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from the HEDIS® 2017 trenches: for MRRV success, don’t overlook over-reading

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May 18, 2017

Now that we have a second season with the new medical record review validation (MRRV) guidelines under our belts, were you better prepared this year? In the latest edition of our blog series, “from the HEDIS® 2017 trenches,” Carrie Taylor, Verscend’s manager for HEDIS abstraction, discusses what Verscend did this year to ensure MRRV success for our clients, and offers tips for health plans performing their own abstraction and over-read.

 

Where are health plans in the HEDIS process now that we’re nearing the end of the season?

 

We just completed MRRV, which entails the plan’s auditor selecting 16 compliant samples for one numerator in each of the six HEDIS measure groups to audit. This step is one of the most challenging of the season because the auditor no longer tells the plan which numerators will be reviewed in advance. Instead, selection is based on new or revised measures, complex measures, or measures that the plan struggled with in previous years.

 

What should health plans with MRRV issues this year do to pass with flying colors next year?

 

Focus your over-read efforts on measures you think are most likely to be selected. In an ideal world, you could perform 100 percent over-read on all numerators throughout the entire season, but most health plans don’t have the resources it would take to do this.

 

We recommend the following strategies:

 

Start over-reading early

By starting over-reads early in the season, you can catch trends in errors as well as decrease the burden in the final two weeks of the season. This season, Verscend’s abstraction team began increasing over-read rates in early March to meet our clients’ MRRV goals.

 

Make a plan

Having a plan of attack for MRRV early in the season allows you to staff appropriately for over-reads later in the season. It also allows you to evaluate prior-year MRRV selections, new measures that have been added to the plan, and trouble spots from previous years, and it enables you to work closely with your auditor. Throughout the season, your plan may change, but it’s important to have a starting point, clear goals, and a thoughtful timeline. We usually see clients choose one of three strategies for MRRV: 

  • Focus on just one numerator within each measure group. Health plans that report hybrid data for only a limited number of measures often use this approach, as do plans with new product lines. The major advantages are you’ll have confidence in one numerator and will be able to pull fewer staff from abstracting to conduct over-reads. The biggest risk is that you’ve put all your eggs in one basket. If your auditor doesn’t select that measure for MRRV, you’re at risk of failing the selected measure.
  • Focus on multiple numerators within each group. This tactic, which larger health plans often use, requires you to pull more abstractors for over-reads but covers a larger breadth of measures, giving you more security when your auditor selects measures for MRRV. This strategy allows you to spread over-reading more widely among your staff to leverage your resident experts on each measure. The breadth and depth can be any combination that works well for you. For example, we have worked with plans that successfully pass MRRV by over-reading 35 percent of all numerators, as well as plans that over-read 50 percent of two numerators. The strategy should fit your specific situation.
  • Focus on specific measures regardless of how they’re grouped. You know your auditor will select a measure from each of the six groups, but sometimes it still makes sense to focus on multiple measures within one group, particularly when you’ve added NCQA measures to your products or when significant changes to numerator specifications have occurred. The downside of this approach, however, is you can put entire measure groups at risk of failing MRRV if you didn’t target them for over-read.


Watch seasonal trends

Finally, keep an eye on the quality of abstraction throughout the season so you can retrain or remove abstractors who are not meeting your quality goals. You also need to watch for trends in errors and address the underlying causes. Listen closely to your auditors’ feedback regarding medical record review. If they have concerns in certain areas, you may need to re-evaluate your plan.

 

What are some best practices for working with your abstraction vendor during MRRV?

 

Communicate with your vendor as early as possible about prior-year selections, new measures, measures you have historically struggled with, and your convenience sample. Work with your vendor to choose which over-read strategy makes the most sense for you. Once you choose, make sure you re-evaluate frequently based on quality scores, pain points, and auditor feedback. Don’t get so attached to your plan that you’re missing red flags during the season.

 

We hope your second HEDIS season under the new MRRV guidelines was a success. It’s never too early to start preparing for next season.

 

Stay tuned in June for our final report “from the trenches” for the HEDIS 2017 season.

 

 

 

Interested in learning more about how Verscend ensures abstraction success for our Quality Improvement clients? Download our fact sheet for details on our rigorous training and QA processes.

 read the fact sheet

Carrie Taylor is the HEDIS abstraction manager for Verscend. In her role, she has shaped the new model for Verscend’s abstraction team and led growth in client satisfaction and abstraction volumes. Carrie has been a Registered Nurse for 14 years, with clinical experience in cardiology as well as management in a variety of healthcare settings. She holds a bachelor’s degree in nursing from Emory University and master’s degrees in business and healthcare administration from the University of Utah.

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