8000 hits on this blog!!

I just want to say thank you for getting to the 8000 hits on my blog mark. My hope is to 10000 by December.  I'll do more posting over the next few weeks.  I'm working as a volunteer camp councilor next week(cub scouts) So I'll have some down time at night.

Thank you all!

Andy

A possible silver lining to the HEDIS changes

Well in any situation you do need to find the silver lining in this case.  I'm going to look at this from the patients point of view.  If there were plans not exactly being honest in their reporting then the fact is people weren't getting better.  The point of these measures was to report if people were closing clinical gaps in their conditions. if they were closing these gaps they would be getting healthier or at least not any worse.  The point of all this is to provide better health care and make people better. Maybe this gets a little lost sometimes with all the different issues that seem to crop up in health care.  What I see changing are organizations turning back to old fashioned health coaching and talking to their members about getting treatments and following up with them. The 20 minute conveyor belt just isn't going to work(not the doctor's fault). The plans and the practices are going to need to work together in outreaching to members after they have left the doctor's office. PCMH is an interesting approach but I think it lacks some teeth in reporting outcomes and outreach post office visit. It's still a good start to seeing changes down the road.  The other winner in this change is really the tax payer surprisingly enough. If plans weren't really supposed to get their bonus payments then HHS isn't going to be paying them extra money. I do recognize the fact however that this may impact plans that were doing nothing wrong.  It's going to be interesting how this all shakes out.

More on the HEDIS Supplemental Changes

I think there will be extra angst as the changes are fully implemented over the next year.  First for measures that have multiple year look backs you will need primary source data in those look back years. That may be difficulty especially if records are stored and not accessible easily.  One area that I think will cause additional pain when plans take on new members.  You will need accurate records to prove that members got required tests and screening from the year that they weren't members of the plan.  Now we all have been dealing with EHR's in some shape or form and this may not be as easy as you think.  What about the pneumonia vaccine you got 4 years ago or the double mastectomy 12 years go. How about doctor tests and results? Hopefully you got your portable records with you. Now as the impacts become more apparent I think some of the rules maybe modified as NCQA gets the feedback rolling in. Personally I don't see any major changes allowing anything but primary source validation.  Because there is state and federal money implications with these scores and there appears to be some indications that there was improper reporting going on NCQA was placed in a pretty difficult position. Either ratchet down the rules or face possible litigation from the OIG is probably what occurred. While NCQA was formed from Health Plans trying to put industry standards and its roots are in health plan promotion I don't think they had much choice in these changes.

HEDIS Supplemental Changes

Sorry I haven't been blogging a while tied up with submission dates and some time off.  I would like to talk about the recent changes to HEDIS supplemental data rules.  Back in April NCQA notified its participants of the changes. In a nutshell unless you have primary source validation for your supplemental data you can't use it. What is primary source?  Basically the hard copy receipts or results of tests and exams.  Without that you can't use the data.  Why did this happen? I suspect there were legal issues with HHS were organizations were playing fast and loose with the rules.  Someone had to have complained and most likely there are open investigations and I suspect you will see OIG cases going to court.  There is a lot of money tied in Medicare STAR ratings and somebody or a few somebodies had to be doing some rather sketchy things.  While the organization that I work for is doing HEDIS Data collection we also were putting this into a disease management registry system, recording calls and had a documented process on what was valid information plus following clinical guidelines for health coaching of patients(our phone staff are RN's).  I suspect there were companies out there just doing cold calling and recording information... With the changes that have occurred we will be out of that line of business.  My guess is there will lowering of scores across the board for Health Plans.  If Plans were using to supplemental data to even boost them half a star its going to hurt. 

More on this on the next post