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Hedis 2005...

Quality Improvement   (13,549 Views 23 Comments)
by hoolahan hoolahan (New Member) New Member

hoolahan works as a Quality Nurse & Home Health Nurse.

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Has anyone gotten their assignments yet? On the road yet? Are you using laptops or paper tools?

This is my first year. Everytime we hear the data is ready, it has to be re-run, so we continue to wait for our assignments, getting more anxious as the available days to get it accomplished in tick by.

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Mission works as a Global Health Researcher.

5,842 Visitors; 240 Posts

We're supposed to get our data today. We'll see what happens...

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ARBY works as a RN, part-time.

3,652 Visitors; 85 Posts

I did HEDIS the last 3 springs when I lived in So. CA and, as you've said, they can't seem to get their act together to get assignments out in a timely fashion. WE have a time limit but the insurance companies don't seem to know who THEIR clients are. (I worked directly for an insurance co.). We had "class" usually the first part of Feb. and you would think they could have the assignments pretty much ready then.

Hoolahan, the first year we used laptops and the last 2 years we used paper. Both had good and bad points.

This year I live in west TX and they don't seem to care about compliance out here as the only HEDIS jobs I found are in the big cities in east/central TX such as Austin, Dallas/Ft. Worth, Houston and San Antonio. I'd sure like to have done it again this spring but am just in the wrong place.

GOOD LUCK ...wish I were out on the road with ya.

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Mission works as a Global Health Researcher.

5,842 Visitors; 240 Posts

The reason it generally takes so long to get your assignments is because it's better for the MCO to use claims data rather than hybrid data. If the MCO has a claims lag then they have to wait before they can give you your assignments. In some states, like New York, medicare reimbursement rates are tied to HEDIS scores (those are the places, obviously,where they care more about compliance). Also, some MCO have incentive compensation programs for their delegates based on HEDIS scores. I know at my company there's a lot of money tied into HEDIS and heads have rolled in the past because of mistakes.

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hoolahan works as a Quality Nurse & Home Health Nurse.

1 Article; 22,787 Visitors; 1,721 Posts

Well, we got our assignments the end of the second week of March, and I got most of the appointments scheduled the following week.

I have 4 counties in NJ, a total of 700 charts and over 250 sites.

I have been on the road for 2 weeks, and the weather has been terrible, rainy, gloomy. Geez, I thought I'd be cruising abound in sunshine. At least I got some great new CD's to listen to on my new CD player in the car.

I got a lighter assignment, probably because it's my first year, so I'll help everyone else finish.

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ARBY works as a RN, part-time.

3,652 Visitors; 85 Posts

Shouldn't tell you this but when I was in So. CA, part of my assignment was the Palm Springs area. It was a tough job but somebody had to do it. HA! HA! Trouble is, by the time you got done for the day, it was so hot and I was so tired, I didn't do much but go back to the motel and do my paperwork. :( I was usually there for about 9 days total (usually divided it into about 3 times). Luckily I'd been there enough that it didn't bother me to miss the "fun" while there on assignment. The first year I had about 800 charts and wondered how I'd ever do that many. The last 2 years I had about 1300 and they were a breeze...in fact the last year I had 2 weeks when I didn't schedule anything and still had time to help with other offices that didn't get done by other abstractors. Good luck and let us know how things are going.

ARBY

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hoolahan works as a Quality Nurse & Home Health Nurse.

1 Article; 22,787 Visitors; 1,721 Posts

Ah, rub it in why don't ya! Just kidding, that sounds cool.

Are you finding the diabetes and HTN measures very time consuming? I am assuming you are doing these, but I know the commercial MCO's do less measures than the Medicaid MCO's, which is where I work. Looking for eye exams in a 2 year time frame is totally disorganized sloppy charts...ugh!

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ARBY works as a RN, part-time.

3,652 Visitors; 85 Posts

Ah, rub it in why don't ya! Just kidding, that sounds cool.

Are you finding the diabetes and HTN measures very time consuming? I am assuming you are doing these, but I know the commercial MCO's do less measures than the Medicaid MCO's, which is where I work. Looking for eye exams in a 2 year time frame is totally disorganized sloppy charts...ugh!

Hi, I've just arrived in OH to visit relatives for about a month so I was late in getting back to you.

YES, the diabetes measures can take FORVER...especially when the charts are 4" thick and NO dividers and the docs handwriting is TERRIBLE!!!! I kind of liked doing them because they were sugh a challenge.

Our HTN didn't seem to bad, especially if you had an office that was even half-way organized. As I recall, we just had to show their most recent B/P for the year and document when it was dx'd...great if they have a problem/diagnosis sheet.

I DIDN'T like OB but then it seemed like the insurance co. I worked for kept changing their idea all the time about what to accept and how to document it.

Good luck with your audits and keep me posted as to how they are going...sure wish I was doing them this year.

ARBY

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Nitengale326 has 30 years experience and works as a RN....

2,487 Visitors; 136 Posts

Just reading thru the posts and find this very interesting. How did your audits go? Is it something you would like to do again?

I am interested in learning this process and looking into it for the coming spring... is it something I can do while working my other job? I work full time nights at a hospital in Northern Virginia.

Thanks for any info your willing to share.

Wanda

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715 Visitors; 2 Posts

I have done HEDIS for the past 3 years and it is a great temporary project to work on. If you are interested in finding HEDIS positions I would look online for companies that specialize in this type of work, a lot of health plans outsource these projects to nursing agencies. I am excited for HEDIS 2006 to start it will be my third year with the same company. If I can help anyone with some info about HEDIS you can email me.

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715 Visitors; 2 Posts

I have done HEDIS for the past 3 years and it is a great temporary project to work on. If you are interested in finding HEDIS positions I would look online for companies that specialize in this type of work, a lot of health plans outsource these projects to nursing agencies. I am excited for HEDIS 2006 to start it will be my third year with the same company. If I can help anyone with some info about HEDIS you can email me.

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815 Visitors; 3 Posts

Actually this is an iquiry for HEIDS 2006 (Texas). How does the pay usually work when it is based on a per chart rate with a bonus for finishing on time? I did a project last year but it was hourly with mileage. I'm just trying to get a basis for some comparison--Thanks for any inpout!

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