Tips to help make sure your HEDIS scores accurately reflect plan performance
Good HEDIS scores are important to health plans for a variety of reasons. First of all, they provide a way for consumers to compare health plans to one another and decide which plan to purchase. Secondly, they pave the way to accreditation from the National Committee for Quality Assurance, enabling plans to provide services for Medicare Advantage enrollees. And, finally, good HEDIS scores are a way for health plans to confirm their success in providing excellent care for their enrollees.
Low HEDIS scores, on the other hand, can be a huge problem for a health plan provider. In many cases, low scores are not due to poor care at all, but instead stem from flaws in the data collection and analysis process. Here are some of the top causes of low HEDIS scores, along with suggestions for addressing them.
Incomplete Medical Record Documentation
If the staff at the medical clinic fail to capture all of the relevant information about a patient during a visit, this will affect the outcome of your HEDIS reporting. So will the failure of your staff to secure all the relevant pieces of a medical record, such as immunization flow sheets or diabetes flow sheets. Training is the solution to this possible cause of low HEDIS scores.
Inaccurate Chart Abstractions
If your HEDIS reporting is not based on complete and accurate chart abstraction data, naturally it will not accurately reflect the quality of care provided by your network. You can get highly accurate and reliable chart abstraction services by partnering with a contractor like HEDIS Nurses who specializes in this activity.
Lack of Referral for Recommended Services
Sometimes HEDIS measures call for certain patients to receive services that may not be available from their primary care provider. If the primary physician does not know about these measures or does not know of a trusted entity for referrals, you will not score well on these measures. You can improve your performance by providing physicians with resources about the latest HEDIS measures.
Providing HEDIS Services Outside Required Timeframe
Sometimes HEDIS services may be performed too early or too late to help your score. For example, prenatal visits that occur after the 1st trimester or postpartum visits that occur more than 56 days after birth would both be examples of good services provided at a bad time. Again, this can be addressed by providing physicians with resources and reminders.
Patient Non-Compliance
Sometimes patients don’t want to follow their physician’s advice and may refuse to get treatment as recommended by various HEDIS measures. There’s not really a whole lot you can do about this issue. Fortunately, it is relatively rare for patients to outright refuse treatment. More often, patients do not receive recommended treatment because they fail to show up for appointments. To correct this problem, make sure that it is easy for plan enrollees to schedule appointments, and also consider issuing appointment reminders by text or email.
Recent Comments