This measure assesses chronic obstructive pulmonary disease (COPD) exacerbations for adults 40 years of age and older who had appropriate medication therapy to manage an exacerbation.
COPD is a debilitating lung condition that affects one in eight Americans age 45 and older.
A COPD exacerbation is defined as an acute inpatient discharge or emergency department visit with a primary discharge diagnosis of COPD.
There are 2 rates that are reported for this measure:
Dispensed a systemic corticosteroid (or there is evidence of an active prescription) within 14 days of the event
Dispensed a bronchodilator (or there is evidence of an active prescription) within 30 days of the COPD exacerbation event
Providers are encouraged to have a COPD action plan: that is a personalized patient tool that includes the important steps to help manage COPD. This plan includes medications, exercise, diet, and avoidance of triggers, such as tobacco products and other inhaled irritants.
To achieve this measure providers should follow these helpful steps:
Schedule a f/u appt after the COPD exacerbation event.
Review the list of medications and reconcile the medications that were given to the patient during the discharge
Document any barriers that prevent the patient from obtaining the medications for the COPD
Assure the patient with COPD is up to date with the vaccinations, including flu vaccine and Pnuemoccoccal vaccine.
In this blog post we will explore the Comprehensive Diabetes Care HEDIS measure. .
What is New for 2020?
New measure Kidney Health Evaluation for Patient with Diabetes measure was added in 2020. This is a new measure. It evaluates the percent of members that are between 18 and 85 years of age that have diabetes and who received a kidney health evaluation, including estimated glomerular filtration gate test (eGFR) and a urine albumin-creating ration.
What is Comprehensive Diabetes Care Measure?
Measure that evaluates percentage of adult members between ages of 18 and 75 years of age (looks at both type 1 and type 2 diabetes) and who had each of the following:
HbA1c testing
HbA1c poor control (>9%)
HbA1c control of (<8%)
Retinal Eye Exam performed
Blood Pressure Control (<140/90 mm/Hg)\
Documentation:
Record your efforts: document results of, all of the above mentioned test, in the patient’s medical record.
How to meet this measure?
Provide reminders to patients for upcoming appointments and screenings.
Draw labs in your office if available or refer patients to a local lab for screenings.
Refer patients to participating eye professionals for annual retinal eye exams.
Follow up on lab test, eye exams and specialist referrals and document in your chart.
Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).
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Cervical cancer screening is measured by the percentage of women, 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:
Women 21 to 64 years of age who had cervical cytology performed within the last 3 years.
Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.
Note: Evidence of hrHPV testing within the past five years also captures patients who had co-testing; therefore, additional methods to identify co-testing are not necessary.
Documentation:
For women age 24-64 as of Dec. 31 of the measurement year who had cervical cytology during the measurement year or the two years prior to the measurement year, documentation in the medical record must include both of the following: o A note indicating the date when the cervical cytology was performed o The result or finding
2. For women age 30-64 as of Dec. 31 of the measurement year who: 1) had cervical hrHPV testing during the measurement year or the four years prior to the measurement years, and 2) were 30 years or older as of the date of testing, documentation must include both: o A note indicating the date the hrHPV test was performed; generic documentation stating HPV test counts as evidence of hrHPV test o The results or findings
Documentation that will not be accepted for this measure:
Biopsies do not count
Lab results that state the sample was inadequate or that no cervical cells were present are not acceptable unless it is also stated this finding is consistent with a hysterectomy
Documenting hysterectomy is not sufficient; should note if the hysterectomy resulted in the loss of the cervix and include terms like total, complete or radical hysterectomy
Codes that apply to this HEDIS Measure
Exclusions:
1.Women who have had a total, complete or radical vaginal or abdominal hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix; prior to Dec. 31 of the measurement year 2. Hospice or palliative care during measurement years 3. Documentation of vaginal hysterectomy meets criteria for documentation of hysterectomy with no residual cervix
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). All summaries of the measures contained herein are reproduced w ith permission from HEDIS MY2020 and MY2021, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
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