HEDIS 2025 Tips for Measures
DIABETES – EYE EXAM (EED)
Definition: ages 18-75 with an eye screening test for diabetic retinal disease
Service Needed: A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year. A negative retinal or dilated eye exam is good for 2 years
Exclusions: Enucleation of both eyes, palliative care, hospice care, death, age 66 in SNP or LTI, or has Fraility AND Advanced Illness
DIABETES – GLYCEMIC STATUS (GSD)-Formally A1C
Definition: ages 18-75 with a HbA1c test
Service Needed: HbA1c test result of less than 9 in the measurement year.
Exclusions: Palliative care, hospice care, death, Age 66 in SNP or LTI, or has Fraility AND Advanced Illness
CONTROLLING BLOOD PRESSURE (CBP)
Definition: ages 18-85 with a diagnosis of hypertension and whose most recent blood pressure was adequately controlled
Service Needed: Blood pressure measurement of <140/90 in the measurement year
Exclusions: Diagnosis of end stage renal disease (ESRD), kidney transplant, dialysis, pregnancy, palliative care, hospice care, death, Age 66 in SNP or LTI, or has Fraility AND Advanced Illness
BREAST CANCER SCREENING (BCS)
Definition: Women ages 50-74 who have had a mammogram
Service Needed: Mammogram between October 1 two years before the measurement year and December 31 of the measurement year
Exclusions: Bilateral mastectomy, 2 unilateral mastectomies, palliative care, hospice care, death, Age 66 in SNP or LTI, or has Fraility AND Advanced Illness
COLORECTAL CANCER SCREENING (COL)
Definition: ages 45-75 who have had an appropriate screening for colon cancer
Service Needed: One of the following:
- Fecal Occult blood test or FIT between January 1 and December31 of the measurement year
- Stool-DNA (Cologuard) during the measurement year or two years prior
- Flexible sigmoidoscopy or CT colongraphy during the measurement year or four years prior
- Colonscopy during the measurement year or nine year prior
Exclusions: Diagnosis of colorectal cancer, total colectomy, palliative care, hospice care, death, Age 66 in SNP or LTI, or has Fraility AND Advanced Illness
OSTEOPOROSIS IN WOMEN THAT HAD A FRACTURE (OMW/OSW)
Definition: Women 67 - 85 years of age who suffered a fracture
Service Needed: Testing or treatment for osteoporosis afer the fracture
- A BMD test [DEXA scan] on the date of fracture or within the 180-day (6-month) after
- A dispensed prescription to treat osteoporosis on the date of fracture or within the 180-day(6-month)
Exclusions: Fractures of the fingers, face skull, or toes, a filled prescription for osteoporosis in 12 months prior to fracture or BMD test (DEXA scan) within 24 months prior to fracture, palliative care, hospice care, age 66 in SNP or LTI , or has Frailty AND Advanced Illness, death
TRANSITIONS OF CARE (TRC)
Definition: ages 18 or older who had each of the following 4 services
Service Needed:
- Notification of Inpatient Admission. Documentation of receipt of notification of inpatient admission on the day of admission or the following 2 calendar days. Must have time stamp.
- Receipt of Discharge information. Documentation of receipt of discharge information on the day of discharge or the following 2 calendar days. Must have time stamp.
- Patient Engagement On or After Inpatient Discharge. Documentation of patient engagement (e.g. office visits, visits to the home, telehealth) provided within 30 days on or after discharge
- Medication Reconciliation Post-Discharge. Documentation of medication reconciliation on the date of discharge through 30 days on or after discharge
Exclusions: Palliative care, hospice care, death
CARE OF OLDER ADULTS (COA)
Definition: 66 years of age and older who had each of the following services during the measurement year Advanced Care planning – Advance care planning discussed with the patient
- (FSA) Functional Status Assessment – Patient is independent in ADL’s or Patient requires no assistance with ADL’s note
- (PNS) Pain Assessment – Patient does not have pain or Patient has XX pain and affects XX
Exclusions: Hospice care, death
DIABETES – KIDNEY HEALTH EVALUATION FOR PATIENTS WITH DIABETES (KED) (CLAIMS CLOSURE ONLY)
Definition: ages 18 – 85 years of age with diabetes type 1 or 2 who received a kidney evaluation
Serviced Needed: eGFR and urine albumin-creatinine ratio (uACR) in the measurement year with result date
Exclusions: Evidence of ESRD, dialysis any time in the history, polycystic ovaries, gestational diabetes, steroid induced diabetes during the measurement year or year prior, 66 or older with frailty and advanced illness, 81 and older with frailty