This article series is our monthly tool to help you maximize patient health outcomes in accordance with NCQA's1 HEDIS®2 measurements for high quality care on important dimensions of services.
HEDIS® definition
Colorectal cancer screening: The percentage of commercial and Medicare members ages 50 ? 75 who had appropriate screening for colorectal cancer during the measurement year.
Any of the following tests meets the criteria:
- fecal occult blood test ? guaiac (gFOBT) or immunochemical (iFOBT) during the measurement year;
- flexible sigmoidoscopy during the measurement year or four years prior to the measurement year;
- colonoscopy during the measurement year or nine years prior to the measurement year.
Note: Digital rectal exams do not count as evidence of colorectal cancer screening because they are not specific or comprehensive enough to screen for colorectal cancer. Additionally, members who had either colorectal cancer or a total colectomy at any time in their history are excluded.
The importance of screening
"Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. It places significant economic burden on society: treatment costs over $6.5 billion per year. Unlike other screening tests that only detect disease, some methods of screening can detect premalignant polyps and guide their removal, which in theory can prevent cancer from developing." ? NCQA, HEDIS 2013 V1
Learn more
Visit www.ibx.com/providers/resources/hedis.html to view previously publishedHighlighting HEDIS® articles.
If you have feedback about the Highlighting HEDIS® series or you have topic ideas, email us.
QIPS3 Alert!
Colorectal cancer screening is a performance measure in the QIPS program for measurement year 2014 for participating providers.
Stars4 Alert!
This measure is also a Medicare Stars measure.
Register for ePASS® today and start earning!
Did you know that providers registered for ePASS® can receive financial incentives by documenting patient encounters? Documentation for colorectal cancer screening is required when submitting patient encounters.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
1 The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.
2 The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care.
3 The Quality Incentive Payment System (QIPS) is a reimbursement system developed by Keystone Health Plan East for participating Pennsylvania primary care physicians that offers incentives for high-quality, accessible, and cost-effective care.
4 Stars is a program developed by the Centers for Medicare & Medicaid Services to measure quality health care. Ratings are published annually to help educate consumers prior to enrollment decisions.