The National Committee for Quality Assurance next year will start requiring health plans that use its Healthcare Effectiveness Data and Information Set, or HEDIS, to report rates of four healthcare-associated infections at hospitals in their networks.
The new measure on infections is among four new measures added to HEDIS Tuesday for 2017.
The new information is intended to give insurers, employers and patients a new lens through which to judge the quality of different health plans. It could also influence financial incentives offered by employers and insurers to encourage patients to visit one hospital instead of another—and put more pressure on hospitals to improve.
“It occurred to us that health plans that offer coverage for millions of Americans—and in fact pay the bills at the hospital—have not been really brought into partnership to help address the problem of healthcare-acquired infections,” said Mary Barton, vice president for performance measurement at the NCQA.
The new measure includes standard ratios for central line-associated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA) and Clostridium difficile intestinal infections.
These infections are chief among those used by the U.S. Centers for Disease Control and Prevention in annual reports gauging state and national progress in reducing healthcare-associated infections. The CDC has estimated that nearly 722,000 such infections occurred in U.S. acute-care hospitals in 2011, and about 75,000 patients with such infections died while hospitalized.
The four infections added to HEDIS are a valuable metric because they are increasingly viewed as preventable.
“They are regarded as, 'They shouldn't occur with appropriate, high-quality care—or very rarely,' ” said Gail Wilensky, a senior fellow at the international health foundation Project HOPE. “Therefore they are a proxy of the quality of care being provided.”
The NCQA, a nongovernmental, not-for-profit organization, revises HEDIS annually so that the measures it contains remain relevant in an evolving healthcare system. The vast majority of health plans in America, whether commercial or government-run, use this system to evaluate their performance in quality and safety of care, and it gives consumers, employers and others a baseline for evaluating and comparing health plans.
HEDIS currently incorporates more than 80 measures spanning 15 domains, from antibiotic use to diabetes care to fall risk management.
Adding healthcare-associated infections to the mix fits into a broader shift in orientation within the healthcare landscape toward patient safety and health outcomes and away from medical processes.
“These are measures that many hospitals have focused on,” Wilensky said of infection rates.
Michael Millenson, president of the consulting firm Health Quality Advisors, described the new measures as an overall positive step. “It will serve to elevate the importance of patient safety for health plans as they choose their network hospital —and that may be the most important result of all,” he said.
In order to report the new measures, health plans will draw on data from the CMS' Hospital Compare website. They would then manipulate those numbers to examine rates of infection at hospitals within their networks, the NCQA's Barton explained.
“Health plans have always had access to this information,” Barton added, but “nobody was making them look at this.” Now that they have to report these measures, “It could be that health plans, in a desire to get a better score, could work with hospitals to try to get the hospitals to improve.”
The results won't be reported publicly after the first year the measure is in place, which is considered akin to pilot year, Barton said. The NCQA expects to review in another year whether it will require plans to disclose the measure publicly.
The NCQA also added new HEDIS measures of follow-up visits after patients 6 years and older entered the emergency room for mental illness, follow-up visits for patients 13 and older who landed in the emergency room and were diagnosed with alcohol or drug dependence, and remission or response rates for depression in adolescents and adults. It also revised seven existing measures and retired one.
