Keeping you updated on the latest Medicare and Part D news

New Study Finds Underreporting of High-Risk Medication Prescribing Rates Among Medicare Advantage Plans

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Medicare Advantage plans are required to report clinical performance using Healthcare Effectiveness Data and Information Set (HEDIS) quality indicators, but researchers recently compared reported rates with those calculated using Part D claims and found underreporting trends.

Notably, approximately 95% of plans reported high-risk prescribing rates lower than the rates calculated using Part D claims. Also, researchers found that of the approximately 104,000 beneficiaries present in both HEDIS and Part D data in 2006, Medicare Advantage plans incorrectly excluded 10.3 percent as ineligible for the HEDIS high-risk prescribing measure. Unfortunately, the plans that reported rates closest to those derived from Part D claims were adversely impacted in quality rankings. 




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