Posted by Karen Grace Larsen
The Healthcare Effectiveness Data and Information Set (HEDIS) is among the most widely used performance improvement tools in U.S. healthcare. However, its 90+ measures across six domains, diverse data sources, and complex calculations make it confusing and stressful for healthcare providers like you.
With over 90% of health plans using HEDIS to gauge care quality, keeping up with the perpetually advancing standards can be overwhelming. Many practices spend significant time and resources meeting HEDIS quality measures, only to fall short of their goals.
The result? Lost reimbursements and lower patient satisfaction.
With stakes this high, having the technology and expertise to streamline and simplify HEDIS compliance is crucial to your practice's success. And that’s precisely where Meditab steps in.
HEDIS 2024: Key Changes You Need to Know
HEDIS compliance impacts nearly every practice in the United States, directly affecting how you report and improve the quality of patient care you provide. As HEDIS evolves, staying informed about all the changes is essential.
While there are no new HEDIS measures for measurement year (MY) 2024, the National Committee for Quality Assurance (NCQA) has retired several:
- Spirometry Testing in the Assessment and Diagnosis of COPD
- Non-recommended Cervical Cancer Screening in Adolescent Females
- Ambulatory Care and Inpatient Utilization for General Hospital/Acute Care
NCQA also introduced revisions to existing measures to ensure they reflect patient needs and healthcare goals:
- Hemoglobin A1c Control for Patients with Diabetes (HBD) has been revised to the Glycemic Status Assessment for Patients with Diabetes (GSD) measure.
- Race/ethnicity stratifications have been introduced to the following nine HEDIS measures, allowing for a more detailed understanding of healthcare disparities:
- Follow-up after emergency department visit for mental illness
- Follow-up after hospitalization for mental illness
- Postpartum depression screening and follow-up
- Prenatal depression screening and follow-up
- Childhood immunization status
- Cervical cancer screening
- Prenatal immunization status
- Kidney health evaluation for patients with diabetes
- Eye exam for patients with diabetes
- Gender-affirming approaches have been applied to the Breast Cancer Screening and Cervical Cancer Screening measures, ensuring they include transgender members who are recommended for these screenings.
Common Reasons Why Your HEDIS Scores Are Low
After understanding the HEDIS MY 2024 updates, it's important to reflect on how your current processes impact your performance.
Low HEDIS scores often stem from common challenges that many practices face. Whether it’s gaps in care, inefficient workflows, or issues with patient engagement, identifying the root causes is the first step toward improvement.
During the Meditab-hosted webinar HEDIS Strategies to Maximize Revenue and Maintain Compliance, HEDIS experts enumerated the following common reasons why healthcare practices face open care gaps, get poor HEDIS quality scores, and remain non-compliant:
- Missing or incomplete documentation requirements
- Providing service without submitting the claim or encounter data
- Lacking a referral to obtain the recommended service
- Providing service outside the required time frame or anchor date (e.g., screenings performed after age two)
- Providing incomplete services (e.g., administering the Tdap vaccine but not the meningococcal vaccine for the adolescent immunization measure)
- Failing to document or code the exclusion criteria for a specific measure
How You Can Improve HEDIS Scores in MY 2024
Improving your HEDIS scores requires a clear understanding of your practice's challenges and a proactive strategy to overcome them.
Are you targeting the right measures? Do you have reliable HEDIS reporting tools? Do you have an experienced team to lead your HEDIS compliance efforts?
These critical questions can guide your path to compliance success. With Meditab’s HEDIS solutions and Quality and Risk Assessment (QRA) team, you have the support and expertise to address these challenges effectively. Here are Meditab-recommended actionable steps to enhance your HEDIS performance:
Be Proactive
Boosting your HEDIS scores requires taking a proactive, not reactive, approach to meeting HEDIS measure requirements and timelines.
Stay one step ahead by scheduling follow-up appointments before patients leave your office; this ensures continuity of care and timely completion of key measures, such as preventive screenings and immunizations. By anticipating these needs, you can meet measures and address gaps in care before they become issues.
With Meditab’s HEDIS support, our team of EHR implementors can set up your IMS Scheduler module to streamline this process and automate appointment reminders, allowing you to meet every measure on point and on time.
Anticipate Care Gaps
If your goal is to close care gaps within your practice, you first need to spot them. Using IMS’s robust analytics tool specially configured for HEDIS compliance, audit your electronic medical records for care gaps and identify those you can address in upcoming visits.
For example, if a patient comes in for a sick appointment but has yet to have their annual physical, seize the opportunity to conduct both evaluations in one visit. For adolescents, add education and anticipatory guidance to routine sports physicals; this improves your well-child visit rates, a key HEDIS measure for that age group.
IMS can help you pinpoint these gaps ahead of time, and our QRA team can help you develop practical and efficient strategies to close them.
Code It Right
Accurate and complete documentation is critical to HEDIS compliance. Using the correct CPT II billing codes can improve your scores by ensuring that the services you provide are accurately captured.
If this is one area you’re not very confident in, our QRA specialists can support you by double-checking your practice documentation, providing detailed feedback on your HEDIS data, and preventing coding errors that may negatively impact your scores.
Work with Health Plans
Regular communication with your health plan's point of contact can help keep you informed of provider incentives, patient programs, and any gaps in care. Staying updated on these elements allows your practice to fully utilize available resources and programs designed to close care gaps.
Our QRA team can assist you in establishing these communications and leveraging health plan resources, such as medical record audit support and gap-in-care reports.
Assess and Adapt
Finally, regularly evaluate your practice’s output and adjust as needed. Proactive performance monitoring allows you to identify issues quickly and implement necessary changes before they become bigger problems. With IMS’s powerful reporting module, you can track real-time progress and make data-driven decisions to boost your HEDIS scores.
By acknowledging the challenges, targeting the right measures, and implementing the mentioned strategies with Meditab’s HEDIS solutions and expert support, your practice can smoothly and successfully navigate the complexities of HEDIS.
Hit the HEDIS Mark: Simplify and Score Big with Meditab
The road to HEDIS success is long and challenging, but with state-of-the-art tools and specialized support, you can hit the mark with ease. Meditab’s flagship EHR system, IMS, combined with the expertise of our QRA team, offers a comprehensive solution to simplify your processes and boost your HEDIS scores.
From automated reminders and real-time reporting to streamlined workflows and dedicated support, our tools are designed to enhance HEDIS compliance while improving patient care and practice efficiency.
Contact us today for a free expert consultation on how Meditab’s services and solutions can help your practice succeed with HEDIS and beyond!
