Medicare’s star rating system for health plans, the eValu8 system for employer coalitions, many Medicaid programs and state insurance departments. The measures are used to monitor health plan performance, choose among plans and in some initiatives as the basis for incentive payments.
Because of these uses of HEDIS data, NCQA works very carefully to only include in HEDIS measures that reflect strong evidence that provides a clear signal on what constitutes good quality.
An important part of developing and updating HEDIS measures is the opportunity for the public to review a measure and offer support, recommend changes or ask for clarification. NCQA reviews every comment, synthesizes themes and presents comments to the Committee on Performance Measurement for deliberation. NCQA relies on information received during Public Comment to ensure that the final measure meets the criteria of relevance, scientific soundness and feasibility.
Note that HEDIS and NCQA do not set coverage or benefit policy.
Proposed New Measure
Inappropriate Cervical Cancer Screening in Adolescent Females: NCQA proposes to assess the number of adolescents 16–20 years of age who have not been screened for cervical cancer, in accordance with U.S. Preventive Services Task Force (USPSTF) guidelines, which recommend against screening for women under 21.
- Breast Cancer Screening: NCQA proposes to change the age range for its mammography measure from 40–69 years of age to 50–74 years of age, to align with the USPSTF position that supports waiting until age 50 for routine mammograms every two years. USPSTF review of the evidence found that unclear or false-positive results are more common in younger women. The risks from radiation and invasive testing following such results have been shown to outweigh the potential benefits of screening women in the younger age group. The USPSTF urges younger women to decide with their clinician when to start mammography screening, based on family history and other risk factors.
- Cervical Cancer Screening: NCQA proposes incorporating cytology/human papillomavirus (HPV) co-testing into the Cervical Cancer Screening measure. This new test, used in combination with Pap test, is recommended by the USPSTF and can be used for a subset of women (women 30–65 years of age who prefer this test over the traditional Pap test alone).
- Childhood Immunization Status: This measure monitors whether children under 2 years of age get necessary vaccines to protect against disease. NCQA proposes to assess whether a child receives at least one of two required hepatitis A vaccines by the second birthday, in order to accurately reflect the timing recommended by the Advisory Committee on Immunization Practices (ACIP).
- Management of Urinary Incontinence in Older Adults: This measure assesses how many Medicare adults age 65 and older have problems with urinary incontinence (UI), discussed their incontinence with their current practitioner and received treatment. NCQA proposes to improve the measure’s accuracy by updating the survey questions, changing an indicator to assess discussion of UI treatment and creating a new indicator to examine the impact of UI on daily activities and sleep.
- Potentially Harmful Drug-Disease Interactions in the Elderly: This measure assesses the number of Medicare adults age 65 and older with specific conditions, who were prescribed one or more potentially harmful medications. NCQA is updating this measure to align with the recently published 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The update adds several new, potentially harmful medications.
- Care for Older Adults: This measure shows how many Medicare adults 65 and older had each of the following during the measurement year: pain screening, medication review, advanced care planning and functional status assessment. Proposed changes focus on the pain-screening indicator, renamed “pain assessment,” and clarify the definition of pain assessment.
- Flu Shots for Older Adults /Flu Shots for Adults Ages 50-64: This survey measure currently captures self-reported flu vaccination rates for adults 50–64 years of age. NCQA proposes to expand the age range to include adults 18–49, in order to align with ACIP recommendations that all adults receive an annual flu vaccination. The expanded age range requires the survey question to be revised to refer to multiple forms of flu vaccinations. The revised question will also ask about flu vaccinations received since July, as opposed to September, to reflect the earlier availability of the vaccination. To complement these changes, NCQA proposes changing the measure name to Flu Vaccinations for Adults Ages 18–64. NCQA is also proposing to rename the “Flu Shots for Older Adults” measure to “Flu Vaccinations for Adults Ages 65 and Older” and changing the date in the measure to July.
- Relative Resource Use: NCQA proposes changes to the RRU measures that will assess use of health care services more precisely and allow more plans to publicly report results. Changes will lower the eligible population size requirement to 200 across all RRU measures; remove ESRD and kidney transplant exclusions from the Diabetes and Cardiovascular Conditions measures; and expand the Asthma quality composite to include the new measures Medication Management for People With Asthma and Asthma Medication Ratio.
Proposed Changes to a Measure
Guidelines for Effectiveness of Care Measures: Proposed changes will allow organizations to choose whether to include reversed claims when reporting services and events for Effectiveness of Care measures.
How to Participate in Public Comment
To read and comment on the proposed changes, visit www.ncqa.org/publiccomments.aspx. The public comment period begins at 9 a.m. ET on February 21 and ends at 5 p.m. ET on March 21, 2013. NCQA will review input from Public Comment and will publish new and updated measures in HEDIS 2014, Volume 2, in summer 2013.
NCQA is a private, non-profit 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 is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.