HEDIS, or the Healthcare Effectiveness Data and Information Set, is a collection of statistics that reflects health plan (and provider) performance in meeting specific quality metrics. One important metric is the post discharge medication reconciliation (Category II code 1111F). Obviously, it’s sound medical practice for a primary care provider (PCP) to review a patient’s medications at every visit to ensure they’re appropriate and effective, but more so, when the patient has been discharged from an inpatient stay. Medications change while patients are institutionalized, and the hospital follow-up visit is an opportunity to assure the medication updates are reflected in the outpatient record.
There are two important words above; the first is inpatient. Many providers believe the HEDIS medication reconciliation is for all hospital visits. Not correct. It’s a measure for reconciling meds post-discharge form an inpatient stay. This means hospital and skilled nursing facility (SNF), primarily. Although a patient may visit an emergency department for an acute issue, and the practice would be correct to perform a follow-up visit, it is not appropriate to report 1111F after an ER visit. The medication recon must also occur within 30 days of the discharge.
The other important word is visit. Many PCPs like to see their patient after an inpatient discharge – in a face-to-face appointment – but the medication reconciliation needn’t occur during a F2F visit. It can be telephonic and should probably be done sooner than later so the provider is made aware quickly of medication changes. In addition, the two services don’t need to occur simultaneously. A qualified staff member can review the discharge medications and the PCP can conduct a F2F or telehealth visit after the reconciliation as long as there is documentation that the provider reviewed the medication changes.