NCQA recently released for public comment proposed changes for the HEDIS 2009 measurement set – which will measure performance for the 2008 year.

If you have any comments on the proposed new measures or changes, please call Pat Scheer, Director of Quality Operations at 413-233-3435 or email pscheer@hne.com .  In turn, we will share your comments with NCQA.

Immunization for Adolescents – first year measure

The percentage of adolescents 13 years of age who had one dose of Meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday.

Body Mass Index – first year measure

The percentage of members 18–74 years of age who had an outpatient office visit and who had their body mass index (BMI) documented.

Antidepressant Medication Management – change to existing measure

NCQA proposes to retire the Optimal Practitioner Contacts Rate. The Antidepressant Medication Management measure would continue to assess persistence of pharmacologic management of major depression with two rates reported.

• Effective Acute Phase Treatment. The percentage of members 18 years of age and older as of April 30 of the measurement year  th antidepressant medication and remained on an antidepressant drug during the entire 84- day (12-week) Acute Treatment Phase.
• Effective Continuation Phase Treatment. The percentage of members 18 years of age and older as of April 30 of the measurement year who were diagnosed with a new episode of major depression and treated with antidepressant medication and who remained on an antidepressant drug for at least 180 days.

In the summer of 2007, NCQA conducted a field-test for reevaluation of the Antidepressant Medication Management measure. Concerns had been raised during reevaluation regarding the current specification construction, as well as the lack of evidence to support the Optimal Practitioner Contact rate. The most common requests were to assess lengthening the negative diagnosis and medication histories in order to more accurately identify new episodes of major depression. However, field-test data indicated that lengthening the negative diagnosis period or the negative medication period did not improve the measure, but instead had a negative impact on the eligible population size.

An additional component of the field-test was to assess health plans’ ability to capture care management services to count toward the Optimal Practitioner Contacts rate numerator, since many organizations supplement face-to-face visits with care management services as part of depression care. We collected data on care management visits from two of three field-test sites.

Although permitting care management visits to count toward the optimal practitioner contacts rate offers some potential for improvement, NCQA feels the lack of evidence supporting the rate weighs more heavily. Retiring this part of the measure will enable health plans to pursue strategies to improve medication management of people treated with antidepressants without being limited to in-person, billable visits.

Breast Cancer Screening –change to existing measure

NCQA proposes adding  Diagnostic Mammography codes to the BreastCancer Screening measure.

The measure is currently designed as a primary prevention measure that assesses the percentage of women 40–69 years of age who had a mammogram to screen for breast cancer during the measurement year or the year prior to the measurement year. In order to be considered numerator compliant, the measure requires women to have had a screening mammogram and does not currently allow biopsies, breast ultrasounds or

other diagnostic mammograms for compliance.

In the past, NCQA’s Advisory Panels have contended that diagnostic mammography is not a first-line screening method to detect for breast cancer in this age group, according to guidelines, and should not be included in the measure. Part of the rationale for non allowance has been that if a woman was to detect a change in her breast through self-examination, which led her straight to a diagnostic test, counting the test would lead to overreporting of appropriate first-line screening.

Over time, NCQA has increasingly received comments related to non allowance of diagnostic mammography in the Breast Cancer Screening measure. Criticism is that there are women for whom diagnostic mammography is considered first-line screening; that is, women at higher risk for breast cancer (e.g., those with a family history of the disease, previous breast cancer diagnoses, implants). Feedback from plans and clinicians indicates that the measure, as specified, underreports women who have truly been appropriately screened with diagnostic mammography in these specific cases.

Given this feedback, NCQA recently performed a thorough review of the current clinical guidelines and found that overall guidelines support (albeit in a limited fashion) diagnostic mammography as appropriate first line screening for certain women.

NCQA proposes the addition of Diagnostic Mammography codes to the measure for numerator compliance. An alternative proposal for consideration that would not penalize plans and also would not count diagnostic mammography as numerator compliant would be to exclude those women who have had diagnostic mammography from the denominator.

Childhood Immunization Status – change to existing measure

NCQA seeks comments on proposed modifications to the Childhood Immunization Status (CIS) measure with the addition of the hepatitis A, rotavirus (rota) and influenza (flu) vaccines. With the inclusion of these new vaccines, the Childhood Immunization Status measure will evaluate the percentage of children two years of age who had four diphtheria, tetanus and acellular pertussis (Tdap); three polio (IPV); one measles, mumps and rubella (MMR), three H influenza type B (HiB), three hepatitis B, one chicken pox (VZV), four pneumococcal conjugate; two hepatitis A; three Rota; and two flu vaccines by their second birthday. The measure calculates a rate for each vaccine and three separate combination rates.

The addition of these vaccines and the optional exclusions align with the Centers for Disease Control and Prevention (CDC) and the Advisory Council on Immunization Practices (ACIP) guidelines for immunizations and contraindications. The ACIP recommends routine vaccination of infants with three doses of rotavirus vaccine administered orally at ages two, four and six months. This vaccine should not be administered after age 32 weeks because of insufficient data on the safety and efficacy of rotavirus vaccine in infants after this age (CDC MMWR Rotavirus 2006). The hepatitis A vaccine is recommended for all children one year of age (more specifically, 12–23 months), with the two doses being administered six months apart (American Academy of Pediatrics Committee on Infectious Diseases 2007). The ACIP recommends that all children aged 6–59 months receive the influenza vaccine each year, with the first dose accompanied by a primer dose (American Academy of Pediatrics Committee on Infectious Diseases 2007).