P
Aug 1, 2019

Hints for HEDIS® (and more)

According to the CDC, as of April 19, 2019, a total of 186 pediatric deaths were reported to the CDC during the 2017-2018 season. This number exceeds the previous high number of flu-associated deaths in children reported during a regular flu season (171 during the 2012-2013 season). Approximately 80 percent of these deaths occurred in children who had not received a flu vaccination during the season.

To protect their health, all children six months and older should be vaccinated against flu each year.

We are committed to working with you to improve the quality of care and health outcomes for our members, your patients. HEDIS® (Healthcare Effectiveness Data and Information Set) is one tool we use to measure many aspects of performance. This article details some of the key features of the HEDIS measures for childhood and adolescent immunizations.

Immunization Schedule

Childhood Immunization Status (CIS)

What is the measure?  

This measure assesses the percentage of 2-year-old children who had the following by their second birthday:

  • Four diphtheria, tetanus, and acellular pertussis (DTaP)
  • Three polio (IPV)
  • One measles, mumps, and rubella (MMR)
  • Three haemophilus influenza type B (HiB)
  • Three hepatitis B (HepB)
  • One chicken pox (VZV) – or history of illness
  • Four pneumococcal conjugate (PCV)
  • One hepatitis A (HepA)
  • Two or three rotavirus (RV)
  • Two influenza (flu) vaccines

Acceptable documentation

  • Subjective, Objective, Assessment, Plan (SOAP) note/office note/progress note
  • Certificate of immunizations

Any of the following on or before the member’s second birthday meet optional exclusion criteria:

Any particular vaccine

  • Anaphylactic reaction to the vaccine or its components

DTaP

  • Encephalopathy with a vaccine adverse-effect code

MMR, VZV and influenza

  • Immunodeficiency
  • HIV
  • Lymphoreticular cancer, multiple myeloma, or leukemia
  • Anaphylactic reaction to neomycin

Rotavirus

  • Severe combined immunodeficiency
  • History of intussusception

IPV

  • Anaphylactic reaction to streptomycin, polymyxin B, or neomycin.

Hepatitis B

  • Anaphylactic reaction to common baker’s yeast

*Members in hospice care during measurement year are excluded.

PLEASE NOTE: A note that the member is “up-to-date” with all immunizations without listing the dates of all the immunizations and names of the immunization agents is not sufficient evidence of immunization.

Additionally, when you receive notification that your patient received a flu immunization at a clinic or retail location, please be sure to document this within the patient’s immunization chart with the medical record.