Finders, keepers: Patients who need HEDIS care
Reminder letters, better scheduling boost scores
When it comes to improving preventive health outcomes performance measures, a little information can go a long way.
That is the basis of improvement projects at two multispecialty group practices in California that seek to boost their Health Plan Employer Data and Information Set (HEDIS) scores.
Brown & Toland Medical Group, a multispecialty independent practice association based in San Francisco, improved its mammogram rate from 73% to an estimated 77% by providing letters from physicians to patients who hadn’t received the recommended screening within the past two years.
While that increase may not seem dramatic, it represents a significant step toward Brown & Toland’s goal of mammogram screening of 80% of its women who are 50-69. (The figures come from an internal analysis of mammogram rates; the effect of the reminder program won’t be reflected in HEDIS reports until next year.)
Accurate lists are essential
The key is providing physicians with accurate lists of patients who haven’t received preventive health screenings, such as mammograms, so they can provide effective reminders, says Sharon Katz, RN, director of quality improvement for Brown & Toland Physician Services Organization, which provides management services to the medical group. Physicians for more than 70% of the women needing mammograms completed the reminder letters, she says.
Compiling accurate information is often a stumbling block. Brown & Toland uses claims data to identify which women in the age range of 50-69 have not had a mammogram in the last two years. Creating lists for other measures, such as Pap smears and diabetic retinal exams, is more difficult and often entails chart reviews, Katz says.
This fall, Brown & Toland repeated the mammography intervention, in which physicians receive letters that they can sign and send to patients who haven’t had their mammograms. However, by notifying patients before the two-year period expired, they can still get their screening within the recommended time frame and be counted in the next HEDIS report, notes Katz.
"As we can give physicians real-time reports about patients who need preventive screening, we can have a real impact," says Katz.
Katz is also planning another intervention, which may include surveys or focus groups of women who didn’t receive their mammograms. "We’re going to have to try to figure out what are the barriers to women having mammograms," she says.
Schedule changes help rates
At Palo Alto Medical Foundation, the childhood immunization HEDIS rate was just about 75%, even though virtually all of their patients actually received the recommended shots. The problem was the time frame. Some were too late to be counted for HEDIS; others were too early.
The medical group first tried sending lists of patients who hadn’t been immunized to the doctors. But because immunizations aren’t always billed separately, the lists included patients who had gotten the shots, says Diane Stewart, director of quality management.
"We don’t send any lists now unless we’re sure they’re right," says Stewart. "We only send reminder letters for preventive screenings in which we know our billing records are 90% to 95% accurate."
Staff aid in patient compliance levels
Instead, the medical group found an even better resource for improving compliance: the receptionists.
"When the patient called up to schedule the two-year check-up, the receptionist could educate the patient about the best time for the appointment," says Stewart.
With extra effort on the part of receptionists to work in the physicals and immunizations before the child’s birth date, the group’s HEDIS rate rose from 75% to 80%.
Access to appointments has proven a further barrier to improving the immunization measure, says Stewart. Patients scheduling a routine physical may wait 30 days or more before they can see the physician, she says.
Stewart says she hopes improvements in access to appointments will further boost HEDIS immunization rates.
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