RE: HEDIS chart requests -- free or charge?

[Guest guest]

That was what I was trying to do by asking. They are most

insistent calling 5-6x per day and trying to bully my receptionist into sending

them right away. There is no reason for the doctor or clinic

administrator to be bothered by this. She wanted her to fax records on 19

patients today. All progress notes and labs for the last 4 years.

Now mind you we sent them last year for the previous 4 years, so why should

they need 4 years again? A final resolution on whether we are mandated to

supply these records or not would be great. It will take my clerk about

2-3 hours to copy all of these records; some of these people have very full

charts.

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA 30529

From:

[mailto: ]

On Behalf Of Locke

Sent: Thursday, January 28, 2010 10:47 AM

To: practiceimprovement1; Practice Management Issues

Subject: HEDIS chart requests -- free or charge?

Can we put this issue to rest at all?

RE: Can a doc charge for the HEDIS chart requests?

There seems to be no major advantage to the doc to submit these chart requests,

but HEDIS seems to expect them for free.

Anyone know the bottom line on this?

Is it part of our contracts that we have to supply for free?

Or can we charge a copy fee?

It seems silly for me to pay for something that is only getting the insurance

company a bonus.

I could see if I was in some Pay for Performance program and needed to prove my

worth to get a bump in pay -- I might be responsible for the cost of supplying

this information.

But if there is no advantage to me -- why would I want to pay my staff or take

my own time to supply this data to someone else who is getting all the benefit?

It seems that every year or 2 we discuss this topic, but I don't recall it

being resolved.

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As a reminder for what it is...

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http://www.ncqa.org/tabid/187/Default.aspx

What is HEDIS?

HEDIS®

and Quality Compass®

HEDIS is a tool used by more than 90 percent of America's health plans to

measure performance on important dimensions of care and service.

Altogether, HEDIS consists of 71 measures across 8 domains of care. Because so

many plans collect HEDIS data, and because the measures are so specifically

defined, HEDIS makes it possible to compare the performance of health plans on

an " apples-to-apples " basis. Health plans also use HEDIS results

themselves to see where they need to focus their improvement efforts.

HEDIS

measures address a broad range of important health issues. Among them are the

following:

Asthma Medication Use

Persistence of Beta-Blocker Treatment after a

Heart Attack

Controlling High Blood Pressure

Comprehensive Diabetes Care

Breast Cancer Screening

Antidepressant Medication Management

Childhood and Adolescent Immunization Status

Advising Smokers to Quit

Many health plans report HEDIS data to employers or use their results to

make improvements in their quality of care and service. Employers, consultants,

and consumers use HEDIS data, along with accreditation information,

to help them select the best health plan for their needs. To ensure the

validity of HEDIS results, all data are rigorously audited by certified

auditors using a process designed by NCQA.

Consumers also benefit from HEDIS data through the State of Health Care Quality

report, a comprehensive look at the performance of the nation's health care

system. HEDIS data also are the centerpiece of most health plan " report

cards " that appear in national magazines and local newspapers.

To ensure that HEDIS stays current, NCQA has established a process to evolve the

measurement set each year. NCQA’s Committee on Performance Measurement, a

broad-based group representing employers, consumers, health plans and others,

debates and decides collectively on the content of HEDIS. This group determines

what HEDIS measures are included and field tests determine how it gets

measured.

Included in HEDIS is the CAHPS® 4.0 survey, which measures members'

satisfaction with their care in areas such as claims processing, customer

service, and getting needed care quickly.

HEDIS is designed to provide purchasers and consumers with the information

they need to reliably compare the performance of health care plans. HEDIS

results are included in Quality

Compass, an interactive, web-based comparison tool that allows users to

view plan results and benchmark information. Quality Compass users

benefit from the largest database of comparative health plan performance

information to conduct competitor analysis, examine quality improvement and

benchmark plan performance.

================================================

http://en.wikipedia.org/wiki/Healthcare_Effectiveness_Data_and_Information_Set

The Healthcare Effectiveness Data and Information Set (HEDIS)

is a widely used set of performance measures in the managed

care industry, developed and maintained by the National Committee for Quality

Assurance (NCQA).

HEDIS was designed to allow consumers to compare health plan performance to

other plans and to national or regional benchmarks. Although not originally

intended for trending, HEDIS results are increasingly used to track

year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some

plans submit HEDIS data without seeking accreditation.

An incentive for many health plans to collect HEDIS data is a Centers for Medicare and

Medicaid Services (CMS) requirement that Health maintenance organizations

(HMOs) submit Medicare HEDIS data in order to provide

HMO services for Medicare enrollees under a program called Medicare Advantage.

History

HEDIS was originally titled the " HMO Employer Data and

Information Set " as of version 1.0 of 1991[1].

In 1993, Version 2.0 of HEDIS was known as the " Health Plan Employer Data

and Information Set " [2].

Version 3.0 of HEDIS was released in 1997[1].

In July 2007, NCQA announced that meaning of " HEDIS " would be changed

to " Healthcare Effectiveness Data and Information Set " [3].

In current usage, the " reporting year " after the term

" HEDIS " is one year following the year reflected in the data; for

example, " HEDIS 2009 " reports, which will be available in June 2009,

will contain analyses of data collected from " measurement year "

January-December 2008.[4]

Structure

The 71 HEDIS measures are divided into eight " domains of care " [5][6]:

Effectiveness of Care

Access/Availability of Care

Satisfaction With the Experience of Care

Use of Services

Cost of Care

Health Plan Descriptive Information

Health Plan Stability

Informed Health Care Choices

Measures are added, deleted, and revised annually. For example, a measure

for the length of stay after giving birth was deleted after legislation

mandating minimum length of stay rendered this measure nearly useless.

Increased attention to medical care for seniors prompted the addition of

measures related to glaucoma screening and osteoporosis

treatment for older adults. Other health care concerns covered by HEDIS are immunizations, cancer screenings,

treatment after heart attacks, diabetes, asthma, flu shots,

access to services, dental care, alcohol and drug dependence treatment,

timeliness of handling claims and phone calls, prenatal and postpartum care, mental

health care, well-care or preventive visits, inpatient utilization, drug

utilization, and distribution of members by age, sex, and product lines.

New measures in HEDIS 2009 include " Adult BMI

Assessment, " " Weight Assessment and Counseling for Nutrition and

Physical Activity for Children/Adolescents, " " Care for Older

Adults, " and " Medication Reconciliation Post-Discharge " [6].

[edit] Data

collection

HEDIS data are collected through surveys, medical

charts and insurance claims for hospitalizations, medical

office visits and procedures. Survey measures must be conducted by an

NCQA-approved external survey organization. Clinical measures use the administrative

or hybrid data collection methodology, as specified by NCQA. Administrative

data are electronic records of services, including insurance claims and

registration systems from hospitals, clinics, medical offices, pharmacies and

labs. For example, a measure titled Childhood Immunization Status requires

health plans to identify 2 year old children who have been enrolled for at

least a year. The plans report the percentage of children who received

specified immunizations. Plans may collect data for this measure by reviewing

insurance claims or automated immunization records, but this method will not

include immunizations received at community clinics that do not submit

insurance claims. For this measure, plans are allowed to select a random sample

of the population and supplement claims data with data from medical records. By

doing so, plans may identify additional immunizations and report more favorable

and accurate rates. However, the hybrid method is more costly, time-consuming

and requires nurses

or medical record reviewers who are authorized to review confidential medical

records.

[edit] Reporting

HEDIS results must be audited by an NCQA-approved auditing firm for public

reporting. NCQA has an on-line reporting tool called Quality Compass that is

available for a fee of several thousand dollars. It provides detailed data on all

measures and is intended for employers, consultants and insurance brokers who

purchase health insurance for groups. NCQA's web site includes a summary of

HEDIS results by health plan. NCQA also collaborates annually with US News and

World Report to rank HMOs using an index that combines many HEDIS measures and

accreditation status. The " Best Health Plans " list is published in

the magazine in October and is available on the magazine's web site. Other

local business organizations, governmental agencies and media report HEDIS

results, usually when they are released in the fall.

[edit] Advantages and disadvantages

[edit] Advantages

Proponents cite the following advantages of HEDIS measures:

HEDIS measures undergo a selection process that

has been described as " rigorous " [7](p. 205).

Steps in the process include assessment of a measure's " importance,

scientific soundness and feasibility " ; field testing; public comment;

a one-year trial period in which results are not reported publicly; and

evaluation of publicly reported measures by " statistical analysis,

review of audit results and user comments " [8].

HEDIS data are useful for " evaluating

current performance and setting goals " [9].

In some studies, attainment of HEDIS measures is

associated with cost-effective practices or with better health outcomes.

In a 2002 study, HEDIS measures

" generally reflect[ed] cost-effective practices " [10].

A 2003 study of Medicare managed care plans

determined that plan-level health outcomes were associated with HEDIS

measures[11].

An " Acute Outpatient Depression

Indicator " score based on a HEDIS measure predicted improvement in

depression severity in one 2005 study[12].

As stated in a 2006 Institute of Medicine (IOM) report,

" HEDIS measures focus largely on processes of care " [13];

the strengths of process measures include the facts that they

" reflect care that patients actually receive, " thereby leading

to " buy-in from providers, " and that they are " directly

actionable for quality improvement activities " [13](p. 179).

HEDIS measures are " widely known and

accepted " [7](p. 205).

The NCQA claims that over 90% of U.S. health plans use HEDIS measures[5].

[edit] Disadvantages

HEDIS was described in 1995 as " very controversial " [14].

Criticisms of HEDIS measures have included:

HEDIS measures do not account for many important

aspects of health care quality.

In 1998, HEDIS measures were said to

" offer little insight into... [a health] plan’s ability to

treat serious illnesses " [15].

A 2002 study found " there are

numerous non-HEDIS interventions with some evidence of cost

effectiveness, particularly interventions to promote healthy behaviors " [10].

According to a 2005 study, HEDIS-Medicaid

3.0 measures covered only 22% of the services recommended by the second U.S. Preventive Services Task

Force (USPSTF)[16].

Attempts by health care providers to improve

their HEDIS measures may cause harm to patients.

As of 2001, there was concern that the

asthma HEDIS measure may " encourag[e] more casual prescribing of

controller medications " and may place emphasis " on the

prescribing of a controller medication rather than on its actual use " [17].

There is a risk of hypoglycemia if a

provider strives to meet the HEDIS measure concerning a hemoglobin A1c (HbA1c) level of

<7% that was adopted in 2006 for HEDIS 2007[18].

NCQA later decided to not report results of the HbA1c<7% measure

publicly in 2008, to modify the HbA1c<7% measure for HEDIS 2009

" by adding exclusions for members within a specific age cohort and

with certain comorbid conditions, " and to add a new HbA1c<8%

measure[19].

The process to develop HEDIS measures may be

flawed.

There is a possible conflict of interest because NCQA

" works closely with the managed-care industry " [14].

Furthermore, approximately half of NCQA's budget is derived from

accreditation fees, " which may create an incentive against setting

[HEDIS] standards too high " [20].

The process to develop the measures is not

completely " transparent, " that is, " information about

existing conditions, decisions and actions " is not completely

" accessible, visible and understandable”[18].

In some cases, attainment of HEDIS measures is

not proven to be associated with better health outcomes.

In 2004, a multi-site study determined

that persons with persistent asthma per the HEDIS definition at the time

had more " asthma-related adverse events " if they were

classified by HEDIS as having appropriate asthma therapy than if they did

not have appropriate therapy[21].

This cause of this " unexpected " finding was thought to be that

some people with intermittent asthma were miscategorized by HEDIS as having

persistent asthma[21].

A 2008 study of 1056 adults with asthma

found that " compliance with the HEDIS asthma measure is not favorably

associated with relevant patient-oriented outcomes " such as scores

on an Asthma Control Test[22].

Although " glaucoma

screening in older adults " is a current HEDIS measure[6],

the USPSTF found " insufficient evidence to recommend for or against

screening adults for glaucoma " in 2005[23];

as of 2008, the American Academy of

Ophthalmology was attempting to convince the USPSTF to review its

statement[24].

Furthermore, a 2006 Cochrane review ( " last assessed

as up-to-date " in 2009) concluded that there was " insufficient

evidence to recommend population based screening " for glaucoma

because no pertinent randomized controlled trials exist[25].

One summary of the Cochrane review was " population-based screening

for glaucoma... is not clinically or cost-effective " [26].

A 2001 IOM report noted that " there is incomplete

reporting of [HEDIS] measures and health plans resulting in lack of

representativeness at the national level " [7](p. 205).

As stated in the 2006 IOM report, the

limitations of HEDIS process measures include " sample size

constraints for condition-specific measures, " " may be confounded

by patient compliance and other factors, " and " variable extent

to which process measures link to important patient outcomes " [13](p. 179).

Locke, MD