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Jul 03, 2014

NCQA Releases New Technical Specifications for the 2015 Edition of HEDIS

Published

Jul 03, 2014

NCQA has released new technical specifications for the 2015 version of Health Effectiveness Data and Information Set (HEDIS) to include four new measures, changes to seven measures, the retirement of two measures and minimal changes to various other measures.

NCQA’s four new measures include: 

  1. Non-Recommended PSA-Based Screening measure assessing unnecessary prostate cancer screenings in men above the age of 70.
  2. Use of Multiple Concurrent Antipsychotics in Children and Adolescents.
  3. Metabolic Monitoring for Children and Adolescents on Antipsychotics.
  4. Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics. 

Based on the current clinical evidence, the HEDIS measurement set will retire the following measures: 1) Glaucoma Screening in Older Children, and 2) Cholesterol Management for Patients with Cardiovascular Conditions. 

The changes to the seven existing measures for the 2015 reporting year include the following:  The addition of the new measure on non-recommended PSA-based screening is consistent with USPSTF’s recommendation against PSA-based screening for prostate cancer in men. The addition of three new measures addressing antipsychotics reflects a continuation of NCQA’s focus in mental health. Changes to existing measures will most likely result in minimal changes to the information that plans are collecting and how the measure is being used in pay-for-reporting and pay-for-performance programs.

  1. Controlling High Blood Pressure will now include age and condition-specific treatment goals.
  2. Comprehensive Diabetes Care no longer includes LDL-C Screening, LDL-C Control (<100 mg/dL) and Blood Pressure Control (<140/80 mm Hg) as indicators of quality. 
  3. Annual Monitoring for Patients on Persistent Medications will no longer include the anticonvulsant monitoring rate and has a revised numerator for angiotensin converting enzyme as well as a revised Digoxin rate.
  4. Osteoporosis Testing in Older Women now specifies the location on the body where a bone density test was performed (back or hip) and has an added age limit of 85.
  5. Osteoporosis Management in Women Who Had a Fracture has a newly revised exclusion requirement related to bone mineral density and an added upper age limit of 85. 
  6. Plan All-Cause Readmissions now allows readmissions to serve as a potential index admission with planned readmissions added as an exclusion.
  7. The Consumer Assessment of Healthcare Providers and Systems health plan survey changed the response options in the Shared Decision Making Composite from a 4-point to a 2-point scale.

For the four new measures, NCQA will spend the first year evaluating their relevance, scientific soundness and feasibility. CMS may consider adopting the new measures into one of their pay-for-reporting and pay-for-performance programs. 

View NCQA’s full release.

In October 2014 Avalere will bring to market a quality measures database that will enable our clients access to a comprehensive set of quality measures across therapeutic areas. Given the proliferation of quality measure development by various agencies and entities, the challenge to stay abreast of the measures and the impact they have on healthcare delivery is growing significantly.  For information about this product please contact Leila Nowroozi at lnowroozi@avalere.com.

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