The COVID-19 pandemic prompted health care providers and systems to rapidly adopt and expand telemedicine services. Telemedicine provides a safer alternative to in-person visits during the pandemic, but simultaneously introduces multiple decision points for implementation.
While many providers already have telemedicine in place, emerging evidence, policies, and guidance on implementation and maintenance indicate that answers to the question, “how do we implement telehealth equitably, safely, and sustainably?” are very much still evolving. Here, we summarize one of the many of the components of telemedicine implementation for health care system leaders. This is particularly important in safety-net settings that already face challenges related to limited resources and fragmented health information technology.
Health care quality measure sets have required modifications during COVID-19 to provide flexibility for care delivered remotely. Many measurement bodies and payers have approved adjustments to their measure sets for 2020 to align with recent telemedicine guidance from CMS and other federal and state regulators. The resources below provide information about how the HEDIS (health care effectiveness data and information set), PRIME (public hospital redesign incentives), and UDS (uniform data system) measure sets have been adapted for 2020-2021.
- National Committee for Quality Assurance (NCQA): HEDIS Measurement Year 2020 & Measurement Year 2021 Volume 2 Summary Table of Measures, Product Lines and Changes — This PDF summarizes HEDIS measurement years 2020 and 2021 changes to address when telephone visits, e-visits, and virtual check-ins are allowable.
- California Department of Health Care Services: PRIME Projects and Metrics Protocol — This PDF has information regarding the Public Hospital Redesign & Incentives in Medi-Cal Program (PRIME). For calendar year 2020, the PRIME transition metrics are most applicable as the PRIME program evolves into the Quality Incentive Program (QIP). These (here and here) may be helpful resources that outline the specific metrics.
- Health Resources & Services Administration (HRSA) Bureau of Primary Health Care: Telehealth Impact on 2020 Uniform Data System (UDS) Clinical Measure Reporting — This PDF is intended to help health centers determine how services to patients provided via telehealth should be considered for the UDS clinical measures. It includes a table to help health centers determine how services to patients provided via telehealth should be considered for UDS.
- Health Resources & Services Administration (HRSA) Bureau of Primary Health Care: Uniform Data System (UDS) Reporting Instructions for Calendar Year 2020 Health Center Data — This PDF describes the annual UDS reporting requirements for all health centers that receive federal award funds under the Health Center Program. The document contains instructions for telemedicine visits.