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Problems with HEDIS scores relate to data collection as well as patient care. Here are some ways to improve your HEDIS performance, as identified by a study of the California Cooperative Healthcare Reporting Initiative, a collaborative of providers, purchasers, and health plans:
• Improve your coding.
Monitoring HEDIS events at the group practice or health plan level requires the proper use of ICD-9 (diagnosis) and CPT-4 (procedure) codes. If the code isn’t used, the practice won’t get credit for the HEDIS care.
For example, the first trimester prenatal exam was often coded as a routine office exam, the study found. To receive credit as HEDIS events, childhood immunizations must specify the type of vaccine.
• Work with outside providers to improve data collection.
Patients often do not transfer their prior medical records. Group practices also may not receive specific information about immunizations that occurred at a school or clinic and or tests provided by a radiology center or OB/GYN. Groups that actively pursued those records had higher HEDIS scores, the study found.
For example, one group sent a list of live births to the hospital to identify the patients’ OB/GYN. The group then contacted the provider to obtain proof of the first prenatal care visit. The group also convinced the hospital to alter its prenatal database to include information about the first prenatal visit, which will make HEDIS collection easier and more accurate in the future.
• Educate patients and physicians, and follow up with patients.
As a part of its quality improvement program, the San Jose (CA) Medical Group provided a preventive care brochure to members that includes information about HEDIS measures. It also developed an extensive packet for physicians and staff that explains HEDIS and includes a coding tool for physicians.
Most groups participating in the study also tracked patient compliance whether they missed appointments or failed to receive recommended services. That information is then provided to physicians for follow-up with patients.