2018 HEDIS HYBRID MEASURE EDUCATION TOOL - … 2018 Hybrid Measures...HEDIS HYBRID MEASURE DOCUMENT...
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HEDIS HYBRID MEASURE DOCUMENT REQUEST (TARGETED ELEMENTS) HYBRID MEASURE DEFINITIONS ABA Adult Body Mass Index Assessment A 2016 or 2017 Progress Note (Documentation of Height, Weight, and Calculated BMI Value) CBP Controlling High Blood Pressure A 2017 Progress Note prior to June 30, 2017 with a diagnosis of hypertension (HTN). AND The last Progress Note in 2017 with a documented blood pressure. Members 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year. Members 18 - 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled during the measurement year based on the following criteria: -Members 18-59 whose BP was <140/90 mmHg. -Members 60-85 with a diagnosis of diabetes whose BP was <140/90 mmHg. -Members 60-85 without a diagnosis of diabetes whose BP was <150/90 mmHg. CDC Comprehensive Diabetes Care 2017 Labs (A1c, Urinalysis), 2017 Progress Notes (BP, Medical Attention for Nephropathy), 2016 or 2017 Dilated Eye Exam (Presence or Absence of Diabetic Retinopathy) Members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following: *Hemoglobin A1c (HbA1c) testing. *HbA1c poor control (>9.0%). *HbA1c control (<8.0%). *Eye exam (retinal) performed. *Medical attention for nephropathy. *BP control (<140/90 mm Hg). PPC Prenatal and Postpartum Care All Maternity Notes Associated with Delivery Date (Timeliness of Prenatal Care and Postpartum Care) Deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. *Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. *Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery. CIS Childhood Immunization Series Complete Immunization History (DTap, IPV, MMR, Hib, HepB, VZV, PCV, HepA, RV, Flu) W15 Well-Child Visits in the First 15 Months of Life All Well Child Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance) Children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates. W34 Well-Child Visits in the 3rd, 4th, 5th, & 6th Years of Life All 2017 Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance) Members 3–6 years of age who had one or more well-child visits with a PCP during the measurement year. Members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: *No well-child visits. *One well-child visit. *Two well-child visits. *Three well-child visits. *Four well-child visits. *Five well-child visits. *Six or more well-child visits. COA Care for Older Adults All 2017 Progress Notes (Advance Care Planning, Medication Review, Functional Status Assessment, Pain Assessment) Adults 66 years and older who had each of the following during the measurement year: *Advance Care Planning. *Medication Review. *Functional Status Assessment. *Pain Assessment MRP Medication Reconciliation Post Discharge Discharge Summary AND Progress Note of a Hospital follow-up visit with evidence of a medication reconciliation. Discharges for members 18 years of age and older for whom medications were reconciled the date of discharge through 30 days after discharge (31 total days). TRC Transition of Care All of the following documentation: -Notification of Inpatient Admission -Receipt of Discharge Information -Patient Engagement After Inpatient Discharge -Medication Reconciliation Post-Discharge Members 18 years of age and older who had each of the following during the measurement year: -Notification of Inpatient Admission. -Receipt of Discharge Information. -Patient Engagement After Inpatient Discharge. -Medication Reconciliation Post-Discharge. CCS Cervical Cancer Screening Cervical Cytology Report OR Documentation indicating the date when the cervical cytology was performed. Women 21–64 years of age who were screened for cervical cancer using either of the following criteria: -Women 21–64 years of age who had cervical cytology performed every 3 years. -Women 30–64 years of age who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years. COL Colorectal Cancer Screening Documentation of Screening for Colorectal Cancer (2017 FOBT/2015-2017 FIT-DNA/2013-2017 Colonography, 2008-2017 Colonoscopy, 2013-2017 Sigmoidoscopy) Members 50–75 years of age who had appropriate screening for colorectal cancer. IMA Immunizations for Adolescents Complete Immunization History (Tdap, Meningococcal, HPV) Adolescents 13 years of age who had one dose of meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates. AWC Adolescent Well-Child Visit All Well Child Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance) Members 12–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. WCC Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents All 2017 Progress Notes (Documented BMI percentile, Counseling for Nutrition, Counseling for Physical Activity) Members 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year: -BMI percentile documentation. -Counseling for nutrition. -Counseling for physical activity. This is a reference tool identifying the measures and their documentation needs. Please submit these documents to AlohaCare to evidence the services listed below. Should you have any specific questions regarding the contents of this reference tool, please contact Patricia Elmiger, RN at (808) 973-6332 or [email protected]. 2018 HEDIS HYBRID MEASURE EDUCATION TOOL
Transcript of 2018 HEDIS HYBRID MEASURE EDUCATION TOOL - … 2018 Hybrid Measures...HEDIS HYBRID MEASURE DOCUMENT...
HEDIS HYBRID MEASURE DOCUMENT REQUEST (TARGETED ELEMENTS)
HYBRID MEASURE DEFINITIONS
ABAAdult Body Mass Index Assessment
A 2016 or 2017 Progress Note (Documentation of Height, Weight, and Calculated BMI Value)
CBPControlling High Blood Pressure
A 2017 Progress Note prior to June 30, 2017 with a diagnosis of hypertension (HTN). AND The last Progress Note in 2017 with a documented blood pressure.
Members 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
Members 18 - 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled during the measurement year based on the following criteria:-Members 18-59 whose BP was <140/90 mmHg.-Members 60-85 with a diagnosis of diabetes whose BP was <140/90 mmHg.-Members 60-85 without a diagnosis of diabetes whose BP was <150/90 mmHg.
CDCComprehensive Diabetes Care
2017 Labs (A1c, Urinalysis), 2017 Progress Notes (BP, Medical Attention for Nephropathy), 2016 or 2017 Dilated Eye Exam (Presence or Absence of Diabetic Retinopathy)
Members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following: *Hemoglobin A1c (HbA1c) testing. *HbA1c poor control (>9.0%). *HbA1c control (<8.0%). *Eye exam (retinal) performed. *Medical attention for nephropathy. *BP control (<140/90 mm Hg).
PPCPrenatal and Postpartum Care
All Maternity Notes Associated with Delivery Date (Timeliness of Prenatal Care and Postpartum Care)
Deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. *Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. *Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.
CISChildhood Immunization Series
Complete Immunization History (DTap, IPV, MMR, Hib, HepB, VZV, PCV, HepA, RV, Flu)
W15Well-Child Visits in the First 15 Months of Life
All Well Child Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance)
Children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.
W34Well-Child Visits in the 3rd, 4th, 5th, & 6th Years of Life
All 2017 Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance)
Members 3–6 years of age who had one or more well-child visits with a PCP during the measurement year.
Members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: *No well-child visits. *One well-child visit. *Two well-child visits. *Three well-child visits. *Four well-child visits. *Five well-child visits. *Six or more well-child visits.
COACare for Older Adults
All 2017 Progress Notes (Advance Care Planning, Medication Review, Functional Status Assessment, Pain Assessment)
Adults 66 years and older who had each of the following during the measurement year: *Advance Care Planning. *Medication Review. *Functional Status Assessment. *Pain Assessment
MRPMedication Reconciliation Post Discharge
Discharge Summary AND Progress Note of a Hospital follow-up visit with evidence of a medication reconciliation.
Discharges for members 18 years of age and older for whom medications were reconciled the date of discharge through 30 days after discharge (31 total days).
TRCTransition of Care
All of the following documentation:-Notification of Inpatient Admission-Receipt of Discharge Information-Patient Engagement After Inpatient Discharge-Medication Reconciliation Post-Discharge
Members 18 years of age and older who had each of the following during the measurement year:-Notification of Inpatient Admission.-Receipt of Discharge Information.-Patient Engagement After Inpatient Discharge.-Medication Reconciliation Post-Discharge.
CCSCervical Cancer Screening
Cervical Cytology ReportORDocumentation indicating the date when the cervical cytology was performed.
Women 21–64 years of age who were screened for cervical cancer using either of the following criteria:-Women 21–64 years of age who had cervical cytology performed every 3 years.-Women 30–64 years of age who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.
COLColorectal Cancer Screening
Documentation of Screening for Colorectal Cancer (2017 FOBT/2015-2017 FIT-DNA/2013-2017 Colonography, 2008-2017 Colonoscopy, 2013-2017 Sigmoidoscopy)
Members 50–75 years of age who had appropriate screening for colorectal cancer.
IMAImmunizations for Adolescents
Complete Immunization History (Tdap, Meningococcal, HPV)
Adolescents 13 years of age who had one dose of meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates.
AWCAdolescent Well-Child Visit
All Well Child Progress Notes (Health History, Physical Developmental History, Mental Developmental History, Physical Exam, Health Education/Anticipatory Guidance)
Members 12–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
WCCWeight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
All 2017 Progress Notes (Documented BMI percentile, Counseling for Nutrition, Counseling for Physical Activity)
Members 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year:-BMI percentile documentation.-Counseling for nutrition.-Counseling for physical activity.
This is a reference tool identifying the measures and their documentation needs. Please submit these documents to AlohaCare to evidence the services listed below. Should you have any specific questions regarding the contents of this
reference tool, please contact Patricia Elmiger, RN at (808) 973-6332 or [email protected].
2018 HEDIS HYBRID MEASURE EDUCATION TOOL
