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 document details some of the key features of the HEDIS measure for colorectal cancer screening.

What is the measure?

This measure focuses on members age 50 to 75 who had appropriate screening for colorectal cancer. Appropriate screenings are defined by one of the following:

• Fecal occult blood test (FOBT) during the measurement year (2019)
• Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year (2015-2019)
• Colonoscopy during the measurement year or the nine prior years (2010-2019)
• Computerized tomography (CT) colonography during the measurement year or the four prior years (2015-2019)
• Fecal immunochemical test (FIT)-DNA (Cologuard®) test during the measurement year or the two prior years (2017-2019)

Acceptable forms of documentation

Documentation in the medical record must include the note indicating the date when the colorectal cancer screening was performed. Pathology Report – indication of the type of screening (e.g., colonoscopy, flexible sigmoidoscopy, FIT, Cologuard) and the date the screening was done.

• For colonoscopy and flexible sigmoidoscopy, a result is NOT required if the documentation is clearly part of the medical history section of the record.
• If it is unclear whether the documentation is part of the medical history, the result or finding must be present. This ensures that the screening was performed and not just ordered.
• Member-reported colorectal cancer screenings will count if performed and/or documented in the measure timeframe (e.g., member reports colonoscopy in 2015 was normal).

Unacceptable forms of documentation

Unacceptable forms of documentation are:

1. A digital rectal exam (DRE) does not count as evidence of a colorectal cancer screening because it is not specific enough to screen for colorectal cancer.
2. FOBTs performed in an office setting or performed on a sample collected via DRE do not meet criteria.
3. An order alone does not meet compliance.

Exclusions

Either of the following, any time during the member’s history through 31 de dezembro, 2019, are exclusions for this measure:

• Colorectal cancer (Colorectal Cancer Value Set)
• Total colectomy (Total Colectomy Value Set)

Hospice care during the measurement year is also an exclusion from the measure.