HEDIS, what is it? What does it mean to me? How does it affect my practice?

Abstract

Collection of data to allow for fact based comparison of health coverage is needed. While the intent is commendable, one must contemplate how to deal with the stream of auditors coming into the office Another issue, proposed to be addressed in the 1996 version, is adjustment of the data for severity of illness. Physician-patient populations are not exactly alike and require severity adjustments to enable valid comparison. Results of data analysis should be shared with the physician. Clarification with each health plan is necessary to ascertain if the analyzed data will be used in a punitive manner (deselection) or in a true CQI (continuous quality improvement) process to allow for identification of weakness and subsequent improvement. Hopefully in the future it will be possible for HEDIS data to be collected by one organization with subsequent distribution of the information to the respective health plans. Not only would this decrease intrusions into daily operation of a medical practice, it would also result in a standardization of collection methodology among all health plans. Until the HEDIS process matures, it may be wise to address some of these concerns in the contract between the physician and health plan. HEDIS can be of benefit not only to employers, but to everyone involved in the health care system--purchasers, patients, and physicians. The HEDIS development process must be closely monitored to be certain data collection is consistent ant reliable, the data collected is meaningful, and the data analysis results are used to improve health care quality--not just for cost control and health planning.