HEDIS Audit at a Doctor’s Office (VIDEO)

Written by Aaron Lebovitz, President
Contact him at 1.800.974.4828 ext 102, or aaron@carenational.com

With H.E.D.I.S. ® (Healthcare Effectiveness Data and Information Set) production work right around the corner, CareNational has been on a quest to find qualified nurses and clerical support staff to fill assignments for our clients related to this critically important Quality Improvement survey. We make it our mission to find quality individuals with the appropriate backgrounds to best suit our clients’ needs. When considering a large-scale project like HEDIS, it is important to recognize the efforts of all of the positions involved that allow the audit to run smoothly. This week we wanted to highlight a topic encountered every year, the dynamic between provider office staff and the clinical or non-clinical HEDIS professional charged with extracting required information for this annual audit.

So what are some of the challenges for HEDIS nurses and Service Associates coordinating with physician offices, particularly when onsite record scanning and/or chart abstraction is required to effectively audit quality of care? Well, there are many factors to be considered such as the geographical locations of the offices, the size of the practice and EMR v. paper records. However, we primarily want to address in this blog the temperament of the HEDIS professionals tasked with this sometimes precarious responsibility of onsite visits to the health plan’s contracted providers.

We have learned much about this topic in our many years of HEDIS recruitment, and in our role as consultants to a variety of hiring managers such as Directors of Quality Improvement and HEDIS Program Managers. The consensus is clear that a warm, outgoing personality is critical for those that must travel to and work out of provider offices. In a sense, these professionals are in an educator capacity that may need to explain the importance of their visit, how it can affect Health Plan reimbursement, and how it therefore impacts the bottom line of the practice.

There are other important factors to consider as well. These HEDIS professionals must be exceptionally well organized and persistent in scheduling these visits. They may hear repeatedly that it is bad timing, or that the practice is not prepared for the visit. Regular follow up to ensure that this visit is completed within the audit timeline is, of course, essential. Additionally, these professionals must be flexible in regards to how work conditions will be set up once onsite. A larger Medical Group or IPA may have an unoccupied office or desk available for use. However in some offices space is at a premium; this is especially those that still maintain paper medical records, they take up A LOT of physical space. Therefore it is not uncommon to have to set up your computer, scanner/printer in a patient examination room, or even a storage closet.

In conclusion, the annual HEDIS audit may feel like an enormous disruption to a provider’s office, but it is really an opportunity for each provider to demonstrate the high quality of their care to the networked Health Plan, who in turn can report their over-all numbers to the Centers for Medicare and Medicaid Services (CMS). Without these data points being collected and reported, the Health Plan risks having a lower STAR rating, losing new members due to reputation, or possibly even losing the right to enroll new members. If those situations start developing, the Health Plan is often forced to remove non-compliant provider offices from their service network, which means less business income and people start losing their jobs.

As stated initially, CareNational specializes in HEDIS staffing and career search consultation in these specialized areas, but we do not perform the functions ourselves. So, how did we do? What is your experience with the challenges associated with onsite provider visits? We welcome your feedback and look forward to your thoughts!

Written by Aaron Lebovitz, the Vice President of Client Development. For more information on how we can assist your organization with all your HEDIS staffing needs, reach out to one of CareNational’s founding partners!
Contact him at 1.800.974.4828 ext 102, or email him at aaron@carenational.com


® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”