NCQA releases proposed HEDIS MY 2025 updates


Every year, the Nationwide Committee for High quality Assurance (NCQA) publishes an inventory of measure updates, additions, and deletions for future HEDIS® measure years for public remark. For Measurement 12 months (MY) 2025, NCQA has proposed including 5 new measures, revising 5 present measures, and making further updates associated to gender inclusivity and race-ethnicity stratification. The group has additionally shared finalized modifications to anticipate for MY 2025 that aren’t up for public remark.

Right here, we provide a abstract of NCQA’s proposed modifications because the group seeks suggestions from Health plans by March 13, 2024.

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Proposed new measures for MY 2025

Proposed measure

Measure description

Acute Hospitalization Following Outpatient Surgical procedure (HFO)

For Medicare Benefit beneficiaries, this risk-adjusted utilization measure would seize the share of choose outpatient procedures that have been adopted by an unplanned acute hospitalization for any prognosis inside 15 days, and the expected likelihood of an acute hospitalization. This would come with 4 charges:

  • Colonoscopy
  • Normal surgical procedure
  • Orthopedic procedures
  • Urology procedures

Blood Strain Management for Sufferers With Hypertension (BPC-E)

This could measure the share of members for all product strains from 18–85 years outdated who had a prognosis of hypertension and whose most up-to-date blood stress was on the following ranges in the course of the measurement interval:

  • <140/90 mm Hg
  • <130/80 mm Hg

BPC-E can be an digital scientific information programs (ECDS) measure meant to ultimately substitute the hybrid Controlling Excessive Blood Strain (CBP) measure. The draft measure expands on the CBP denominator by including members who’ve a prognosis of hypertension and at the least one distributed anti-hypertensive medicine, and contains race and ethnicity stratifications (RES).

Documented BI-RADS Evaluation after Mammogram (DBM-E)

This could measure the share of mammograms for members 40–74 years outdated from all product strains which have a documented breast imaging reporting and information system (BI-RADS) evaluation inside 14 days of the process. DBM-E can be an ECDS measure.

Observe-Up After Irregular Breast Most cancers Screening (BCF-E)

This could measure the share of inconclusive or high-risk BI-RADS assessments that acquired acceptable follow-up care inside 90 days for members 40–74 years outdated from all product strains. BCF-E can be an ECDS measure.

Cervical Most cancers Screening Observe-Up (CCF-E)

This could measure the share of business and Medicaid members from 21–64 years outdated with potential or confirmed higher-risk cervical most cancers screening outcomes who obtain follow-up care inside 90 days. CCF-E can be an ECDS measure.

Proposed measure modifications for MY 2025

Present measure

Proposed change

Acute Hospital Utilization (AHU)

This measure can be added to HEDIS reporting for Medicaid plans for members 18–64 years outdated.   Medicaid members with six or extra inpatient or commentary keep discharges in the course of the measurement yr can be excluded as outliers.

Grownup Immunization Standing (AIS-E)

To enhance vaccination charges, an indicator can be added to this measure to evaluate hepatitis B vaccination charges for members 19–59 years outdated. This numerator can be made compliant by the presence of both the childhood or grownup Hepatitis B vaccine sequence, proof of anaphylaxis as a result of Hepatitis B vaccine, or a optimistic consequence for Hepatitis B prevaccination blood testing.

As well as, updates to decrease the oldest age stratification from 66+ to 65+ years outdated are proposed for the influenza, Td/Tdap, zoster, and pneumococcal immunizations. The herpes zoster reside vaccine would even be faraway from the zoster immunization indicator as IT is not obtainable in the US.

Observe-Up After Emergency Division Go to for Psychological Sickness (FUM) and Observe-Up After Hospitalization for Psychological Sickness (FUH)

For each measures, further diagnoses can be added to the denominator together with:

  • Phobia
  • Nervousness
  • Intentional self-harm X-chapter codes
  • Suicidal ideation

Any prognosis place can be allowed for intentional self-harm diagnoses, whereas the principal place requirement can be maintained for different psychological Health diagnoses.

Within the FUH measure’s numerators, to acknowledge the scarcity of psychological Health suppliers, follow-up care carried out by any care supplier slightly than solely by a psychological Health supplier can be allowed if accompanied by a psychological heath prognosis..

For each measures’ numerators, the psychological Health prognosis can be allowed in any prognosis place on the follow-up declare, slightly than simply within the principal place, and psychiatric residential therapy, in addition to peer help providers and occupational remedy for a psychological Health prognosis, can be included as choices for follow-up care.

Probably Dangerous Drug-Illness Interactions in Older Adults (DDE)

Medicines can be up to date to align with suggestions within the up to date AGS Beers Standards, including anticholinergics to the Historical past of Falls Charge. The Complete Charge can be retired primarily based on suggestions suggesting that IT is just not clinically significant.

Different proposed modifications for MY 2025

Gender inclusive measurement

As NCQA continues to adapt the HEDIS program to be extra inclusive of transgender and gender-diverse members, IT notes that the Chlamydia Screening in Girls (CHL) measure at present excludes members whose gender is just not listed as “lady,” even when they’re really useful for routine screening. As such, NCQA proposed to rename the measure to Chlamydia Screening in Adolescents and Adults (CHL) and replace the outline as follows:

The share of members 16–24 years of age really useful for routine chlamydia screening who have been recognized as sexually energetic and who had a chlamydia check inside the measurement yr.

This replace would comply with the same sample to the latest updates to BCS-E and CCS-E, utilizing Intercourse Assigned at Start of feminine and Intercourse Parameter for Scientific Use of female-typical as further strategies of figuring out eligible members. NCQA can also be proposing to incorporate members who’ve a Intercourse Assigned at Start of male with a historical past of vaginoplasty.

Race and ethnicity stratification (RES)

As of MY 2024, 22 HEDIS measures might be stratified by race and ethnicity as a part of NCQA’s ongoing efforts to enhance Health fairness and cut back disparities in care. For these measures, plans are at present required to report the information supply for every race and ethnicity worth, whether or not IT’s direct information (self-reported by the member), oblique information (alternate information sources such because the American Group Survey), or unknown. Nevertheless, stakeholder suggestions signifies that this requirement has been burdensome for plans as a result of variety of indicators IT requires them to report. As such, NCQA proposes to remove this requirement from the RES stratifications and solely report the information sourcing particulars by way of the Race/Ethnicity Variety of Membership (RDM) measure. 

Measure modifications for MY 2025 not up for public remark

Present measure

Introduced change

Use of Excessive-Threat Medicines in Older Adults (DAE)

Medicines might be added, eliminated, and regrouped to align with suggestions within the up to date AGS Beers Standards.

Breast Most cancers Screening (BCS-E)

Members 40–49 years outdated might be added to the measure and efficiency might be stratified by ages 40–49 and 50–74 for all product strains.

Nicely-Little one Visits within the First 30 Months of Life (W30) and Little one and Adolescent Nicely-Care Visits (WCV)

Telehealth visits might be faraway from consideration for measure compliance.

Childhood Immunization Standing (CIS), Immunizations for Adolescents (IMA), and Cervical Most cancers Screening (CCS)

In a latest replace to the general public remark supplies that have been initially posted, NCQA has now confirmed that CIS, IMA, and CCS will transition to ECDS-only reporting for MY 2025, retiring administrative and hybrid reporting for these measures.

Register for Cotiviti’s High quality Decoded webinar sequence as we current a group of quick webinars designed to maintain you knowledgeable about pivotal updates, measure modifications, and bulletins from NCQA and the Facilities for Medicare & Medicaid Companies (CMS) all year long.

Our March 6 webinar will tackle the annual request for public touch upon proposed HEDIS measure modifications, giving plans the chance to weigh in on the importance and feasibility of proposed modifications and ask questions of related stakeholders.

Be a part of us as we:  

  • Overview proposed measure modifications  
  • Advocate areas of suggestions to supply to NCQA 
  • Share observations on how proposals might affect future HEDIS measure years 

Register now

HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).





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