HEDIS stands for Healthcare Effectiveness Data and Information Set. Through the use of standardized measurements, developed by the National Committee for Quality Assurance, specially trained nurses review doctors’ and hospital records in order to verify that consumers are receiving quality healthcare.
Who Uses HEDIS?
Initially, the measurements were designed in order to help consumers compare the quality of their health plan to other available plans and to available benchmarks. Today, the results of HEDIS evaluations are used more and more to track year-to-year performance. Also, HEDIS is part of the NCQA’s accreditation process. The evaluation is also used as a requirement by other organizations, such as the Centers for Medicare and Medicaid Services (CMS).
What Does HEDIS Measure?
There are “domains of care” in which the many different measures are grouped:
- Access/Availability of Care
- Effectiveness of Care
- Experience of Care
- Health Plan Descriptive Information
- Health Plan Stability
- Informed Healthcare Choices
- Utilization and Relative Resource Use
Within these domains, the measures are often revised, added, or deleted in order to stay current with today’s healthcare setting. As legislation and healthcare evaluations change, the measures with HEDIS also change to reflect up-to-date standards and requirements.
Why Is HEDIS Useful?
Those agencies who use HEDIS as part of evaluations find that HEDIS data is valuable for gauging performance and for setting new goals. HEDIS data is useful when the time comes to review practices in regard to cost-effectiveness. Proponents of the evaluation appreciate that it reflects the care that patients are receiving and that it holds the providers to a high level of care. Additionally, HEDIS measures are well known throughout the medical community and are accepted by almost all health plans in the United States.
How Is HEDIS Data Collected?
Much of the data collected for a HEDIS evaluation comes from medical charts, insurance claims, surveys, and interviews with clinic or hospital staffing. Doctors’ offices and hospitals can smooth out a HEDIS evaluation by developing charting systems, appointing one staff member to become an expert on HEDIS, complete internal audits of charts, and create a plan for staying compliant with HEDIS regulations.
Responsibilities of HEDIS Abstractors
The responsibilities of abstractors may vary from one project to another, but often include researching and resolving abstraction projects, analyzing medical record charts specifically for NCQA compliance, working independently, maintaining a high level of accuracy and attention to detail, and more.
How to Become a HEDIS Abstractor
Nurses are often a great fit as HEDIS abstractors. They generally have the necessary education background, clinical certification such as LPN, RN, or MA, and proficiency with related computer programs.
If you believe that you would be a good fit as a HEDIS abstractor, contact HEDIS Nurses for more information.
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