Posted in HEDIS Measures, Training

Hedis Measure: the Pharmacotherapy Management of COPD Exacerbation Measure

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:

  1. Schedule a f/u appt after the COPD exacerbation event.
  2. Review the list of medications and reconcile the medications that were given to the patient during the discharge
  3. Document any barriers that prevent the patient from obtaining the medications for the COPD
  4. Assure the patient with COPD is up to date with the vaccinations, including flu vaccine and Pnuemoccoccal vaccine.

Posted in BCBS (Various States), NY Providers, Training, Updates

HEDIS Measure: Update Colorectal Cancer Screening for 2022

Are you a primary care physician and is reporting HEDIS measures? Then this following blog post is for you.


In this blog post we will discuss the changes/updates that NCQA just released for HEDIS Colorectal Cancer Screening Measure.

Measure Description: Measures the percentage of members 45 to 75 years of age who had appropriate screening for rectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age.

In order to meet this measure your patients need to fall in ANY of the following criteria:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

If you would like to report this measure via Electronic Clinical Data Reporting system you will need to select: Colorectal Cancer Screening (COL-E).


Reminder: please make sure to document all of needed information in the patient medical records.


#HEDIS #Cancer #primarycare #physicians #NCQA


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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Comprehensive Diabetes Care

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:

  1. HbA1c testing
  2. HbA1c poor control (>9%)
  3. HbA1c control of (<8%)
  4. Retinal Eye Exam performed
  5. 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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