Managed Care


NCQA Revises 6 HEDIS Measures

MANAGED CARE August 2010. © MediMedia USA
News and Commentary

NCQA Revises 6 HEDIS Measures

MANAGED CARE August 2010. ©MediMedia USA

In a move to reflect the latest scientific thinking, the National Committee for Quality Assurance (NCQA) is revising six measures, retiring two measures, and adding one measure to the newest edition of the Healthcare Effectiveness Data and Information Set (HEDIS), known as HEDIS 2011, volume 2.

“The driving force for these revisions is to help plans gather better data and give the plans the ability to take further action and do more analysis,” says Cindy Ottone, director of HEDIS policy for NCQA.

The measures pertain to spirometry testing for COPD; classifying inpatient hospital stays as either acute, medicine, surgery, or nonacute; amending and capturing data on language needs of members who are in commercial plans; removing gender stratification reporting; reporting on bariatric weight loss surgery; removing reports on ambulatory surgery/procedures and observation room stays.

NCQA will no longer require reporting of nonacute inpatient utilization and outpatient prescription utilization. “These measures aren’t linked to diagnostic criteria,” says Ottone.

The new measure, “Plan All-Cause Readmissions,” tracks reasons for hospital readmissions in commercial plans and adjusts rates based on past comorbidities, primary discharge conditions, presence of major surgery, age, and gender.

NCQA will offer education seminars for the revisions and training for the All-Cause Readmission measures. Check for details about the seminars.


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