Medicare AdvantageMay 2, 2023
Colorectal Cancer Screening (COL) and Care for Older Adults (COA) for HEDIS
HEDIS® 2023 documentation for Colorectal Cancer Screening (COL) and Care for Older Adults
HEDIS (Healthcare Effectiveness Data Information Set) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.
HEDIS 2023 documentation for Colorectal Cancer Screening (COL)
Measure description: The percentage of members 45 to 75 years of age who had appropriate screening for colorectal cancer. (Revised the age range from 50 to 75 years of age to 45 to 75 years of age).
What we are looking for in provider records
Documentation in the medical record indicating the date when the colorectal cancer screening was performed and result or finding of one or more of the following:
- A pathology report that indicates the type of screening (for example, colonoscopy, flexible sigmoidoscopy) and the date the screening was performed.
- Documentation of a fecal occult blood test (FOBT) during the measurement year (2023).
- Documentation of a flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year (January 1, 2019 to December 31, 2023)
- Documentation of a colonoscopy during the measurement year or the nine years prior to the measurement year (January 1, 2014 to December 31, 2023)
- Documentation of a CT colonography during the measurement year or the four years prior to the measurement year (January 1, 2019 to December 31, 2023)
- Documentation of stool DNA (sDNA) with FIT test during the measurement year or two years prior to the measurement year (January 1,2021to December 31, 2023)
- Documentation of members who are diagnosed with colorectal cancer on or before December 31, 2023
- Documentation of a total colectomy on or before December 31, 2023(documentation must state total not partial)
- Evidence of hospice services in 2023
- Evidence patient expired prior to January 1,2024
Helpful hints:
- Recommend colorectal cancer screening to all patients 45 to 75.
- If patient is hesitant, discuss different screening options.
- Educate that screening is recommended even if there is no family history of colon cancer.
HEDIS 2023 documentation for Care for Older Adults (COA)
Measure description: The percentage of adults 66 years and older who had each of the following during the measurement year:
- Medication review
- Functional status assessment
- Pain assessment
What we are looking for in provider records:
- Medication review: Both of the following during the same visit during the measurement year:
- At least one medication review by a prescribing practitioner or clinical pharmacist and the date it was performed along with the presence of a medication list in the medical record
- Notation that the member is not taking any medication and the date it was noted
- Functional status assessment: At least one functional status assessment during the measurement year (2023):
- Notation of activities of daily living (ADL) were assessed or that at least five of the following were assessed (bathing, dressing, eating, transferring, toileting, walking)
- Notation that instrumental activities of daily living (IADL) were assessed or at least four of the following were assessed (shopping for groceries, driving or using public transportation, using the telephone, cooking or meal prep, housework, home repair, laundry, taking medicines, handling finances)
- Result of assessment using a standardized functional status assessment tool
- Pain assessment: At least one pain assessment during the measurement year:
- Documentation that the patient was assessed for pain (positive or negative)
- Result of an assessment using a standardized pain assessment tool or scale
- Evidence of hospice services in 2023
- Evidence patient expired in 2023
Helpful hints:
- Encourage at least yearly visits. Older adults, many of whom have multiple complex chronic conditions require regular care addressing their physical, mental, cognitive, and behavioral needs.
- Most older adults take multiple drugs; a medication review to check safety and potential savings is recommended.
- Many older adults believe that pain is a normal part of aging. Regular screening for pain is recommended. Utilization of a standardized pain tool may assist in evaluating and adjusting care.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MULTI-BCBS-CR-020739-23-CPN20116
PUBLICATIONS: June 2023 Provider Newsletter
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