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
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