The National Committee for Quality Assurance (NCQA) is accepting comments through March 11 on proposed changes for HEDIS® Measurement Year 2022 (MY 2022), which will be published in August 2021. Jamison Gillitzer, product director for Cotiviti’s quality improvement solutions, summarizes the important details on proposed new measures, changes to existing measures, and measures proposed for retirement for plans that report HEDIS data.
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Future of HEDIS
Introduction of Race and Ethnicity Stratification into select HEDIS Measures
NCQA is proposing to introduce race and ethnicity stratifications to five HEDIS measures for MY 2022 with an expansion to a minimum of 15 measures by MY 2024 to help identify and reduce disparities in care. As the agency states, “this effort builds on NCQA’s existing work dedicated to advancing health equity in data and quality measurement.” Candidate measures for MY 2022 include:
- Controlling High Blood Pressure (CBP)
- Comprehensive Diabetes Care (CDC)
- HbA1c <8% indicator
- Eye Exam
- Antidepressant Medication Management (AMM)
- Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)
- Adults’ Access to Preventive/Ambulatory Health Services (AAP)
- Prenatal and Postpartum Care (PPC)
- Well-Child Visits in the First 30 Months of Life (W30)
- Child and Adolescent Well-Care Visits (WCV)
- Mental Health Utilization (MPT)
Roadmap for Electronic Clinical Data Systems (ECDS) Reporting Method
NCQA plans to add the ECDS reporting standard to three additional existing measures for MY 2022. As part of a larger strategy to encourage and improve health information exchange, NCQA also proposes removing traditional reporting from measures currently specified for ECDS.
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Measure Name
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Summary of Proposed Changes
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Childhood Immunization Status (CIS)
Immunizations for Adolescents (IMA)
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
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Allow ECDS reporting for MY 2022
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Breast Cancer Screening
Follow-Up Care for Children Prescribed ADHD Medication (ADD)
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Choose ECDS or Admin reporting for MY 2022, ECDS only MY 2023
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Colorectal Cancer Screening (COL)
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Choose ECDS or Hybrid reporting for MY 2023, ECDS only MY 2024 (Hybrid removed)
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Cervical Cancer Screening (CCS)
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Add optional ECDS reporting for MY 2023
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Noting that it will “enable more efficient data exchange, reduce provider burden, and align with other quality measurement use cases,” NCQA is also continuing the gradual transition to the Fast Healthcare Interoperability Resources (FHIR) data model.
Changes to existing HEDIS measures
NCQA is proposing several changes to measures related to acute hospitalization utilization, use of imaging studies for low back pain, mental health utilization, alcohol and drug use, and diabetes care for MY 2022.
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Measure Name
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Summary of Proposed Changes
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Acute Hospital Utilization (AHU)
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- Exclude planned hospitalizations
- Remove reporting of separate medical and surgical categories, retaining just the total hospitalization rate
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Use of Imaging Studies for Low Back Pain (LBP)
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- Expand the upper age limit from 50 to 74 years
- Apply four additional clinical exclusions: any history of osteoporosis; any history of spinal surgery; any history of ankylosing spondylitis; and fragility fracture within 90 days prior to index date
- Apply two cross-cutting exclusions: palliative care and advanced Illness/frailty
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Mental Health Utilization (MPT)
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- Rename to Diagnosed Mental Health Disorders
- Change from utilization to diagnosis prevalence, follow the reporting guidelines for Effectiveness of Care Measures
- Consider mental health diagnosis from any position (instead of principal only)
- Remove mental health practitioner requirements
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Identification of Alcohol and Other Drug Services (IAD)
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- Rename to Diagnosed Substance-Related Disorders
- Change from utilization to diagnosis prevalence, follow the reporting guidelines for Effectiveness of Care Measures
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Initiation and Engagement of Alcohol and
Other Drug Abuse or Dependence Treatment (IET)
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- Change to episode-based instead of member-based
- Rename to Initiation and Engagement of Substance Use Disorder Treatment
- Add stratification for “behavioral health complexity”
- Modify age stratifications
- When categorizing the drug cohort, choose the principal diagnosis or the position closest to the principal position
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Follow-up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
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- Rename to Follow-up After Emergency Department Visit for Substance Use
- Update denominator and numerator criteria to look in any diagnosis position
- Add additional follow-up options to numerator that don’t require an SUD diagnosis
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Comprehensive Diabetes Care (CDC)
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- Retire the HbA1c Testing numerator
- Move the optional exclusions to required exclusions
- Split the remaining numerators into three separate hybrid measures:
- Hemoglobin A1c Control for Patients with Diabetes (HBD)
- Two numerators: HbA1c control (<8.0%) and HbA1c poor control (>9.0%)
- Eye Exam for Patients with Diabetes (EED)
- Remove Diabetic Retinal Screening in the year prior with a negative result from the admin numerator
- Blood Pressure Control for Patients with Diabetes (BPD)
- Replace numerator requirement for BP reading setting (outpatient, telephone, online, remote) with exclusion of BP readings in acute inpatient or ED visit settings
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New HEDIS measures being introduced
NCQA is proposing the addition of three new measures for MY 2022.
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Measure Name
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Description
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Advance Care Planning (ACP)
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- The percentage of adults 66–80 years old with advanced illness, frailty or palliative care, and adults 81 years of age and older, who had advance care planning during the measurement year
- Medicare product line only
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Deprescribing of Benzodiazepines in Older Adults (DBO)
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- The percentage of Medicare members 67 years of age and older who were dispensed benzodiazepines and experienced a decrease in benzodiazepine dose during the measurement year.
- Three numerators: ≥10% Reduction, ≥25% Reduction, ≥50% Reduction
- Medicare product line only
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Antibiotic Utilization for Acute Respiratory Conditions (AXR)
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- The percentage of episodes for members 3 months of age and older with a diagnosis of an acute respiratory condition that resulted in an antibiotic dispensing event.
- Proposed replacement for Antibiotic Utilization (ABX)
- Commercial, Medicaid, and Medicare product lines
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Ready to comment?
NCQA seeks public feedback on these proposed new HEDIS measures, revisions to existing measures, proposed measure retirement, and initiatives by 11:59 p.m. (ET), Thursday, March 11. Submit all comments via NCQA’s Public Comment website.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).