UDS 2021 Changes

For context on the UDS report, please refer to the HRSA’s UDS Resources and the UDS 2021 Manual.  Relevant strives to follow the implementation guidelines provided by HRSA as closely as possible. The following notes reflect areas where Relevant’s logic has been updated from 2020 or where questions of interpretation frequently arise.

Changes to Table 3B

Line numbers have been removed in Relevant.

Changes to Table 6A

  • Diagnosis and billing codes have been updated to match HRSA’s 2021 guidelines.
  • For Lines 21-26d, all visits with qualifying diagnosis or billing codes for selected tests/screenings are counted if they were performed for a UDS patient, regardless of whether the service was performed at a UDS countable visit.

Changes to Table 6B Quality Measures

Major logic updates

  • Cervical Cancer Screening. For women aged 30 and older, HPV testing every 5 years, without concurrent cervical cytology, is now sufficient to meet cervical cancer screening criteria. This change is reflected in Relevant’s quality measure “Cervical Cancer Screening (UDS 2021 Table 6B)”.
  • Tobacco Use Screening. Patients must now be screened at least once for tobacco use within the past 12 months, rather than 24 months, in order to be considered compliant. This change is reflected in Relevant’s quality measure “Preventive Care and Screening: Tobacco Use: Screening And Cessation Intervention (UDS 2021 Table 6B)”.
  • Follow-Up Plans for Positive Depression Screenings. HRSA no longer considers suicide risk assessment sufficient when documenting a follow-up plan following a positive screen for  depression. This impacts the logic of Relevant’s quality measure “Preventive Care and Screening: Screening for Depression and Follow-Up Plan (UDS 2021 Table 6B).” Health centers should address this change by re-defining the “Depression Follow-up Plans” Data Element. Please reach out to support@relevant.healthcare if you have questions.

Minor logic updates

The following quality measures now treat certain conditions as denominator exceptions rather than denominator exclusions:

  • Preventive Care and Screening: Screening for Depression and Follow-Up Plan (UDS 2021 Table 6B)
    • Conditions mapped in the “Depression Screen Exclusions” Data Element, including patients:
      • who refuse to participate
      • are in urgent or emergent situations where time is of the essence and to delay treatment would jeopardize the patient’s health status
      • whose cognitive or functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tools
  • Dental Sealants for Children between 6–9 Years (UDS 2021 Table 6B)
    • Children for whom all first permanent molars are non-sealable
  • Statin Therapy for the Prevention and Treatment of Cardiovascular Disease (UDS 2021 Table 6B)
    • Patients with adverse effect, allergy, or intolerance to statin medication
    • Patients who are receiving palliative care
    • Patients with active liver disease or hepatic disease or insufficiency
    • Patients with end-stage renal disease (ESRD)

Determining a patient’s insurance group for ZIP Codes and Table 4

Both the Zip Codes table and Table 4 classify patients by insurance. In each case, the UDS manual specifies that patients should be classified based on their primary medical insurance at the time of the patient’s last visit during the UDS year.

When clicking a drill-through link in a UDS table, the list of patients you see will display the patient’s current primary insurance. This may differ from the patient’s primary medical insurance as of their last visit during the UDS year.

In Relevant, patient insurance for UDS purposes is controlled by the “Insurance Enrollments” data element. If you’re looking to see how this works, we recommend examining this data element and also referring to the “UDS Validation: Payer Assignments” report. (If this report is not available on your instance, it can be added by an administrator with the “Manage Reports” ability via the Report Library.)

The logic of the Insurance Enrollments data element can be configured by your health center, with or without assistance from Relevant. In many cases, limitations in the EHR data mean that an approximation of the UDS definition is required.

References: 2021 UDS Manual, instructions for Zip Codes, p. 24: “Report the patient’s primary medical insurance covering medical care, if any, as of the last visit during the calendar year”; and instructions for Table 4A, p. 36: “Report the primary medical insurance patients had at the time of their last visit regardless of whether that insurance was billed or paid for any or all of the visit services.”